Increase Capability, Decrease Wasted Time
To Truly Support the Health Plan
Ensuring the Work Gets Done
Technology isn’t a one size fits all for health plans. A “best in class” solution for one health plan might be an unnecessary expense for another. By combining Catalyst’s deep knowledge of health plan operations with hands on expertise with most vendor technologies, Catalyst seamlessly guides health plans through selecting, implementing, and optimally using the right solutions to meet the needs of the plan.
The contract is integral part to the success of a vendor relationship.
Representing the health plan, Catalyst will negotiate meticulous terms and conditions and ensure the vendor addresses the specific health plan issues and long-term objectives, while focusing on negotiating better pricing/terms and dramatically reducing the TCO of the application.
Using knowledge gained from working with over 185 plans, Catalyst assists health plans with negotiating pricing, contractual obligations, and ensures the health plan’s interests are protected. Catalyst helps with issue resolution, contract evaluation, new contract negotiation, due diligence, vendor relations, budgeting and cost management.
Technology Business Logistics
Simplifying Vendor Negotiations and Contract Management
Getting it Right When it Matters
Government regulations, business expansion, and frequent application release schedules drive the need for a robust enterprise-wide quality assurance model. Catalyst applies a comprehensive quality assurance methodology which results in fewer production outages, reduces systems change costs, shortens release cycles, and improves stakeholder satisfaction.
- Implementation/Upgrade Quality Assurance Strategy
- Business Requirements Analysis
- Test Strategy Development
- Test Tool Selection/Optimization
- Test Automation
- Test Plan, Scenario, & Case Creation
- Test Execution & Management
- Results Analysis for Alignment with Business Requirements
Revolutionary improvements in technology provide significant improvements in data collection and utilization. New tools and architecture allow for the cost-effective consumption and analysis of large volumes of semi-structured data. Catalyst works with health plans to build a data-centric organization which enables plans to uncover valuable insights, make better decisions, and solve business problems.
The first step in a big data/data analytics strategy is documenting future-state infrastructure and applications in such a way that the business can effectively use big data on an everyday basis. Catalyst will design a future-state architecture – so that data flows as planned – and the right users can access it via the right tools. This architecture is a conceptual or graphical model that depicts the necessary: hardware, software, interfaces and application integrations, and protocols for data sharing and information security. Similarly, the architecture will govern how data and other information assets will be captured, stored, managed, and made accessible to various user groups and applications.
Analytics & Informatics
Making Decisions Based On Actionable Data
Adopting a Data-Centric Culture
Teaching Data-Driven Decision-Making
The success of data and analytics investments is not in the data and modeling. Success is driven by the effectiveness of the end-user. Health plans need to develop the skills of frontline managers and end-users in tool utilization and data analytics skills (e.g., Descriptive, Diagnostic, Predictive and Prescriptive), with end-users also needing to understand reporting methodologies and data visualization.
Introducing a data-centric culture can feel herculean-but it doesn’t have to be. Catalyst will work with project stakeholders and key team members to determine the best ways to maximize adoption and introduce a Change Management plan that fits into the unique culture of the health plan. Catalyst will develop a program that creates an environment where data-driven decision-making is the norm and that utilizing analytics is part of everyone’s job.
Artificial Intelligence (AI) is more accessible now than ever before. From driving down medical costs and personalizing health care shopping options, to identifying and triaging fraud, waste and abuse, plan use of machine learning and AI is critical to stay ahead in the competitive payer landscape. However, most health plans struggle to implement and use AI solutions effectively, facing numerous challenges along the way, often with disappointing results.
For plans that do not yet have machine learning, or if the current AI solution is nonviable, Catalyst’s team will identify and implement the best AI solutions for the health plan based on the specific needs of the plan. Catalyst also has extensive experience optimizing the use of existing AI tools. Once properly implemented and configured, Catalyst works closely with the health plan to maximize the use of tools and data. As a result, Plans achieve ROI faster and ultimately operate more strategically and efficiently.
Stay Ahead of the Competition
Data Management and Governance
Everything In Its Place
Data Management and Governance are increasingly critical as more organizations rely on data. Catalyst employs a framework to help health plans understand the relationship between strategy, management, and governance, as well as demonstrate areas where plans need to mature to use the data in the most strategic way possible.
Catalyst will work with the plan to provide a framework for managing the people, process, policies and culture around data, while leveraging data for strategic advantages, such as data quality, master data management, and data warehousing. Catalyst can also help IT teams manage multiple data sources, repository locations, format integrations, and metadata.
The technological ecosystem of a modern health plan involves more than just a single application. A plan’s solution is usually a suite of applications linked together through integration and interfaces best suited to achieve business objectives. Achieving seamless integration can be expensive and require expertise that does not always exist within the health plan’s IT department.
Catalyst offers integration of solutions as well as the connection of all relevant interfaces. The use of integration layering allows for clean structuring and easy management of integrated systems and interfaces. Catalyst’s team of experts will build solutions in which all systems are optimally coordinated with one another. Catalyst’s solutions can connect proprietary programs with existing systems, cloud solutions, as well as mobile applications.
Catalyst will ensure the enterprise architecture is optimized and interfaces are transparent, even between modules from different application vendors. Catalyst can help with:
- Develop, Test & Implement Custom Interfaces
- Optimize Existing Infrastructure
- Guide Integration Planning During Deployment of a New Application
- Inbound/Outbound EDI Configuration & Optimization
Integration & Interfaces
Connecting Systems and Data
Storing Data. Sharing Knowledge
For many health plans, the time and resources required to update and manage content pose significant challenges. Market conditions require more speed and functionality than many plans can coax from their existing content management solutions.
Catalyst helps plans maximize technology investments by delivering solutions that provide real value to end-users in the plan, as well as, members and providers. Plans benefit from a Catalyst team of content management experts that bring a blend of technical expertise and business acumen. Catalyst’s designers, information architects, and business analysts deliver business solutions, stunning designs, and exceptional user experiences, while also addressing regulatory, risk, and compliance requirements.
Health plans working with Medicare and Medicaid must meet exhaustive and continuously changing encounter data requirements. Catalyst works with plans to build an effective encounter data program which will help the plan to stay compliant.
Catalyst’s works with plans to improve their submission abilities by understanding what is in the encounter data, identifying systemic issues, and building solutions and processes to correct inherent problems. This allows the health plan to build a foundation for accurate CMS risk scores and premiums, which is pivotal to success in the Medicare and Medicaid markets.
Encounter Data Submission
Ensure Compliance to CMS
Client Led Initiatives
Catalyst offers several flexible solutions for long and short-term human capital objectives. Whether a health plan needs an interim executive or a team of claims analysts for overflow capacity, Catalyst provides experienced resources with deep health plan expertise who can immediately hit the ground running.
- Interim Health Plan Executives
- Staff Augmentation for Plan Operations & IT Roles
- Flexible support teams for Claims, Configuration, Testing, Development & Customer Service
- Catalyst On-Demand support based upon “bucket of hours”