covermyquality: implementing a quality program by rick neighbarger and susan bradley
TRANSCRIPT
CoverMyQuality: Implementing a Quality Program
February 7, 2017Rick Neighbarger & Susan Bradley
Agenda
© 2016 CoverMyMeds LLC. All Rights Reserved.
• Who is CMM?• From Startup to Growth Company• Special Challenges• Implementing Big Q Strategy• Initial Implementation• Phase Two Implementation• CMM Journey• Questions?
Founded in 2008, CoverMyMeds automates Prior Authorization (PA) for all plans and any medication. We automate the medication prior authorization (PA) process, saving health care professionals valuable time and ensuring patients receive the medication they need to be well and don’t abandon their prescription.We currently process more than 2.65 million PA requests each month, with more than 50 million requests processed to date.
Who is CMM?
© 2016 CoverMyMeds LLC. All Rights Reserved.
About CMM
What We Do
Patient
Pharma
Prior authorization requests are a permission slip from health plans for their patient to begin taking a medication, ensuring the right therapy for the condition and cost-effectiveness. Before CoverMyMeds, the PA process was paper-based and accomplished through multiple faxes and phone calls between providers, pharmacists and health plans.
Today, CoverMyMeds works with electronic health record systems (EHRs), health plans, pharmacy systems and providers to initiate, transmit and track the status of PA requests within the clinical workflow.
From Start-up to Growth Company
© 2016 CoverMyMeds LLC. All Rights Reserved.
2008 2011 2014 2016Employees: 5 14 73 466
Yearly PAs: 187,500 1.56 million 12.5 million 50 million
Ave. Monthly PAs: n/a 61,861 729,486 1,612,710
Lives Helped: n/a 1 million 12 million 46 million
Challenges:
CMM moved from startup to quickly growing company—new set of risks• From “Just Do It”, get a foothold to sustaining growth and rapidly increasing
complexity Data privacy for rapidly growing database of Protected Health Information
Organizational growth requires more process & communication than before• Many new managers & individual contributors• Not familiar with processes, systems & the organization
Complexity of systems, customer hierarchy & regulations requires strategic planning• Can’t rely on series of tactical steps & “you’re smart/you’ll figure it out” like startup
phase
Initial applications not meant to handle current rate of growth (scaling/technical debt vs. new business)
Quality was primarily associated with testing activities
Special Challenges
© 2016 CoverMyMeds LLC. All Rights Reserved.
• Company culture: Start-up—resistance to central control & standards; freedom to choose whatever tools, processes, etc. by team or even individuals
• Constantly hiring: bringing on new staff, promoting new managers
• Organization structured in business verticals: need to maintain their ecosystems while working as one business
Solution: Implement Big Q strategy
© 2016 CoverMyMeds LLC. All Rights Reserved.
Joseph Juran established the field of quality management and
wrote the Quality Control Handbook which taught
manufacturers worldwide how to be more efficient and productive
Little “q” quality generally just equates to testing, which is
good, but not enough!
Big “Q” Quality is a system for achieving high quality results that supports:•Bullet-proof privacy and security•Rock-solid reliability•Best-in-class performance
Big Q vs. Little q strategy
© 2016 CoverMyMeds LLC. All Rights Reserved.
Getting Buy-In for Big Q Strategy• Talking to Leadership
• Outlined Benefits (What’s In It for You?)• Targeted their goals: Promoted expense/waste reduction as an enabler
for revenue enhancement• Included them so they felt vested in the outcome
• Sold the “Why?” to leadership, mid-level managers, and individual contributors
• Reduction in risk• Improve customer relationships• Avoid the “Company Killer”
• Best Practice
CMM Initial Implementation: 3-Legged Stool
© 2016 CoverMyMeds LLC. All Rights Reserved.
Requirements Management
Risk Management
Root Cause Analysis
Measurements & Metrics
Remember, our biggest risks involve the privacy
and security of our patients’ data!
1
2
3
M&M
Big Q, Phase 1: The 3 R’s – Requirements, Risk & Root Cause
© 2016 CoverMyMeds LLC. All Rights Reserved.
1) Requirements Management
2) Risk Management 3) Root Cause Analysis
• Owned By: Product Owner (from the Business!)
• Answers: What should we build, NOT build, in what order, and why?
• Activities: Project vetting, grooming and prioritizing; Requirements definition; Project Management;
• Other Players: Users, Account Mgrs., PMs, Engineering Mgrs., Testing Engineers, Devs, InfoSecurity, DBAs, Analysts
• Owned By: Engineer Manager/Testing Engineer
• Answers: What are the worst things that could go wrong, and how can we mitigate them? (Especially PHI!!!)
• Activities: Risk Analysis; Risk-based test planning; Test execution; Monitoring; Security assessments;
• Other Players: POs, Engineering Mgrs., Devs, InfoSecurity, ProdOps, DBAs, Analysts
• Owned By: Testing Engineer/Quality Analyst
• Answers: What went wrong, and what should we do about it?
