A healthcare PMO today must have a strong constitution. Not only are they faced with challenges unique to healthcare, PMOs are also going through the trends mentioned in our recent post, “Conquer Your Business Transformation.” These include realizing Agile-at-scale, embracing the changing world of work, and creating an innovation culture.
During the recent Planview Horizons Customer Conference in Austin, TX, 25 of our Blue Cross Blue Shield (BCBS) customers from six different affiliates met to discuss how they are handling these challenges and opportunities. The group included BCBS customers who spoke at Horizons, representing Blue Cross and Blue Shield North Carolina, Cambia Health Solutions, and Excellus BlueCross BlueShield, as well as others from across the United States.
Here are five highlights from the discussion:
1. Challenges Connecting Strategy and Delivery: “How do we ensure we are investing in the right things?”
One of the challenges discussed was how the healthcare industry’s constantly shifting dynamics make connecting strategy to delivery more complex at all times. Healthcare PMOs must frequently incorporate regulatory changes into the portfolio, for example. Then there is the pressure to innovate and deliver the right products and services to BCBS members quickly. Healthcare PMO’s should ensure that the organization has the right portfolio mix to accomplish its goals and be able to pivot and re-prioritize as needed.
A representative from Blue Cross and Blue Shield North Carolina (BCBS NC), the largest insurer in the state, put these challenges into perspective: “You have to be innovative to help drive change in healthcare. We want to be one of those leaders.” He said they are focused on several key questions:
- “How do we ensure that we stay up to date and are in front of it?”
- “How are we funding and creating new, better, improved ways of delivering healthcare products and services?”
- “How are we making sure we are investing in the right things?”
- “How do you align to the different types of work required?”
- “How do we give insight to the organization about the work?”
Using Planview solutions, the PMO at BCBS NC has evolved from basic resource management to strategic, enterprise portfolio management. Today, the organization has shifted its focus from projects that were completed on time and on budget to optimizing a project portfolio worth hundreds of millions of dollars that focuses on achieving strategic outcomes.
Investing in and prioritizing the right work were also hot topics for the rest of the group.
One BCBS customer mentioned how pleased their stakeholders were to realize the data already exists in Planview Enterprise OneTM for prioritization: “The scoring formula sets priority. We argue less and spend more time discussing what we plan to work on.”
At this organization, the PMO runs their Planview solution at the executive strategy meetings: “It’s caused the realization that there are gaps to address and that in some cases, we are working on things that are a lower priority. It’s an exciting time as we go through the portfolio process. Executives are asking for information from us to drive financial discussions.”
Another participant is also focused on using the data already in Planview to better align strategy and execution. “This year has been very transformational for us as an organization to start using Planview Enterprise One more holistically. We are integrating the strategy process with our portfolio process and using Planview’s investment and capacity planning with the portfolio.” The PMO is now working with executives to connect delivery more tightly to strategic planning and get people the right data at the right time for execution.
2. Technology Rationalization: “Our enterprise architecture team is absolutely engaged.”
BCBS organizations know that achieving strategic outcomes is increasingly tied to technology. New products and services are often digitally based. Linking technology with business context can drive revenue and growth, but only if IT leaders – and specifically enterprise architects – are able to optimize their application and technology portfolios.
This is where the healthcare PMO comes in, but the group agreed that it’s presenting challenges. One participant offered: “Over and over someone makes an enhancement to a system and it breaks something we were just rolling out, because there wasn’t that full picture.”
Another BCBS participant said: “We have blueprinting that informs strategic roadmaps for each business area. Now, we don’t invest unless it aligns to those strategic roadmaps. This has afforded us more discipline than we had a few years ago. Our enterprise architecture team is absolutely engaged prior to planning at that strategic level.”
One BCBS customer has decreased their company’s applications from 1,352 to 591 using Planview’s capability and technology management application. She said their executives have asked to see more data. “It’s a big eye-opener when we started to look at the data. The way it all works together is amazing.”
Their enterprise architecture team is also more engaged and involved: “Our hope is to start driving strategy based on business need versus business teams deciding they want a tool and bringing it in.”
3. Creating an Innovation Culture: “Crowdsourcing is powerful.”
Innovation can give businesses an edge, whether it’s improving internal processes, solving issues, or coming up with game-changing product ideas. To that end, many BCBS organizations are institutionalizing the process of innovation, creating departments dedicated to it. They are also using purpose-built tools to tap the collective wisdom and creativity of their employees, partners, and others.
