ASSESSMENT SERVICES

Assessment Services:

Evaluating and Enhancing Key Business Areas

Assessment services are essential tools for organizations seeking to improve their operations and performance. These services provide a structured approach to evaluating various aspects of a business, identifying strengths and weaknesses, and recommending strategies for enhancement. Projé Assessment services consist of Operational Assessment, Technical Debt Assessment, PMO Maturity & Project Management Maturity Assessment, Value-Based Care Assessment, and Medical Management (Care Management and Utilization Management) Assessment.

1. Operational Assessment:

Operational business process assessments focus on evaluating and optimizing the day-to-day workflows and activities within an organization. These assessments help identify inefficiencies, bottlenecks, and areas where processes can be improved. By analyzing how work is done, organizations can streamline operations, reduce costs, and enhance customer satisfaction. Projé has developed and optimized industry specific and field tested tools and artifacts that ensure rapid and accurate execution of assessment engagements.

This is a time-bound, high-speed (8-14 weeks), high-value Projé service customized to provide actionable assessment and analysis of client specific business challenges for Commercial and Government funded programs. The objective of this service is to provide data-driven transparency into root causes of operational gaps across business processes, tools/technologies, operational data, workforce skills, resource gaps and necessary remediation actions for increased operational efficiency and effectiveness.
The scope of the engagement can span a wide spectrum of business problems such as end-to-end assessment of the business operations across all critical business processes, or select set of business processes (e.g. enrollment, claims, care management, etc.), or operational impact and readiness for scenarios such as introducing a new benefit plan, etc.
This Projé service is designed to enable a prioritized and quantified set of immediate, short, medium, and long-term action plans that are designed to achieve pragmatic, and high value improvements in business operations.

2. Technical Debt Assessment:

Technical debt is a complexity in operational maintainability and supportability, increased operational costs and reduced operational agility accumulated over years into enterprise infrastructure operations supporting critical business processes. Examples of key sources of technical debt are:

Lack of formal technology life-cycle management and governance process.
Highly customized assets that require specialty knowledge and skills to support.
Aging legacy business and IT assets with availability of little or no internal or external support.
Too many assets with duplicate or overlapping functionality.
Unsupported technology components.
Poor asset management resulting in similar assets with multiple versions.
Pervasive data integrity issues due to lack of data governance and/or lack of enterprise sourcing model.
Shadow IT assets supporting critical business operations.
Shortage of skills and/or resources needed to support the existing environment predictably.
Low adoption of assets purchased resulting in inability to maximize investments.

This Projé service provides a rapid, Independent, and objective technical debt assessment of the state of the current technology investments that includes business and IT applications, infrastructure tools and technologies and critical data sources. The assessment encompasses all methods of deployment including In-House custom, On-Premise, and Cloud (SaaS, IaaS, PaaS).

Projé Technical Debt Assessment service provides the organizations with an actionable remediation plan to consolidate, standardize, and improve supportability and maintainability to maximize the return on investments while reducing operational support costs.

The engagement is designed to enable and support both short and longer-term business and IT technology planning initiatives.

3. PMO & Project Management Maturity Assessment:

Project Management Offices (PMOs) play a crucial role in ensuring efficient project execution. Assessing PMO and project management maturity involves evaluating how well an organization plans for and manages its projects. These assessments examine alignment with strategic objectives, resource allocation, and the effectiveness of program and project management practices and tools. The goal is to enhance project success rates, control costs, and increase overall project management maturity.

The ability to predictably manage and execute annual portfolios, programs and projects that are high quality, on-time and on budget, require a high-degree of organizational maturity in PMO and Project Management processes. In addition, the focus should include industry best practices with pragmatic and value-based solutions.
This Projé service provides the organization with a rapid, objective and data driven assessment of the maturity of the current PMO and Project Management practices, gaps in organizational alignment, governance, planning and delivery and a list of prioritized recommendations to remediate those gaps. Recommendations typically include practical action items for PMO operational processes, Project Management methodologies, tools, and templates and provides a laser focus intent on achieving tangible, value-based improvements.

4. Value-Based Care Assessment:

The shift towards value-based care models in healthcare emphasizes delivering quality care while controlling costs. Poor care delivery, care coordination, over-treatment and/or low-value care, administrative complexity, fraud, and abuse result between $760 to $950 billion dollars of waste annually in US healthcare spending. As such, high quality and cost-efficient care delivery is a major focus for many health plan organizations.

Planning for and implementing a value-based care (VBC) requires a multi-prong approach and deep understanding of the current maturity of existing processes that span across areas such risk stratification, member attribution, care and utilization management, performance measurement, provider practice reports, network management, alongside with organizational and operational changes that need to be instituted in order to support a high-performance VBC program.
This unique Projé service is designed to give health plans rapid but holistic actionable insights into the maturity of their existing operations in support of value-based programs, evaluating current processes for population definition, care gaps, risk stratification, member and provider engagement and communication, care management and coordination, and measurement of outcomes.
As part of the assessment, Projé deploys best practice evaluation criterion that spans across population assessment, panel management, clinical data and reporting, provider contracting, network performance, clinical model, care program governance, and transformation activities needed to ensure short-term benefits and long-term predictability.
The Projé service provides the health plans with an actionable and prioritized roadmap of remediation actions across organizational boundaries including people, process, tools/technology, and operational data that focus on delivering both short-term wins and long-term, predictable, high quality and sustainable VBC program.

5. Medical Management Assessment:

Care Management (CM) Assessment
- The scope of this service includes, but is not limited to, thorough review (across people, process, technology, and data) and analysis of current care management programs, program governance, health risk assessment, risk stratifications, individual care plans, interventions, care transitions, member engagement (including communication, education and outreach), provider communication and engagement, performance management, and vendor management.
- Projé's recommended remediation actions focus on improving the effectiveness and efficiency of the existing CM programs that are value-based and prioritized to reduce risks and deliver short, medium, and long-term needs in support of organizational objectives to improve the health of its members.
- This Projé service is designed to provide organizations with fast yet comprehensive and actionable insights into the efficiency and effectiveness of the current clinical management operations.

Utilization Management (UM) Assessment
- Efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients are areas of critical focus for health plan organizations. Ensuring that patients receive effective care at the appropriate time, for the appropriate duration of time, delivered at a reasonable cost is essential. They are the cornerstone of improving patient care, keeping costs in check, and increasing the overall health of the population.
- This Projé service is designed to provide the health plan organization with fast, holistic, and actionable insights into the overall efficiency and effectiveness of existing utilization programs by reviewing and analyzing the maturity of current processes, resources/skills, data and tools/technologies that support them. The scope of the engagement covers all critical areas of utilization management including prospective, concurrent and retrospective reviews, medical policies, appeals and grievances, quality of care and accreditation (e.g. NCQA, URAC)