Transcript Agenda - TriZetto

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Copyright © 2014 TriZetto Corporation
When an Upgrade
isn’t an Upgrade
Josh Poper, Brad Kelsey, Eric Reed – TriZetto
Erin Lenser – Health Plan of San Joaquin
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Copyright © 2014 TriZetto Corporation
Agenda
Upgrade
Overview
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Copyright © 2014 TriZetto Corporation
Case Study:
Health Plan
of San
Joaquin
Upgrade
Testing
Services
Application
Release
Services
Upgrades
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Today’s Upgrade Challenges
Upgrades are too lengthy and unpredictable
Focus on upgrades diverts resources
from other strategic business initiatives
Realization of new functionality does not occur
How do I get ready for Release cycles?
Client Goals and Expectations for this Upgrade
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Upgrade Services
Upgrade Services ensures a more efficient,
cost-effective upgrade of clients’ solutions
Value to: Client:
Prescriptive,
Integrated, Centralized
Approach
Rapid Project
Initiation
Collaborative
Partnership with
Client Team
Efficiency
Experience
Patent-pending
Tools
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Expertise
Copyright © 2014 TriZetto Corporation
Experienced,
Denver-based
Resources
Test Cases and
Documentation for
Future Use
Value for Your Organization
Corporate Concerns
Typical Upgrade
Services clients identify
concerns including:
1. Resource constraints
2. Department productivity
impacts
3. Project delays
4. Financial impacts
5. Product knowledge
limited to existing system
functionality
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TriZetto Solution
TriZetto Upgrade Services
address client concerns
by:
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Dedicated upgrade resources
Minimal operational impacts
for the upgrade
Defined schedule
Predefined cost structure
Experienced upgrade product
experts partner for knowledge
transfer
Upgrade Services
Goal: Minimize the technical effort, allowing you to focus
on business improvements with new releases
Quantifiable Results
1. Comprehensive TZG test
approach supports smooth
transition to go live
Go-Live
2. Reduced technical downtime
3. Minimized end-user disruption
4. Shorter project timeline
5. Realize opportunities for
measureable business
acceleration
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Summary
Project
Management
Expertise
QNXT &
Facets
Upgrades
Quality
Assurance &
Testing
Manual, Automation
&
Performance Testing
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Upgrade
Services
Product
Expertise
TriZetto Advantage
Framework (TZAF)
&
Project Events
Technical
Expertise
Environment Builds,
Conversion, Custom Code
Upgrade Services Workstreams
 Upgrade
Methodology with
defined Project
Events
 Healthcare ,
product, upgrade
knowledge &
experience
 Collaborative
partnership with our
customers
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Go-Live
Comprehensive testing approach
Environment QA
Functional and System Integration Test
Regression test of Interfaces, Extracts, Extensions, Reports
User Acceptance test planning, mgmt, and coordination
Performance testing
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 Assist with or build
environments /
architecture utilizing
Upgrade Services
domains for initial
environment
 Deploy upgrade
environments
 Installation of
upgrade application
 Database
conversions
 Custom code
relevancy review
and refactoring
 Custom code
deployment
 Tailored product
enhancement review
 Configuration
recommendations
& best practices
Upgrade Services
Event 1 Client Feedback
5= Very Satisfied or Understand Completely
Understanding
Satisfaction
1 = Very Dissatisfied or Do not Understand At All
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Upgrade Expertise & Resources
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Domain
Project
Management
Product
Consulting
Quality
Assurance
Technical
Delivery
Custom
Code
Production
Support
Operations
Resources
Program
Executives and
Project
Manager
Product
Consultants
Testing Leads
and Testing
Resources
SA, DBA,
Infrastructure
engineers,
Batch
System
Integration
Team
Customer
Delivery Team,
Production
Operations,
Help Desk
Skillset
Executive
oversight
managed 100+
upgrade
projects
20 5.X Projects
Leading
experts in
TriZetto
Product 5.x.
The team
supported all
5.x upgrade
projects
Dedicated 5.x
upgrade
testing team.
