Portfolio Management

In the last decade, the healthcare market has been very dynamic. Not only have there been amazing technological breakthroughs, but there have been numerous mergers and acquisitions. Consequently, technology teams are faced with questions: How do we decrease my total cost of ownership? Why does it take so long to upgrade? What platform should we consolidate to or should we even consolidate? Why does it take so long to make a new product or get into a new market?

Portfolio Rationalization

Catalyst will work with the technology team at the health plan and look at the various applications that are in use or on the shelf. Through a careful consideration of the plan’s current-state capabilities and future-state goals, Catalyst will provide and execute a roadmap that streamlines the existing application portfolio, achieving the following goals: improving human and technological efficiency, reducing complexity, and lowering total cost of ownership (TCO).

System Selection

Catalyst has extensive knowledge of most major health plan core and ancillary systems and tools and guides plans to products that best suit the needs of the plan. Catalyst will provide unbiased advice for vendor evaluation and the selection of new systems. With Catalyst’s library of business and technical requirements knowledge and our structured methodology, Catalyst helps plans to develop the RFP, identify a short list of qualified vendors, and conduct systems evaluations.

Additionally, Catalyst will:

  • Develop Scenarios for Proof of Concept
  • Facilitate Software Demonstrations
  • Conduct Vendor Due Diligence
  • Provide Support during Contract Negotiations
  • Create & Execute Plan for Implementation

Systems Implementation

A health plan’s productivity and growth potential are largely dependent on the technology at their disposal. Choosing the right software solution, whether it is a core/claims platform, a clinical management application, or a provider data management system, is a serious investment of time and money.

Many software implementation and integration projects run in to challenges due to the complexities they present.

Leveraging decades of systems implementation expertise, Catalyst helps plans to “do it right the first time” when implementing, integrating or optimizing technology.

Technology Business Logistics

Vendor Negotiations/Contract Management

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.

Analytics / Informatics

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.

Data-Centric Architecture

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.

Data Management/ Data Governance

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 advantage, 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.

Content Management

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.


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.

Core Platform Support

Core Platform Optimization

IT departments in today’s health plan are forced to do more with less. Maintaining a sophisticated IT environment with multiple platforms and points of integration is costly. In addition, compliance with government regulations and the delivery of new products and technologies further strain already tight budgets. Therefore, it is crucial that the plan’s core system perform at optimal efficiency.

Catalyst is a leader in providing core platform consulting services to health plans and will maximize the performance of the core platform via:

  • Business Rule Design, Configuration & Build
  • Custom Code Rationalization & Maintenance
  • Business Process Assessment & Workflow
  • Configuration Audit & Optimization
  • Model Office Test Planning
  • Data Conversion & Auditing
  • Systems Performance Optimization
  • Real-Time Transactions
  • Database Migrations (i.e. Sybase to SQL)
  • Report Design & Implementation
  • Design, Development, Testing and Implementation of Data Interfaces & Extensions
  • EDI Systems Implementation, Data Transformation, Message Flow Management

Upgrade Optimization

Upgrades to the core platform are a fact of life for most non-hosted health plans. In many cases, it is necessary for:

  • Compliance with Vendor Contracts
  • Delivering Fixes for Bugs/Other Issues
  • Increasing Platform Security
  • Providing New Functionality

Through Catalyst’s extensive experience with most claims and clinical platforms, Catalyst has developed several services that can make upgrading the system easier and more cost effective. These services include:

  • End to End Upgrade Execution
  • Governance Planning
  • Project Management
  • Automation
  • Test Plans & Use Cases
  • Feature & Functionality Maximization
  • Training & Change Management
  • Staff Augmentation

EDI Set-Up and Optimization

Catalyst understands the challenges that health plans face when it comes to managing EDI data. Payers are under tremendous pressure to drive healthcare outcomes while improving revenue cycle effectiveness. Slow EDI processing and lack of compliance can result in penalties and may require significant manual workforce hours.

Catalyst’s EDI optimization practice will drive the plan to achieve maximum efficiency. Catalyst will evaluate the plan’s integration environments and identify a detailed list of issues within the plan environment, and provide a prioritized action plan for further tuning and optimization of the installation. Additionally, Catalyst can help in solution design and implementation, ensuring the plan maintains optimal integration to enhance capacity to meet business demands.

Encounter Data Submission

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.

Platform De-Hosting

Health plans need to ensure their technology is secure, controlled, cost-effective and highly available. Many vendors commit to delivering hosting and infrastructure management services that promise to keep the healthcare plan’s applications optimized, secure, and running smoothly.

But what happens when the vendor fails to deliver on that promise, or the vendor becomes too costly?

At Catalyst, we partner with the health plan’s technology team to make the move back to an on-premise or a hybrid solution. Catalyst offers:

  • Solution Architecture Guidance with Automated Deployments
  • Implementation and Project Management
  • Architecting Ancillary Software in all New Environments
  • Database Migrations

Quality Assurance/Testing

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.

Catalyst provides:

  • 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

Technology Optimization

Integration and Interfaces

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 the integration of solutions as well as the connection of all relevant interfaces. The use of integration layering allows for clean structuring and the easy management of integrated systems and interfaces. Catalyst’s team of experts can 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.

Integration, Automation, & Interfaces

Properly executed system integration, especially amongst multi-vendor applications, can improve product quality and drive value to end users. Executed poorly, it can result in skyrocketing operational costs and response times. Catalyst can 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
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