Cambia Health Solutions mentioned that they have achieved significant results using the Planview SpigitTM innovation management solution: “We’ve been fortunate to work with Spigit for about seven years now. We’ve had our Innovation team stood up for eight years. We’ve gone full cycle to introducing products in the marketplace and starting new businesses. It’s a great tool and we are grateful for it. That philosophy of crowdsourcing is powerful.”
For example, Cambia launched a recent challenge that yielded $4 million in cost savings associated with process changes. Another idea became a new sales engagement tool that has supported over $60 million in sales and renewals. See Cambia’s presentation at the Ignite 2019 conference here.
4. The Changing World of Work: “How do we align different types of work?”
The focus on the end game – delivering fast, measurable value to the business – means healthcare PMOs increasingly support the different ways employees work. This includes various types of work methodologies such as waterfall, collaborative, iterative, Lean-Agile delivery or a combination of these methodologies. Today’s healthcare PMOs must seek the right balance of these delivery approaches to create market-leading products, services, and member experiences.
Continuous planning helps healthcare PMOs ensure that work is constantly delivering value to the business – connecting strategy, planning, and delivery for everyone in the organization and helping them adapt as priorities, regulations, and markets shift.
As a result, BCBS NC has transitioned to a multi-methodology delivery: “We’ve gone from using one method to a hybrid model to multiple methodologies to find which one is suitable to the work. We’re not calling it scalable agile but more calling it business agility. For us that is a big change management item that goes across the enterprise.”
The majority of the BCBS participants agreed that agile transformation is a challenge. While some of them are far in the journey, most are working through defining the best areas for agility and their roadmap.
One customer discussed an Agile directive from his company’s executives: “‘We should go all Agile!’ they said. How do we introduce a more agile approach to traditional projects or have a mixture of types of projects, rather than trying to force all work to be Agile? Has anyone else experienced that? How are you trying to handle it?”
Having faced this same issue, one customer replied: “The realization came that everything cannot be Agile. It’s just not possible. Not everything fits into that. They started to get the bigger picture: Let’s put stuff into Agile where it fits.”
Agile presents different ways of working: A one-size-fits-all way of working is no longer sustainable. Becoming more Agile requires healthcare PMOs to learn and incorporate different methodologies, frameworks, and terminologies.
“We’re going through the project versus Agile war right now,” responded another BCBS customer. “Our IT director brought in a great Agile leader to implement SAFe on the entire company. She ran into walls as she worked through how to scale Agile into our existing financial, executive reporting, and governance processes.”
“How can you be so specific to SAFe and still manage a project?” he said. “What SAFe, Agile, and even classic governance have in common is that you can ‘lean them’ and include lean aspects to introduce ‘just enough’ governance, and more incremental funding and look at different KPIs. We now have common terms and metrics we use.”
5. Agile Funding: “It’s a step in the right direction.”
The discussion turned to Agile funding processes and how difficult it is to make that transition. The rapid pace of Agile requires dynamic funding rather than annual, project-based funding. Continuous portfolio planning lets healthcare PMOs reallocate funding as products die, priorities change, and new, promising ideas arise.
Yet, how do you fund the people and not the project as in traditional healthcare PPM?
“That’s part of what we struggle with,” said one customer. “We have this planning mentality where it’s still, ‘Okay, you have X amount of budget for this year, I want you to develop Y.’ Executives are trying to fit those projects into an Agile format. They still expect a fixed deliverable by the end of a fixed period of time.”
Some customers said their organizations are making headway:
“This year we’re closer than ever to funding value streams. We gave them the money but they still identify projects so we’re not quite there yet. It’s a step in the right direction. They know that as emerging work occurs, they have to re-rationalize within the work they wanted to do this year.”
This is the second consecutive year these BCBS customers have convened at Horizons to discuss their challenges and opportunities. They find it valuable to share ideas in this forum and throughout the year, and hopefully their insights have been useful to you as well. Looking ahead to the healthcare trends and predictions of 2020 – everything from telehealth to “social determinant” data to the “retailization” of the industry – healthcare PMOs will continue to evolve and adapt to bring innovative, high quality, low cost offerings to their members.
Learn more by reading the “Break Through the Status Quo: Embrace the Changing World of Work” eBook.