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Development / Implementation Policy and Procedures or Standards

Optum, a subsidiary of UnitedHealthcare, does not have a published policy and or procedure for outsourcing IT to outside vendors. Optum's IT department is made up of Optum employees and all aspects of IT are handled internally. SubroPoint is a cloud-based application, however, UnitedHealthcare owns, operates, and manages the cloud internally for Optum.

Optum does have a published application development and acquisition procedure, which began in 2019. The procedure instructs the business managers to give their problem statement, identifying the issue at hand, to the IT department, who is responsible for making the necessary fixes and changes. When the IT department receives the problem statement, they are expected to use their specific process or methodology. Unfortunately, only the IT department is privy to their processes, and the information was not sharable upon our request.

When faced with an issue that will require a software fix or enhancement, Optum's development and acquisition project managers are expected to use a particular process or methodology.The managers will identify the issue and generate a problem statement. The problem statement will identify the issue at hand and the goal statement, which will explain the expected result of the project. Once the problem statement is completed, the business manager then creates a project business benefit, which will identify the savings to the company as well as other benefits associated with the project, for example, reduced provider abrasion. The project business benefit will also contain a blue-chip alignment, which will call out what business objective the project is tied to, for example, revenue growth.

In addition to creating the problem statement, the business managers are also responsible for maintaining the project status and reporting the project milestones as they are completed. Milestones are typically reported on in phases, the business manager will define the phase the project is in along with its status, this includes reporting when the phase is ready for completion and sign off. The business manager will also identify any phase deliverables that are outstanding with projections for completion.

Additionally, the business managers are responsible for identifying project risks and issues. This would include any foreseen issues, for instance; time zone differences, process questions, additional system enhancements required, along with the expected costs. The project issues step would also contain information about the next steps of the project.

Once the problem statement is completed and signed off, the business manager will gather the information and create a project charter. The project charter will contain a project title, project id, project champion, project black belt, problem statement, goal statement, critical quality, objectives and measures, business case and financial impact, scope, and schedule estimates and initiative resources, who is handling what aspects of the project and their estimated completion dates. The schedule estimates and initiatives will consist of several phases; define, measure, analyze, improve, and control and will identify when each phase was completed, and contain the important notes from that phase.

Though SubroPoint was purchased and customized, the process followed would best fit the RUP method. The RUP method which is "owned by IBM, provides a framework for breaking down the development of software into four gates" (Blatzan, 2020). SubroPoint's customization closely resembled RUP methodologies. When Optum began customizing SubroPoint, the first step was to identify who the stakeholders were and give them access to the test site so they could learn how the system worked. The next step was to figure out what customizations were needed and then design the fixes. The final step of RUP identifies the training of the users.

Optum does have IT governance, risk, and compliance requirements in place. Optum follows the standards of UnitedHealth Group's (UnitedHealth Group is the umbrella that all subsidiaries fall under) information security policy. These policies provide "the foundation for assuring the availability, integrity, and confidentiality of all UnitedHealth Group Information Assets, whether verbal, written, printed or electronic, that is processed or stored on information technology systems, transmitted over networks, or maintained in any form" (UnitedHealth Group, 2020).

The Enterprise Information Security Organization sets the Information Security Policies and Standards across UnitedHealth Group. At UnitedHealth Group, the resource administrators are responsible for protecting the IT systems they have been assigned. Their duties are "establishing, monitoring, and operating them consistent with all applicable policies and control standards as documented in the UnitedHealth Group's Information Security Policies, related baselines, security standards, and security procedures" (UnitedHealth Group, 2020)

UnitedHealth Group also has established an Information Risk Services office, this office is part of the "Enterprise Information Security (EIS) Organization and is designed to promote compliance with the Company's mission and various federal, state, and local security and privacy regulations" (UnitedHealth Group, 2020).

The enterprise information security organization has designated a Business Information Security Officer to each business organization, who is responsible for overseeing the information risk program within that business organization.

UnitedHealth Group's "Chief Compliance Officer is responsible for overseeing UnitedHealth Group's compliance with all applicable laws and regulations as well as coordinating compliance programs between regions and Business Organizations. The Chief Compliance Officer reports on the effectiveness of UnitedHealth Group's compliance programs to the Audit Committee for the Board of Directors" (UnitedHealth Group, 2020)

Establishing the requirements/project leadership

The need for a new system became apparent as Optum's subrogation business continued to grow it was discovered that SubroTrack would need to be replaced as it did not have the functionality or the ability to be customized to Optum's specialized clients and to grow with the organization. SubroPoint was selected because of the functionality that currently existed within the application as well as the relative ease it offered for making enhancements and changes.

