Process and Delivery Methods. Root Cause Analysis will be performed using industry standard practices. Supplier will conduct weekly Cross Functional meetings with representatives across the towers to review identified issues, identify and analyze root cause, and discuss progress towards resolution of root cause. Supplier will participate in meetings related to RCA with Health Net as needed to address RCA across the enterprise as needed. Meetings will increase in frequency as needed, including daily and multiple times each day during peak periods. During these meetings, call drivers will be analyzed, identifying systemic issues in upstream processes. Supplier will establish a centralized RCA function to manage and oversee activities across the towers. The Supplier Solution includes the following: • Collecting issues from multiple sources, including proactive search for issues that are candidates for Root Cause Analysis, • Maintaining catalog of issues requiring Root Cause Analysis, • Identifying owners responsible for RCA for each issue, • Developing solution / corrective action, • Monitoring status from identification to resolution, • Documenting and reporting issues and root cause for compliance related issues within required timeframes. Final Supplier will periodically meet with Health Net to refine the process and monitor progress. As required by Health Net, Supplier will include representatives from other areas of Health Net (e.g., Provider Network Management Department). Specific procedures to perform the Root Cause Analysis function will be documented in the Procedures Manual. Identifying and categorizing all issues that need RCA including the following activities: • Assessing the impact of the incident, • Gathering data and other information required for the RCA, • Performing RCA for all identified issues, • Creating a corrective action plan to address and resolve the root cause while working to prevent recurrence of the incident, • Providing RCA status reporting including action items, • Performing root cause analysis as required by Health Net regulators in the required time frames, • Monitoring and report on success of RCA solutions implemented, • Analyzing incidents and RCA to identify trends, • Analyzing trending to proactively identify, diagnose and correct recurring problems, and performance degradation and identify associated consequences, • Tracking, diagnose and report recurring incidents, problems and failures, and performance degradation, • Leveraging trending analysi...
Process and Delivery Methods. The Managed Third Party Contract management team will liaise and communicate directly with technical and subject matter expertise in the Health Net retained organization and also report to the commercial and service integration team from a portfolio management and cost standpoint. For the BPaaS portfolio, each contract will be evaluated and recommendations will be made to Health Net based upon review of the results. When applicable as outlined in Schedule O (Health Net Provided Resources), Supplier will determine if a contract already exists with Supplier that could be leveraged and, if not, look to negotiate appropriate terms and conditions for the Supplier to contract for the services directly. Supplier may choose to use the same or similar solution as Health Net is currently using or in some cases may consider replace the technology or service component with something different but comparable allowing Health Net to terminate current services. Depending on the category of third party services, different expertise and tools will be leveraged. There will be a central contract repository which will be the database for each contract to be managed by Supplier. While Supplier continues to manage the Managed Third Party Contracts, the original Final Health Net contracts will be maintained by Health Net. Linked to this database will be other Supplier interactions which may be pertinent to the review process. Copies of all contracts and notes on key terms, conditions and licensing will be linked to the database. Reporting will be created that forecasts, at the individual or portfolio level depending on agreed, “Hard Cap” or gain sharing agreements actual costs vs. baseline costs and performance. Compliance reports will be created to document license usage and to ensure no third party contracts are in violation of stated licensing requirements or guidelines. Managed Third Party Management Services activities for both BPaaS and Non-BPaaS Health Net Contracts include: • Identification of all suppliers services, and categorizes them according to supplier type, significance and criticality. Maintain formal documentation of technical and organizational relationships covering the roles and responsibilities, goals, expected deliverables, performance track record of past and current issues, escalations, and resolutions, • Performance monitoring to ensure compliance with contract terms and conditions, SLAs, • Recommendations and resolution of issues related to non-complian...
Process and Delivery Methods. Supplier will use tools and methods available as of the BPaaS Service Commencement Date to: • Continuing with same reporting format as at the time of execution of the Agreement. Any changes to the content and format must be pre-approved by Health Net, • Providing reports based on ad-hoc and on-going requests, • Analyzing the data to identify trends and potential risks. The output of this exercise will be added to the monthly and quarterly management reports, • Leveraging the performance reports and the results of the trend analysis to assist Health Net develop business strategies and solutions. As part of Stage 2, the Supplier will implement a Service Reporting tool that enables the Supplier to create reporting and dashboards for performance, joint situational awareness and governance meetings and end to end service delivery management. Supplier will also provide other inputs to Stage 2 (reporting) and Stage 3 (analytics) as input to the Innovation Plan providing comparison with market peers and industry trends as input to market and Industry capabilities related to performance reporting for like services in the marketplace.