HP ALM, HP
QTP and CTP
AMS/CTSS
enterprise
architecture,
technical
resources, and
infrastructure
Developers
and
Analysts
100+ years of
combined
operational and
application
management
experience
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Comparison of ResponsibilitiesLicensed Customers
Tasks
Client Technical
Upgrade
TriZetto
Client
Upgrade Services
Upgrade
Upgrade
Client
Services
Overall Project Management
Environment Architecture, Build, and Migration Approach
TriZetto Custom Code Analysis/Remediation
Non-TriZetto Custom Code Analysis/Remediation
Custom Code Relevancy Review
Product Usage and Enhancement Review
Supporting
Role
Product Configuration and Documentation
Test Strategy Documentation
Functional and Technical Test Planning: Test Case Readiness
Test Execution (SIT, E2E, Regression)
User Acceptance Test Planning and Execution
Planning
Performance Testing
Scalability
Execution
Technical Go-Live Readiness
End to End Go-Live Readiness
Go-Live Management
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Planning
Supporting
Role
5.x Upgrade Lifecycle
= Key Milestone
= Data Conversions
= Environment Available
= Production Achieved
Project Duration
Project Events
Event 2
Test Execution
Review
Event 1
Project Kick-off
Event 4
Pre Cutover
Preparation
Event 3
UAT Prep
Production
Support
Production
Support Cutover
4.x Code Freeze
Project Support
Configuration
Custom Code
Remediation
5.01 Code Freeze
Sys Test
CONFIG
Assessment
Functional Design
Build 2
Build 1
DEV
TEST
IIT
Build 3
SIT 1
Formal Testing
SIT 2
PROD
SIT 3
IIT
UAT 1
PPMO
5.1 Upgrade
Milestones
Remediation
Plan/Design Complete
Upgrade
Conversions
Conv #1
Paper Mock Go-live
Conv #2
Conv #3
Conv #4
UAT 2
Pre-Production/Mock Go-live Testing
Timed Full
Non-timed Full
Mock Go-live
Mock Go-live
Mock #1
Align
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Go-live
Window
Mock #2
End-user Training
TZAF Phase
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UAT 3
Performance Testing
Training and
Deployment
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Event 5
Project Close Out
Configure
Confirm
Copyright © 2014 TriZetto Corporation
Deploy
Realize
TriZetto Advantage Framework Events
Event 2
Event 3
Event 4
Event 5
Project
Kick-Off
Test Collateral
Review
Test Results
& UAT
Preparation
Pre-Cutover
Preparation
Project
Close Out
Initiates the project
and commences
project Align
Phase Activities
After first
environment is
delivered: allows
for testing review
and progress
check against
schedule and risk /
issues. Scope
confirmation.
Collaborative
planning for
organizing the
execution of User
Acceptance
Testing
Pre-Cutover
walkthrough.
Review of cutover
plan, and
authorization to go
live
Post cutover
go-live of project.
Review of overall
delivery against
schedule, budget,
and business
expectations.
Gain final sign-off
of delivered
upgrade and solicit
client for managed
reference program.
Activity Brief
Event Name
Event 1
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Health Plan of San
Joaquin
Case Study
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Health Plan of San Joaquin
Client Overview
 Health Plan of San Joaquin (HPSJ) is a not-for-profit
health plan located in California’s Central Valley
 Established in 1996, HPSJ provides access to health
care for over 230,000 members and employs 250+
staff
 HPSJ is the leading Medi-Cal Managed Care provider
in San Joaquin and Stanislaus counties
 HPSJ is the Third Party Administrator (TPA) for San
Joaquin County employees
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HPSJ Upgrade
Case Study Details
Licensed Client
Customer Situation
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4.71 – 5.01 Upgrade
200+ K Members
Short timeframe
Licensed client
Limited testing resources
Limited resources for
custom code remediation
Need for full understanding
of Upgrade Impacts to
business
TriZetto Solution
•
•
•
•
•
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QA offering of System
Integration Testing through
HP ALM
TriZetto executed Claims
Test Pro for full claims
processing scenario
validation
Joint Custom Code
Remediation of Custom
Code
QNXT Functional review
helped gain agreement on
current business
configuration
Application builds through
vApp technology, Joint
deployment and
configuration of
environments
Results
• A smooth go-live with zero
critical reported defects /
incidents post go-live
• CTP second run summary
document standardization
for QA
• Full custom code
remediation and library for
future upgrades
• Alignment of business needs
vs. upgrade offerings and
more accurate estimates for
the future
• Go Live Migration over 2 day
weekend
HPSJ Project Overview
 HPSJ’s QNXT Upgrade was in progress this time last year; planned
project timeline was February to July 2013
 TriZetto experienced an unplanned departure of the TriZetto Project
