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Markets & Clients | Typical Engagements
Typical Engagements
Top Tier Consulting has extensive experience consulting to the health care and health insurance industries. Below are examples of major projects that T2C consultants have lead and assisted with at Top Tier Consulting and in previous consulting engagements with other firms.
Merger Assistance
A large HMO undergoing a merger with a plan of similar size needed to address its provider database and systems strategy. The current systems were limiting the plan's ability to contract with certain specialties, were unable to support tiering, as well as other key strategies in the management of provider performance.
A key success factor was for key executives and management to fully define their requirements and then provide knowledgeable input to the design of a consolidated database and comprehensive provider strategy. This addressed not only the immediate issues but also the broader issues that would become more important post-merger. A key element of the strategy included defining a new set of provider applications.
Enterprise Architecture Design
A large group model HMO initiated a major project to develop a strategic architecture plan. This included an assessment of major initiatives to determine critical architecture needs. A series of architecture projects to address these needs were developed. Projects ranged from establishing an enterprise middleware/integration strategy to developing an information management and reporting approach.
Project Turnaround
A major insurer was looking for alternatives and direction to address a troubled implementation project that had already expended over $70 million. In addition to recommendations for reviving the project in the short-term, the project team defined and analyzed options for management to consider that included custom development, packaged software, and outsourcing solutions.
IT & eCommerce Strategy Development
A large health care insurer initiated a strategic project to develop an integrated information technology and ecommerce strategy. Key aspects of the plan were to replace major parts of their application portfolio and to develop integrated online capabilities for customers and internal operations staff. A primary goal of the insurer was to understand the long-term business case behind the plan and align that with the organization’s corporate strategy. The project team worked closely with management and senior staff to consider various options, analyzes each, and then facilitates a process to arrive at the best strategic option for this client.
Process Reengineering
A major managed care provider re-engineered several of its key health plan functions. The project team helped establish common operating and systems development practices between the organization's two largest regions, each with over two million members. Reengineered processes included product development, sales, customer service, and administration.
New Product Launch
A large HMO initiated a project to develop a new market strategy for its small group business in California. The overall strategy was based on competitive analysis, focus groups, and research. A new suite of products was developed with different commissions, pharmacy benefits, and wellness incentives. Once the strategy was in place, the project team led the effort to launch the new product. A major driver of the project was use of the Internet to drive new sales.
Medical Management Competitive Analysis
A large HMO required a market assessment and evaluation of its custom-developed medical management systems. Significant investment had been made in the internal roll-out of these systems to all regions and for external distribution through either shared services or software sales.
A central issue was whether the current system would be viable in the external marketplace assuming the planned levels of investment. The project team reviewed and compared each of the major medical management vendors to the current and future functionality of the in-house system. Based on this analysis, a medical management systems strategy was developed and recommended to management.
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