• Activities: Incident mitigation & reporting; Retrospectives; Root Cause Analysis (RCA); Change Management
• Other Players: POs, Engineering Mgrs., Devs, InfoSecurity, ProdOps, DBAs, Analysts
1: Requirements Management
© 2016 CoverMyMeds LLC. All Rights Reserved.
• Define Product Owner role• Prioritize Backlog• Serve as liaison between customer and tech groups
• Hired an Agile Coach• Create checklist of considerations when compiling requirements for small requests• Create Epics, Feature, User Stories to create hierarchy• Implement quality measures so quality is built in• House enterprise-wide tool so it’s accessible by all areas
2: Risk Management
© 2016 CoverMyMeds LLC. All Rights Reserved.
• Implemented cross-org Risk Management Team that reviews all production deployment requests; Establishes more consistency in risk management activities throughout development teams
• All deployments checked by 3rd party• Moved risk assessment upstream from pre-deployment to code review• Enterprise Risk Management Program develops and promotes company culture of
enterprise risk management:• Encourages open discussion regarding risk• Integrates risk management into the Company’s goals • Creates corporate culture where people at all levels manage risks
3: Root Cause
© 2016 CoverMyMeds LLC. All Rights Reserved.
• Implemented Incident/Problem Management process• Root Cause Analysis approach: Timeline, Mindmap, Action Items• Cross-org team of RCA facilitators
• Treat “disease”, not symptoms• Ensure common issues remediated across verticals• Create comprehensive and prioritized remediation action plans• Create metrics and reporting• Moved to new standard tool available across all areas
Big Q, Phase 2
© 2016 CoverMyMeds LLC. All Rights Reserved.
Expand Quality and Risk Management focus to the left in the SDLC lifecycle
Plan Requirements Design Code Test Implement Verify
Quality
Big Q, Phase 2
© 2016 CoverMyMeds LLC. All Rights Reserved.
In the Cost of Poor Quality continuum, Shift focus to proactive Costs of Prevention & Assessment to exponentially reduce Reactive Costs of Failure
”Cost of poor quality (COPQ) or poor quality costs (PQC), are costs that would disappear if systems, processes, and products were perfect.”
Big Q, Phase 2
© 2016 CoverMyMeds LLC. All Rights Reserved.
Big Q, Phase 2: Quality & Risk at CMM
© 2016 CoverMyMeds LLC. All Rights Reserved.
Keep evangelizing the merits
of risk prevention
Risk & Quality Blog
& Newsletter
Onboarding training for new hires
Route Root Cause
feedback to upstream
Risk Managemen
t Teams
Formal course through Learning Center
Big Q- Phase 2
© 2016 CoverMyMeds LLC. All Rights Reserved.
Risk Management
Root Cause Analysis (RCA)
Requirements Metrics Testing Role & Processes
Performance Testing
Add Enterprise-wide toolsets
Expand Use of FMEA (Threat Modeling): • Software
Design• Testing• Requirements• Business/
Product Mgt.
Integrate action items into team intake processes across the company
Implement consistent Product Owner role and processes
Improve visibility of key metrics for leadership and individual contributors
Implement appropriate roles and processes to ensure coverage and continuity between:• Unit &
Integration • System• Regression• User
Acceptance
Expand to begin earlier in development lifecycle
Incident Management
New App Risk Assessment
Improve trending & data analysis
Implement consistent Business Analyst role and processes
Assess Evidence Based Metrics for feasibility
Add Capacity Planning & Management function
Problem Management
Created Enterprise Risk Management Program
Integrate with data analytics from other sources
Implement consistent requirements best practices
Defect Management
Team Intake/Backlog Management?
CMM Journey: Initial, Current, Future State
© 2016 CoverMyMeds LLC. All Rights Reserved.
Initial Current Future
Requirements
1) Wide process range from no requirements to overly designed feature request
2) Engineering Mgs deciding priority of work
1) Addition of BA/QA and PM roles2) Epics & Stories entered in Jira3) Hired Agile Coach
1) Build quality into the requirement phase
2) Formally assess risk for customer-facing applications
3) Product Owner deciding priority of work
4) Implement a set of best practices for requirements elicitation and management for PRs and small enhancements
Risk1) Pre-deployment checklist2) No formal risk assessment or
mitigation process
1) Formal risk review before deployment
2) Code Reviews1) New product assessment2) Enterprise Risk Group
Root Cause1) No consistent formal
assessments2) No documented methodology
1) Formal process with facilitators
2) Documented outcomes
1) Group of facilitators2) Convert trends into actions
Measurement
No formal metrics around incidentsNo trending 1) Meaningful metrics around
incidents, 2) Monthly metric report
1) Expand metric report to include risk components2) Target quality metrics to business goals of the organization
Tooling Multiple Tools or no Tools used Centralizing a core tool for work intake, help tickets, and incidents
Expand use of core tool, add new data analytic tools
Q & A
Rick: https://www.linkedin.com/in/rick-neighbarger/Susan: https://www.linkedin.com/in/susan-bradley-cste
www.covermymeds.com