ORI raises the standards of Project Management services, working efficiently and effectively to drive down the overhead cost of project management, improving value realization, improve ROI, provide predictability result and ensuring that set targets are met.

Delivering Project Success through effective methodology selection.

AmeriHealth Administrators is a full spectrum of business process outsourcing (BPO) and self-funded health plan administration services, powered by a culture that is nimble, adaptive, and relentlessly dedicated to solving problems from the ground up. AmeriHealth Administrators has experience managing more than $1 billion in health benefits to help insurers, employers, producers, health care providers, while helping members thrive. AmeriHealth Administrators have nearly 80 years in the health care industry and over 500 employees with expertise ranging from cost containment and regulatory compliance to specialized processing services and self-funded health plan management.

Background: The program goal is to implement an HealthEdge (HE) solution, a Healthcare Insurance core processing system. The program involved HealthRules implementation, portal integration, training and calibration. An additional implementation of a correspondence interface HP Exstream for fulfilment was added to this program. The scale of the program required certain aspects of the program to be managed by agile methodology while others worked well with waterfall methodology. The total program budget was over $4M with very a tight timeline due to the impact of the enrollment season. The implementation of this system affected all aspects of the organization’s business delivery.

Challenges:The scale of the program and use of multiple methodologies required a seamless integration of implementation outcomes to ensure program success.

Solution: An assessment to determine capabilities and limitations of the vendor, client value stream, project management methodologies was conducted, discussed and documented. The result of that assessment was that while the HealthRules implementation required an Agile approach the hybrid Agile – Waterfall approach was best for the interface and integration of HealthRules, the HealthEdge Portal and HP Exstream.

As referenced earlier, AmeriHealth Administrators existing knowledge of Agile was minimal and the program timeline was short. Introducing a new approach/methodology to an already difficult and robust program was very challenging and needed a delicate strategy to ensure success. Knowing how to work with different teams within the program to leverage the strength of each methodology was critical for the success of the program.

Results:The correspondence interface HP Exstream implementation was completed ahead of schedule. The executive management team shared their appreciation of the effectiveness of the management approach to effectively leverage multiple methodologies, integrating them seamlessly and successfully. The program proved to be a success. All the objectives of the HP Exstream program were exceeded.

Key to Success:Experienced Sr. Project/Program Delivery Manager/ Adviser ability to assess, understand the organization and customer capability and needs. Also, knowing how to leverage the strength of different methodologies and adapt them to the clients unique needs delivered a successful outcome. The ability to leverage thought leadership was essential in enabling buy-in of key stakeholder to leverage innovative approach to program management.

Delivering Project Success through effective process improvement.

Alegeus is the industry’s largest and most comprehensive consumer healthcare funding platform, supporting more than 30 million consumers live and 225,000 employer groups. Processing more than $9.1 billion in healthcare payment annually, with 15.3 million active payment cards and servicing more than 40% of the benefits accounts in the market.

Background: TPA training and integration project involved onboarding one of our largest clients at the time, providing training and integrating their correspondence fulfillment vendor.

Challenges: TPA training and integration project for a large client was relatively new; hence there was no process in place to handle the complexities of the integration. It was a high visibility project that would help establish future growth.

Solution: Assessment to determine value stream, capabilities and limitations of the vendor, client and project management methodologies was conducted. The results showed that tools from the waterfall approach were adequate for the project. There was also a need to create a process that allowed direct communication with the development team, without distracting the team from its core focus. Instead of maintaining the current process of having the Project Manager be the middle man/woman reviewing and validating the technical needs of the customer, the development team was engaged much earlier. The new process of leveraged templates, questionnaires and limited client facing events with the development team. The integration process was improved by 10%, allowing the implementation to be completed much faster with higher reliability. The new approach was noticed, and received was awards for the quarter.

Results: The project proved to be very successful and the new process was used for future complex projects going forward. All the objectives of the project were met. Involving developers earlier in the project before implementation, allowed for better communication and support.

Key to Success: Experienced Senior Project/Program Delivery Manager/ Adviser ability to assess, understand the organization, and customer capability and needs. Also, the ability to leverage effective facilitation, communication, thought leadership and oversight drove the project to a successful outcome. The ability to adapt project management tools to the organizations need was also critical.

Improving Project Delivery in an ever-changing regulatory environment.

Blue Cross and Blue Shield of North Carolina (BC NC) is a fully taxed, not-for-profit, North Carolina health insurance company with major operations centers in Durham, Fayetteville, Winston-Salem, and an office in Charlotte. We employ more than 4,700 residents from North Carolina and serve more than 3.89 million customers.

While program management is important for aligning an organization’s projects with its strategic goals in any industry, it is much more critical for large health insurance company organizations such as (BC NC) in the highly regulated and changing world of healthcare.

Several project managers work in the PMO and are responsible for executing projects ranging from compliance to risk mitigation, technology upgrades and process improvement.

In 2009 the enacted healthcare reform act required implementation of changes to healthcare insurance plans to ensure compliance of the new law. This was the start of changes during a 7 year timeframe where new policies were being created by multiple governmental agencies, and old polices were being revamped. This highly dynamic environmental created a lot of challenges for the management of programs due to the overwhelming number of stakeholders, and a constant changing of project scope. An innovative approach of how to execute affected program was needed for a highly visible program named the HCR program.

