For healthcare payers, efforts to consolidate, migrate, or implement systems can feel like performing maintenance on your car while driving on the highway. They are faced with performing a myriad of detailed technical challenges while also maintaining the pace and steadiness of day-to-day operations.
AArete provides strategic and technical support to address systems needs arising from:
- Mergers and acquisitions
- Systems upgrades or replacements
- New market expansion
- Insourcing from third-party hosted solutions
- Cloud migrations
- System retirement
- Data cleansing/conversions
No matter the catalyst, the most significant obstacle in any systems transition is often the successful translation of current business rules. Existing business rules and processes that have been refined over years frequently lack the level of documentation necessary to guide a successful transition. The experienced resources that are best suited to resolve these challenges are the same resources responsible for maintaining a high-level of daily operational excellence.
AArete leverages robust payer business knowledge and technology acumen to expand IT capabilities during system implementations, ensuring a successful go-live and ongoing business performance.
AArete’s Healthcare Systems Integration Expertise
AArete has extensive experience supporting systems initiatives involving commercial off-the-shelf
and homegrown products across all lines of business.
Our Systems Integration Services
AArete has deep healthcare payer operations, systems implementation, and testing expertise that informs our tactical approach and provides a framework to resolve the unique challenges that are inherent to any systems initiative.
End-to-end implementation and project management support including RAID log management, release management, and risk mitigation planning.
Assessment of current infrastructure, future-state cost valuation, and creation of migration/integration timelines.
Hands-on support for business requirements development, solutioning and configuration including fee schedules, contracts, benefits, eligibility, claims, editing, finance and billing.
Support for high-risk migration challenges, including provider data parathion ion and detailed contract review/template matrixing.
Overall test strategy and management including development and execution of test cases (UAT, Parallel, SIT, etc.).
Operational process and workflow documentation and design. Development, deployment, and implementation of training and change management strategies.
Development of business rules and architecture for data migration, cleansing, validation and transformation including integration with ancillary systems.
Support for reduction in technical debt, including claims runout and data archiving of legacy systems.
AArete understands the magnitude of system changes and is committed to helping manage risk, elevate quality, and ensure confidence in the approach taken from planning to post go-live support.
Our Systems Integration Experts
Madhav has been with AArete since foundation bringing over 20 years of experience in consulting across multiple industries. Over the past 10 years, he has led several large Health: Payer engagements in the areas of Cost of Care improvement, Fraud, Waste and Abuse (FWA), Targeted Ancillary Spend Review, Configuration Review and Pharmacy / Medical Crossover with a primary focus on over payment identification and recovery / reclamation. In addition, Madhav’s experience also includes the application of advanced data models to identify and score high risk members, leveraging Medical and Pharmacy claims data for risk stratification, care coordination and case management and designing and implementing customized Coordination of Benefits (COB) solutions. Madhav has also led several strategic profitability improvement and procurement turnkey engagements for clients in healthcare, financial services, professional services, manufacturing, law firms, media and entertainment and higher education. Madhav holds a Bachelor of Science degree from Nagarjuna University, a Master of Science degree from Osmania University and a Masters of Business Administration degree from Northwestern University’s Kellogg School of Management and is a member of the Institute of Supply Chain Management.
Darren has a deep history working at the nexus of healthcare and IT. He has a track record of fostering innovation, positivity, and inclusiveness in his previous roles. Darren has served on the advisory board for Virtual Health (a healthcare technology disruptor) and the board of directors for NASCO (healthcare payer technology provider for Blue Cross Blue Shield plans).
Prior to joining AArete, Darren served as chief information officer of Gulfside Healthcare Services. He has also served as executive vice president and chief information officer for WellCare where he was responsible for further advancing WellCare’s technology capabilities to support the company’s focus on growth and innovation. During his tenure at WellCare, Darren established a focus on innovation by creating the first Innovation Studio, which resulted in over 20 patent submissions. He was a member of the executive leadership team and reported directly to the CEO.
Previously, Darren spent more than 15 years with Anthem, formerly WellPoint, Inc., where he provided leadership for a broad variety of technology initiatives. Darren held roles of increasing responsibility, serving as a director, staff VP, VP and VP/CIO of Anthem’s commercial business unit. Darren also served as a senior project director with Access Systems, LLC and as a product manager with Reynolds and Reynolds.
Darren earned a bachelor’s degree in aerospace technology with a concentration in computer technology and an associate in applied science electrical engineering technology from Purdue University. Notably, in 2013, Darren was recognized as a Computerworld Premier 100 IT Leader, and in 2018 was honored by the Tampa Bay Business Journal as a CIO of the Year.
Maulik is based out of AArete’s Chicago office and leads AArete’s Innovation and Advisory services. He is also responsible for driving AArete’s international growth strategy. Overall, Maulik comes with nearly 20 years of experience in Operational and Management Consulting across multiple industries working with Ernst & Young, Protiviti Consulting and Huron Consulting. He has experience leading advising Fortune 1000 clients on driving operational efficiencies and creating enterprise value. He has led large consulting engagements for clients delivering operational transformation, bottom line improvement, digitally enabled process efficiencies and organizational change, through fact-based data intensive analysis combined with domain expertise. Maulik holds a Master of Business Administration degree from S.P. Jain Institute of Management and Research (SPJIMR), a bachelor’s in accounting and Finance from Mumbai University, and is a Certified Information Systems Auditor and a Six Sigma Green Belt. He was recognized by Consulting Magazine’s for their “35 under 35 – Rising Star of the Profession” award and was selected to the list of Top 50 Healthcare Consultants of 2021 by The Consulting Report. He is a published author and quoted industry expert in Managed Healthcare Executive, Chain Drug Review, ThinkAdvisor, American Pharmacists Association and Chain Store Age.
Jeff brings 7 years of combined experience within the healthcare and retail industries as a leader of AArete’s Health: Payer practice. He has led numerous initiatives supporting cost reduction, operational improvement, and M&A integration with commercial payers and Managed Care Organizations (MCOs). Over a 3 year span, he has conducted rigorous analysis upon partnering with clients to develop tailored implementation strategies and has subsequently delivered over $100M in recurring annual savings. Jeff holds a Bachelor of Arts degree in Economics from the University of Michigan.
Loran offers 10 years of experience working alongside organizations to develop innovative strategies, increase operational efficiency and improve profitability. He has extensive strategic and operational experience and has led numerous enterprise-level engagements with Commercial Payers, MCOs and other health delivery organizations. Loran focuses on bringing the right combination of advanced data analytics and industry knowledge to develop tailored data driven solutions for his clients’ most complex problems. He has extensive expertise in strategic and financial planning, payer operations, network development, utilization management and process design improvement. Loran holds a Bachelor of Science degree in Economics and a Bachelor of Science degree in Business Administration from Skidmore College.