Optum's current platform, SubroTrack, had enough functionality to efficiently handle the department's work, however, the software had numerous drawbacks.One of the biggest drawbacks Optum found in staying with SubroTrack was that it had limited resources available for system enhancements. In the beginning, SubroPoint Optum's management was required to maintain a list of recommendations for system changes related to improving the functionality, efficiencies, and processes of the SubroTrack application. Since SubroTrack does not have its own support staff the IT responsible for making the requested changes is shared across multiple departments. Sharing the IT staff throughout Optum only allowed the business managers to provide quarterly requests for only priority enhancements. Business managers would then work with the IT support staff to promote their initiatives and provide financial savings forecasts along with their evidence of importance. The IT staff would then notify the business manager and identify the items that would fall within their time allotment. Contrarily, SubroPoint has a dedicated IT support staff solely for the subrogation application, which allows Optum's explicit needs to be a priority.

Optum did perform a formal needs analysis, this process was conducted as a meeting used for a general brainstorming session, where the impacted staff, business managers, team leaders, and regional directors gathered to determine what was needed in a new system and what it would take to make it happen. Optum uses brainstorming to gather multiple opinions and ideas to be considered before moving forward with a project.

The initial request for a new application came from the business managers after it became apparent the requests for enhancements, changes, and upgrades from the frontline users would not be considered a priority for the IT department. As previously discussed, Optum's IT department did not consist of any staff dedicated to SubroTrack, therefore, any changes were met with exceedingly, long time delays, if they were determined to be important enough to be implemented. Importance was determined by how many staff members were affected by the issue. Because the subrogation department is divided into business groups, via clients, issues were specific to these small groups, which made it impossible for the business managers to get upgrades and enhancements approved as they were viewed as only having a small impact on the overall business.

The process of finding the next subrogation system was handled by Optum's business managers, regional directors, and SubroTrack's business manager. The frontline users were not involved beyond the requests previously made to their business managers and team leads regarding enhancements and changes Optum's current system required. The business managers were the biggest contributors to finding a new system. They provided the input that was previously received from the frontline users regarding what was needed from a new system. This information was compiled and given to the regional directors and the SubroTrack product manager. The information was compiled by the business managers and provided to the regional directors and the SubroTrack product manager via a fishbone graph and a PowerPoint workflow document. The workflow document contained the entire project, including the issue scope and projected outcome.

The project team consisted of executive sponsors, known to Optum as project champions, Loreen Arms and Dave Sheppard, who are both executive directors. Business manager, Heather Henderson reviewed the requirements as the subject matter expert and worked with the project champions to sign off on the requirements.

Optum's business managers were the champions of the project. Their motivation came from having a system that would be tailored to their frontline worker's needs and would allow future customizations and fixes as needed and the need to meet the increase in project recoveries. As the upper management's expected recovery amounts increased from year to year, the business managers knew they would need a system that would assist the frontline users in obtaining the expected recovery goals. This system needed to streamline the daily tasks of the frontline workers and provide improved efficiency to assist in obtaining their goals. Specifically, the specialized client groups needed enhancements immediately to meet the expectations of upper management.

The project managers were responsible for communicating updates to the business managers, and the business managers would update their teams as to what phase the project was in, what items they were working on, and when the rollout would begin. The project managers and the business managers participated in meetings, to discuss the project's status and issues, three to four times a week. The project leaders were responsible for updating other business owners, who were expected to trickle down the information related to the project to their direct reports. Other forms of communication used by the team were formal email communications and focus groups were created with applicable stakeholders. The product managers and business managers also sponsored office hours where any employee could join and talk about SubroPoint. The office hours concept was used to obtain general feedback from the frontline workers and identify what they expected of the final product.

The process between the affected staff was smooth, all involved were eager to customize SubroPoint and get it implemented. The customization was exciting for the project team because Optum's current system SubroTrack was very limited on changes and was not sufficiently meeting the needs of the frontline users. SubroPoint would allow most of the requested changes to be made and implemented, which reduced the risk of conflict because business managers would no longer be required to show their requests were more important than another business manager's request.

Before SubroPoint went live, a test site was created. The test site had various clients moved to it (those clients remained in SubroTrack and were only used in the test site for testing purposes, the data was not live). A team was selected to work the files in SubroPoint in the test site, while this was taking place issues were identified as well as correspondence that SubroPoint was lacking. For instance, SubroPoint's letter generating tool contained substantially fewer correspondence choices than SubroTrack contained.