Background: HCR was a multiyear program with 13 projects and a budget of approximately $6M focusing on assurance of compliance with CMS regulations. In 2014, when my team became involved in this program as one of 18 other project and programs in my portfolio, HCR had gone through 5 program managers with a program management overhead cost of $900K (21% of the program budget).

Challenges: The HCR was a compliance driving program with high visibility because of its significant financial impact, high potential for loss of member, along with negative media reporting and the overtaking of customer service support during the critical enrollment season.

Solution: Assessment to determine capabilities and limitations of the vendor, client and project management methodologies was conducted. The result of the assessment was that tools from waterfall, iterative, and agile methodology was needed to effectively manage different aspect of the program. To ensure that we improve the prospect project success, it was necessary to include an experienced Senior Program Manager to enable the creation of an effective communication strategy, value delivery strategy and team composition. The overall program management overhead structure was stream lined to ensure that the right experience level was aligned to roles. We quickly realized the original overhead mix created redundancy, resulting in a $270K savings. A more effective war room was created to better facilitate engagement with key stakeholders.

Results: HCR program was acknowledged as one of the most successful programs at BCBSNC in 2014 by the CEO.

Key to Success: Assigning an experienced Senior Project/Program Delivery Manager, focusing on value delivery, task aligment and right sizing the program team. This allowed for program success and cost reduction.

Deliverable Project success through effective assessment of vendor limitations, capabilities and alignment with organizational timeline.

Tufts Health Plan is a nonprofit organization founded in 1979 and is nationally recognized for its commitment to providing innovative, high-quality health care coverage. The plan offers members and employers an array of health management programs, which support evidence-based approaches to health and wellness.
Tufts Health Plan is one of the few health plans in Massachusetts to participate in the commercial, Medicare and Medicaid/subsidized markets, offering coverage across the life span regardless of age or circumstance. With headquarters in Massachusetts, Tufts Health Plan also serves members in New Hampshire and Rhode Island.

Tufts Health Plan is a leader in advancing public policy discussions on several issues: prevention and wellness, affordability, and removing obstacles to accessibility

Background: The Diamond Upgrade Program was a $1.5M multi-year program with the goal to Upgrade Diamond database technology, Upgrade Diamond application and upgrade hardware to itanium servers. This program would increase Tufts Health Plan’s capacity to develop new web screens/data for internal and external services and provide real-time update on the provider and member portal. It would also allow Tufts Health Plan to take advantage of capabilities such as self-service reporting by operations and analytic groups. Implementing this project would help reduce cost over the short to medium term.

Challenges: The Diamond Upgrade Program was mostly a technology upgrade driven program; hence the stakeholders were well defined. The challenges stemmed from the fact that the existing application was written in a highly customizable language not current being supported and needed to be upgraded to a Java based application with limited in-house Java experience. The application upgrade was dependent on a vendor that turned out to be unreliable. The program timeline was significantly shorten because it started late.

Solution: We conducted an assessment to determine capabilities and limitations of the vendor, client value stream and best project management methodologies for this program. The assessment involved facilitation of multiple meetings, it showed that the waterfall approach was an adequate approach for this program. It also showed that based on the criticality of the timeline the best course of action was to effectively reduce risk and have contingency in place to ensure minimum impact on the program timeline. The two significant risk identified were ensuring data integrity was maintained during the transformation and ensuring that vendor was able to start and complete their work on time. The assessment of the vendor concluded that they did not have resource bench depth to quickly and effectively support the program needs. We decided based on the client’s value stream to bring on a developer with some experience in the customize language early to allow for current production support. This resource will also need to learn the JAVA based application for the future state. At a critical point of the program when we needed to start engaging the vendor, they informed us that they would need several months to ramp up before being able to support our needs. Since we assessed the potential for this risk early, we were able to quickly change direction, use the one developer we brought on early, while leveraging the vendor in a consulting role. This approach allowed the program to be completed on time with a $500K savings. The data integrity risk was mitigated by creating a unique testing approach that was quicker and delivered consistent results.

Results: The program proved to be very successful at THP. The program had budget savings of $500K with all objectives of the program exceeded. Bring in a developer earlier instead of waiting for development phase allowed for quick recovering of a potential disastrous outcome. Understand of the how to better align project resource (internal and Vendor) needs to mitigate potential risk was critical to the successful outcome.

Key to Success: Experienced Sr. Project/Program Delivery Manager/ Adviser with the ability to assess, understand the clients value stream, the organizations and vendor capability and needs was critical. The ability to leverage effective facilitation, communication and thought leadership drove the program to a successful outcome.




An important part of the process is to determine the clients capabilities, limitations, value streams, and project management methodology for project delivery.


Thorough assessment can show what is needed to create a collaborated process that will allow effective communication with the IT team without reducing distractions from the organization’s core focus.


By determining where the organization is lacking, and synchronizing activities allows for implementation of a low-risk and high-contingency plan to ensure minimum impact on tight project timelines.