Manager
 TriZetto Upgrade Center leadership met with HPSJ leadership at the
2013 Healthcare Conference and developed a recovery plan
 Our stated goal was to recover HPSJ’s upgrade project, meeting
their quality expectations, and to invite HPSJ back to the 2014
Healthcare Conference to share their story and experiences
 HPSJ experienced an unplanned HPSJ Project Manager departure
shortly after the 2013 Healthcare Conference
This is our shared story…
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HPSJ Upgrade Successes
 The collaboration between TriZetto and HPSJ grew tighter
throughout the course of the project
 Re-baseline go-live expectations from July to October
 The Claim Test Pro helped to identify and correct differences
between historic configuration and current application functionality
 Polished and practiced “Go-Live” planning and execution
 Zero critical or high issues identified post Go-Live
 Week 1 support plan called for a 5 day war-room and support line –
which was transitioned to escalation only after ½ day
 Tight partnership allowed HPSJ resources to remain focused on
their core-business creatively solving market challenges
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HPSJ Lessons Learned
 TriZetto revised the QNXT Licensed estimating model to more
accurately reflect the actual effort
 Areas of shared responsibility need to be tightly managed by
both TriZetto and future clients to meet project timelines:
 Environment Builds
 Custom Code Remediation & Deployment (Client & TriZetto)
 Project team resources should never use a generic / shared
service account
 Adhere to best practice of weekly / bi-weekly executive
stakeholder reviews
 Ensure that Project Change Requests are signed in advance
of any additional work completed beyond scope
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Upgrade Testing
Approach for
HPSJ
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Copyright © 2014 TriZetto Corporation
Testing
 TriZetto collaborated with HPSJ to define the Upgrade
Test Strategy and to document a regression test-suite of
critical business acceptance scenarios
 TriZetto developed a repeatable claim regression suite
using Claim Test Pro greatly reducing the traditional
manual claim regression testing effort. The suite was
executed multiple times and is a reusable asset that
reduces claim regression cycle time and reduces the
overall risk to a health plan’s claims processing when
new changes are introduced
 Both of these regression assets can be re-executed for
any future changes
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Claims Regression Test Inventory
The Claim Test Pro inventory for HPSJ includes the following:

Top 5 Benefit Plans based on Claim Payment Amounts
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All Unique Contract Term Types
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Up to 25 Claims per suite
Both Institutional and Professional suites for each term type
Both Batch User paid (implying auto-adjudication) and Non-Batch User (implying manual
adjudication/intervention)
Examples: ASC, FFS, Per Unit, Custom DRG, etc.
Total Claim Volume: Approximately 1300 claims
Analysis Phases
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25
Up to 25 Claims per suite
Both Institutional and Professional suites for each plan
Both Batch User paid (implying auto-adjudication) and Non-Batch User (implying manual
adjudication/intervention)
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1:
2:
3:
4:
CTP Failures
Edit and In-Depth Analysis of Failed and Pended Claims
Reason Assignment
Payment Differentials
Copyright © 2014 TriZetto Corporation
Manual Regression SIT Inventory
Functional Area
A/R
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Benefits
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Call Tracking
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Carrier – Program
3
Claims
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Contracts
8
Member
20
Payment Manager
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Policy
7
Premium Billing
4
Process Log Browser
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Providers
13
Sponsors
8
User Security Profiles
8
Utilization Management
7
Total
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Script Count
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Functional Area
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Call Tracking
Test Template
Add Member Call
Add Provider Call
Add Sponsor Call
Attach Claim to Member Call
Attach Claim to Provider Call
Attach Claim to Sponsor Call
Reassign Member Call
Reassign Provider Call
Reassign Sponsor Call
Resolve Member Call from Call Tracking Module.
Resolve Provider Call from Call Tracking Module.
Resolve Sponsor Call from Call Tracking Module.
