Modernizing the Healthcare Enrollment Experience: Driving Platform Transition in a Regulated Healthcare Ecosystem
Context
Members were waiting 10+ days to receive confirmation of membership and ID cards, delaying care and increasing friction in the membership process
Industry standards for membership enrollment were 3-5 days
Business faced with growing pressure to modernize its legacy systems to stay competitive, compliant, and reduce risk
Challenges
Homegrown legacy apps were costly to maintain, risky to make changes, and brittle
Core processing systems were tangled in interdependencies from years of ad hoc enhancements
Operations teams built manual workarounds to push enrollment files through 12+ regional workflows across 4 separate systems
Compliance risk was rapidly rising while productivity and member satisfaction were steadily dropping
My Role
Led buy vs. build evaluation, managing the RFI/RFP process across stakeholder teams by leveraging decision matrices, SWOT analysis, and vendor scoring frameworks
Defined 150+ functional and 50+ non-functional requirements, consolidating and prioritizing feedback across 7 regions
Facilitated discovery sessions with 30+ business users and IT leads, analyzing current and future state process flows
Created solution diagrams to support business alignment and system requirements
Developed wireframes and mockups to validate workflows with users
Guided vendor implementation and installation, analyzing out-of-the-box capabilities and configuring internal system requirements
Impact & Results
Positioned platform to decrease member confirmation times from 10+ days to 5 days, improving speed to care
Reduced future rework risk through current state and future state diagrams, enabling stakeholders to visualize process changes and technical dependencies early
Addressed key compliance risks and interdependencies through standardized processes per region, incorporating insight from both business and IT stakeholders
Laid foundation for transitioning to OneKP’s vision, building nationwide enrollment workflows and planning transition phases
What I Learned
Prioritization must be grounded in the “why” and the use case - you can’t please everyone.
Requirements are always changing - don’t resist it. Instead, build in change management frameworks early and implement continuous feedback loops.
A picture is worth a thousand words - it’s the fastest way to get alignment with large groups.
What I’d Do Differently
Formalize a communication management plan for stakeholder alignment, expectation setting, shared responsibility, and consistent messaging
Create shared visibility into progress and bottlenecks via kanban-style visual workflows
Implement hybrid waterfall/agile approach earlier, bridging the gaps in time between waiting for vendor configurations and finalizing requirements