CoverMyQuality: Implementing a Quality Program by Rick Neighbarger and Susan Bradley

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?


About CMM

https://www.covermymeds.com/main/about

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


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


• 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


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


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


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


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


• 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


• 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


• 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


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


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


Big Q, Phase 2: Quality & Risk at CMM


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


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


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

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CoverMyQuality: Implementing a Quality Program by Rick Neighbarger and Susan Bradley

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