Anthem sued for creating ghost networks. What happened to SPS (Strategic Provider Services) migration that was supposed to be ANOTHER magic button? They spent a huge amount of money (led by A Chennuru) on it and took several years to complete.
https://www.fiercehealthcare.com/payers/blue-cross-plan-accused-perpetrated-fraud-ghost-network-class-action-lawsuit
Why would we have reliable data in ANY department at Anthem??? We are using aged systems and patching them together manually. And who’s doing it manually??? Overseas folks…. Oh wait … we bought that overseas company from another insurer when it failed for them…..
@4pmp+1v9ZKbhg post:
“A.C. and EDA are known for being significant drains on funding without much accountability and minimal benefits….. ”
1000% TRUE. WITNESS IT DAILY!
I am switching to the Hybrid plan next year to save some money and hoping I do not get f'd over with bills from my providers who I see today are in network and turn out to be NOT.
AC did such a great job with EDA and various programs such as SPS that they made him in charge of the new TRANSFORMATION program as well! Lol
A.C. and EDA are known for being significant drains on funding without much accountability and minimal benefits. One thing that can be said is that their snakeoil sales and presentation tactics are pretty good. They sell vapor, blame everyone else when it goes bad, and then ask for more money to fix what was their fault in the first place. Lather, rinse, repeat. When faced with scrutiny, they lower the initial request amount and then obscure their funding requests within other projects. They could find 100M savings with that team alone but Rat and the rest of the leadership team are too blind to see it, and don't want to because his presentations fit well with a gucci belt.
@3dhk, you must be new to the company; incompetence in our data organization is not in the least bit surprising.
@3ixs+1v9ZKbhg, I knew things were messy, but what you have outlined is beyond ridiculous! Six months to implement a new field in a database is terrible even according to the 80s standards. And lack of documentation is a recipe for failure.... I am speechless.
SPS is a failure because the wrong people were deciding what was a priority, old timers with no forward vision, and the all-ending promise, that nothing downstream will change, no provider data cleanup, and 6 months to implement a new value in the data repository.
Now let's add that there are ZERO functional design & technical design documents, walkthroughs, or documentation and you get exactly what you pay for, a JIRA story that means nothing because it's written like a 5-year-old.
@1fyk+1v9ZKbhg - worked on a project recently, assumed a few simple data 101 tasks would get done. When they weren’t, we asked them to be completed … it was escalated … blown out of proportion … then our team took the hit. It was literally a few lines of code. More time is spent whining than working. If Copilot can fix the whining, then I’m all for it.
If outsiders only knew how inaccurate our member enrollment & claims payment were, we would be doomed.
Isn't there a frat boy in an oversized suit who can fix this?
Have you tried turning him off and on to see what happens?
The SPS implementation has been a plague since the beginning. Millions of dollars for nothing but worse problems. We've known for years. We barely bother bandaging it. Our own internal staff hate using it and some have to for their job functions which slows them down considerably. The ability to gather data, clean and parse it is basic IT. Basic. You can't do anything without the ability to take in data and decide what's good or not.
How have we spent hundreds of millions of dollars without cracking this problem statement- Some providers have multiple specialities and multiple locations, and not always at the same time. It's like you need an actual primary key. It's like you need someone to tell you what that is. Oh. Oh no. Looks like you rifed them. Guess they can't.
They claim the provider finder tool is "Award winning" and is the best in the Blues system! Give me a f-cking break! May be the real awards are the law suits that it invites Lol.
The EDA team is full of id--ts. They cannot fix the systems and the raw core data behind it. The EDA team is so huge - of the size of a regular company's IT department itself. Carelon is surviving because of the AI team. AI >>>>>>>> EDA
RAT will fix the provider directory. His D--k is in its he-l hole
Provider relations have been a complete JOKE in both departments I’ve been at in this company my 6 years here. Provider ANYTHING is big trouble. For such a large company to have such an unorganized provider services department is beyond me. But as a peon peasant what the f*ck do I know!
SPS has been promised since 2018. Not sure who keeps it going or why we keep putting fresh paint on that tu-d.
SPS data quality is atrocious. It's implementation mirrors all other system migrations at this steaming pile of a company in that they never allocate resources to do it right. The outcome is always the same. They go live when the system isn't ready and then basically shut down the project funding. I get it. After all, they gotta get GB Gucci belts to go with her granny suits.
Sps migration has been a colossal failure from start to finish. What’s left of business is picking up the pieces. No one likes the system.
Color me shocked.
Why am I not surprised? Oh right it is because I have tried and failed to get the online provider finder tool to work ...
Why am I not surprised. This is probably going to make more people get rifd.
https://www.pollockcohen.com/docs/2024.10.22-BCBS-Ghost-Network-Complaint.pdf