Functional Area
Claim
Claim
Claim
Claim
Claim
Claim
Claim
Test Template
Add HCFA 1500 Claim
Add UB04 Claim
Manually Reprice a HCFA 1500 Claim
Manually Revising an Existing HCFA 1500 Claim
Modify HCFA 1500 Claim
Refund a claim
Validate Claim
Application
Release
Services
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Releases vs Upgrades
 Software Release will be delivered quarterly
 Lower volume of application changes per release
 Releases, unlike Change Packages, will be impactful
and contain database and service layer changes
 Assessment, Remediation, and Testing will be
required to accept releases into production
 Maintaining current release levels will be required to
receive hot fixes and regulatory changes
 Technology compatibility will be decoupled from
release when available
 Release are cumulative
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Application Release Schedule
Release Approach
***The 5.10 version for each product will remain as the current version through the 5.10 R6 release***
***After the 5.10 R6 release, 5.20 becomes the current version, 5.10 releases will move to standard maintenance. 5.01 product versions move to extended
maintenance after 5.01 R19***
Version
5.20 Current Release
R1
***Not In Development Yet***
5.20
5.20.001.000
11/5/2014
Version
R4
3/19/2014
Version
2/4/2015
R5
R6
5/7/2014
8/6/2014
R7
5.10.007.000
11/12/2014
R8
R16
R17
5.01.015.000 5.01.016.000 5.01.017.000
2/12/2014
3/26/2014
5/14/2014
5/6/2015
8/5/2015
R9
2/11/2015
5/13/2015
***Standard Maintenance***
(1 year) Begins November 2015
and continues through
November 2016
5.10 Ext. Maintenance
R10
5.10.008.000 5.10.009.000 5.10.010.000
5.01 Maintenance
R15
5.01
R4
5.10 Maintenance
5.10.003.000 5.10.004.000 5.10.005.000 5.10.006.000
2/5/2014
R3
5.20.002.000 5.20.003.000 5.20.004.000
5.10 Current Release
R3
5.10
R2
5.20 Maintenance
8/12/2015
***Extended Maintenance***
(1 year) Begins November 2015
and continues through
November 2016
5.01 Extended Maintenance
R18
R19
5.01.018.000
5.01.019.000
8/13/2014
11/12/2014
***Extended Maintenance***
Begins November 2014 and continues through
November 2015
T3 Release Dates Notes
-5.10 R4 is an optional release and will only be used by: NetworX & TMS
-Foundation will release its most current code line on 5.01 R15 and will begin releasing on the 5.10 version on 5/21/2014 with release on R5.
-CAE & Clinical Content will release 5.01 R16 on 4/2/14. CAE & Clinical Content will keep 5.01 as the current version and align with the Portfolio 5.1 dates as of R5.
CAE & Clinical Content will skip the 5.1 Version and go directly to 5.2 in November with the rest of the Portfolio. CAE & Clinical Content 5.01 will then be on
Standard Maintenance with release dates one week post the Portfolio 5.10 dates.
-Facets and NetworX Facets Pricer 5.01 R17 will be available on 5/7/2014.
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Number of Enhancements by Release
900
800
700
600
500
FACETS
400
QNXT
300
200
100
0
4.81 - 5.01 R8 5.01 R8 - R9 5.01 R9 - R10
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5.01 R10 R11
5.01 R11 R13
5.01 R13 R14
5.01 R14 - 5.1 5.1 R3 - R5
R3
Application Release Services
A consistent, predictable and faster
approach to implementing and managing
the application release process
How?
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• Learning and understanding client specific
application usage and business
requirements
• Providing a dedicated team of specialists
with deep experience in TriZetto software
release content and best practices
Copyright © 2014 TriZetto Corporation
Details: What is Application Release
Services?