As the users in the test site identified issues and necessary changes, the business managers created change requests, identifying the change needed and why it was needed. The business manager would give the change request to their regional director for approval. After the request was signed off on by their regional director it was given to SubroPoint's product manager. The product manager would work with the IT department to determine the cost of the change and the time it would take for the fix to be created and implemented. Once the impact and change cost were determined, the request would be presented to the executive directors, who would review the change request and either approve the request and sign off or deny the request.

Systems development / Implementation options and decisions

Optum faced three options when looking to their future need of a subrogation system they could either develop a new system in-house, further develop their current system SubroTrack or purchase a system that was ready to go live. Since Optum developed SubroTrack in-house they were aware of the time restraints of further development and the functional capabilities that did not exist with the system, the decision to purchase a ready-to-go system was immediately made.

The decision to purchase a system ready to go live was essentially made by Optum's CEO. The largest contributor to the decision was provider abrasion, Optum needed to roll out a system as seamlessly as possible to avoid disrupting the business. Optum also wanted to find a system that contained its own IT staff to participate in the implementation and provide future support.

Optum did not present a formal request for proposal, this type of request would be considered external and only used if Optum was developing something for a customer. What was presented as a summary and synopsis which was drafted by the project leader, this was used as the proposal request.

There were not any external vendors involved in the purchase or implementation of SubroPoint. When Optum decided they wanted the SubroPoint software, they purchased Legacy Equian, the company that developed and owned it. Optum then brought Legacy Equian employees on as Optum employees. To protect the sensitive data contained in the systems, UnitedHealth Group and Optum do not outsource to external vendors for IT. Optum does have IT staff dedicated to supporting application development; however, the services they provide are geared towards Optum's customers. This service is used to "seamlessly implement and optimize enterprise applications" for Optum's customers (Optum, 2021).

SubroPoint required many customizations to fit Optum's needs, there was not an option for Optum to accommodate SubroPoint's structure. The customizing was completed by Optum's IT department dedicated to SubroPoint. Though the actual customizing was completed by the IT department, the business managers, project managers, and regional directors were responsible for identifying the need, and the process followed until it was handed off to the IT department.

Application Implementation

The implementation of SubroPoint was handled by the SubroPoint IT staff, the business managers, SubroPoint's product manager, regional directors, and executive directors. The implementation was handled internally by Optum employees. Though the project had a project champion, once it was time to implement the software, this project was handed off to the IT department. To prepare for the "go live" date Optum's staff attended system training sessions and provided feedback to their business managers, who forwarded that information to Heather Henderson, the subject matter expert. Heather compiled the information into internal documentation, which was used to customize SubroPoint to meet Optum's specific needs.

The frontline users will receive additional training as their clients are brought live into SubroPoint. The business managers and team leads were trained initially by Equian staff and now assist in training the frontline users. Once a user becomes familiar with SubroPoint they are also considered a reference point for new frontline users in training.

After the foreseen enhancement was made, additional testing was performed using real-case scenarios which identified issues with the medical claims data load, as well as errors with membership. Though there was not the creation of test strips, once the data was taken live in SubroPoint it was easily identified by the frontline users and business managers there were errors with how the claims data loaded into SubroPoint. Additionally, it was found that membership was not transferring from the claims systems into SubroPoint correctly. The IT staff was responsible for creating the fix and implementing it to resolve these issues. How these two issues were fixed was handled by the IT department and other departments are not privy to that information.

After the Optum IT staff completed the restructure of the coding system and the issues with the medical claims data load and membership were corrected, Heather Henderson collaborated with the Optum IT staff to categorize what changes were most important and needed now versus the changes that could be rolled out in a later release. Once the changes that were needed now were completed and the test site appeared to be functional, Heather decided it was time to go live with SubroPoint. Heather gathered the final signoffs and requested the move of Optum's clients in phase one to be moved over to SubroPoint, phase one was now live.

Due to the large volume of work Optum was dealing with, they decided to move each line of business from SubroTrack to SubroPoint in six separate waves. This would ensure a thorough and work-based migration starting with Optum's smallest clients to reduce any potential impact to workflow, Optum identified these waves as phases. Optum starts with the smallest client groups and will move towards the largest. To date, Optum has completed phase one and is in the process of completing phase two. SubroPoint was the system Optum wanted which led to Optum's purchase of Legacy Equian. The system was specifically chosen because of its ability to be customized and assist Optum in gaining additional ground in the subrogation industry. SubroPoint was chosen because of its functionality and ease of customizations, and the ability to grow with Optum's subrogation business.

Slides 7 thru 9: Describe the systems development process for the information system project that was your target of study?