• Multi-year solutions partnership
• Designed to assist clients in accepting smaller,
more frequent new releases of TriZetto
software
• Repeatable, predictable, client-specific process
for clients using Facets or QNXT
• Support implementation and management of
the new release process
• Enable clients to enjoy new functionality of new
releases sooner
• Costs are often more predictable
• TriZetto can provide customized project
engagement to help clients with their unique
business and strategic objectives
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Release Delivery
QNXT & Facets
Release Updates and
Version Upgrades
Quality
Assurance &
Testing
Manual, Automation
&
Performance Testing
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Project
Management
Expertise
Application
Release
Services
Product
Expertise
TriZetto Advantage
Framework (TZAF)
&
Project Methodology
Technical
Expertise
Release Deployment,
Conversion, Custom Code
Baseline Offer
Release
Acceptance
Planning
•
Working directly with clients to develop 12-24 month release
acceptance plan based on product roadmap and client
dependencies
Project
Management
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Resource Management
Project Schedule
Issue Management Plan
Functional Domain
 Evaluate
Evaluate current
current application
application usage
usage and
and identify
identify new
new release
release impact
impact on
on
existing processes
processes
existing
 Provide
Provide reports
reports of
of impacts,
impacts, enhancements
enhancements and
and relevant
relevant documentation
documentation
TriZetto will
will triage
triage and
and resolve
resolve issues
issues during
during project
project life
life cycle
cycle
 TriZetto
Technical Domain
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•
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Issue escalation & support
Release implementation plan
and approach
Assist in software installation and identification of technical
compatibility or enhancements
QA & Testing
Domain
• Provide targeted regression testing guidance for each release specific to the
defined client business processes
• Plan configurations and workflows as derived from the functional assessment
and custom code impacts
Custom Code
Domain
• Impact assessment, review of custom code inventory, offer best practice
recommendation
• TriZetto can evaluate custom code that interacts with TriZetto software.
• At client direction, TriZetto can provide code remediation, unit testing services,
issue suport and resolution for custom code.
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Enhanced Offer – everything in the Baseline
Offer, plus the following:
•
Implementation of independent enhancements through an
internal partnership with application implementation SMEs to
perform requirements gathering, design, configuration, migration
planning, business process design, and implementation.

For licensed clients, we can perform the software release
updates. We can also partner with Enterprise Architecture to
support software compatibility upgrade requirements, such as
OS, DB, Web container upgrades.
QA & Testing
Domain

Enhanced QA can range from manual testing of releases to full
automation and end-to-end QA services.
Custom Code
Domain

Custom code remediation and code enhancements can be
offered.
Enterprise Release
Management
(Future)
• Work with clients to develop an Enterprise Release Management
process. Offering can range from working with clients to design
release management to running client release management for
them.
Functional Domain
Technical Domain
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Application Release Service Delivery
How it’s done:
ARS team’s
detailed
understanding
of release
content
Definitions of
‘Dependent’
and
‘Independent’
enhancements
Technical
impact
assessment
Custom Code
impact
assessment
and
remediation
Software
deployments
Testing
services are
scalable
Delivered as
an ongoing
service
TriZetto release content: learned once, delivered across clients
Client knowledge: discovered once, leveraged consistently
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Application Release Services
Key Benefits:
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Release Knowledge
Client Knowledge
Tools
ARS team leverages one
time discovery across all
clients
Client application usages is
baselined and maintained to
perform release gap
analysis
Application Data Mining and
Environment QA is being
built as automated tools to
be used by ARS
Scalable
Lower Client Impact
Predictable Model
Clients can choose from
impact assessment to full
application deployment and
QA
Reduce client resource
requirements
Fees are based on duration
and services provided
• Monthly Fee
• Pre-Paid Buckets
Software Quality
Compliance
Lower TCO
Releases and Hot Fixes are
supported based on a most
current release support
model
ACA, ITS, CMS
requirements are delivered
to the current release
Removing the Upgrade
Project requirements and
building a comprehensive
client release support model
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HPSJ Release Services Approach
HPSJ will be leveraging the activities performed per domain
during their upgrade to support Release Services
 Functional Impact:
Using the Function Usage Analysis and Enhancement Impact a quick Gap
and Impact Analysis will be performed to identify impactful enhancements
 Technical installation:
Understanding the environment architecture assists in identifying
compatibility impacts and allows for rapid deployment of releases
 Custom Code:
The Custom Code inventory and documentation will be leverage to
perform a quick Impact Analysis, remediation, and testing plan
 Quality Assurance
Building on the test plans and test cases already developed, SIT and
Regression testing cycles can be quickly executed
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Session Survey
We would like to extend you an
opportunity to provide candid feedback.
During the workshop you should’ve received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time, we would
greatly value your feedback. For your convenience, the survey will be
available throughout the remainder of the conference should you not
be able to complete immediately.
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Thank You!
Simplifying healthcare…
one release at a time.
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