TLC Family Care Health plan, Healthcare

Company Uses Project Management to

Develop Online Claims Program

Details of Presenters

NAME- Ujjwal Balyan & Harman

SECTION – A
CLASS – BBA

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 1. About the Organisation

• TLC Family Care Health plan is the largest Medicaid-managed care program in western Tennessee, United States. It focuses on providing quality healthcare services to low-income children, pregnant women, and citizens with disabilities.
• The organization operates wellness and disease management programs to ensure the best possible care for its members. TLC is a part ofAMERIGROUP Community Care of Tennessee, which is a subsidiary of the Virginia Beach-based AMERIGROUP Corporation.
Together, they serve approximately 1.7 million members across 11 states.

• TLC Family Care Health plan is headquartered in Memphis, Tennessee.

• TLC Family Care Health plan prioritizes enhancing online functionality for healthcare providers, improving claims processing efficiency, and ensuring high member satisfaction.
• Leveraging PMBOK® Guide-based project management methodologies, TLC effectively plans, executes, and monitors projects to align with business goals. Initiatives like digitizing the claims process have led to substantial cost savings and operational improvements, reflecting TLC's commitment to innovative and excellent healthcare services.

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 2. About the industry
The Medicaid-managed care industry plays a crucial role in providing
healthcare services to low-income individuals, families, pregnant women, and
people with disabilities who qualify for Medicaid coverage. This industry
operates under the Medicaid program, which is a joint federal and state initiative
aimed at providing healthcare coverage to eligible individuals.

Key aspects of the Medicaid-managed care industry include:

• Healthcare Coverage: Providing essential healthcare services to vulnerable

populations.
• Managed Care Organizations (MCOs): Coordinating care and managing
provider networks.
• State and Federal Regulations: Compliance with complex regulatory
requirements.
• Quality Improvement Initiatives: Focused on enhancing patient outcomes and
access to care.
• Technology and Innovation: Leveraging digital tools to improve healthcare
delivery and administrative efficiency. 3
 3. Which aspect of Project
Management case talks about
This case study highlights the significance of Project Integration
Management through the following key points:
1. Coordination of Concurrent Projects: The organization managed multiple
online projects simultaneously, emphasizing the need for effective
coordination to prevent conflicts and optimize resource allocation.
2. Prioritization of Tasks: Amidst competition for resources, tasks were
prioritized based on dependencies and project objectives, ensuring alignment
with overall organizational goals.
3. Regular Communication and Alignment: Weekly meetings were conducted
to review and prioritize tasks, fostering open communication among project
teams and stakeholders to maintain alignment and address any issues or
concerns promptly.
4. Risk Management Strategies: The project team conducted ongoing risk
assessments to identify potential delays or opportunities and implemented
proactive measures to mitigate risks, ensuring project success within budget
and ahead of schedule.
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 4. What were the problems
identified?
1. Competition for Resources: The organization faced challenges due to
concurrent online projects, leading to competition for time, manpower, and
other resources. This competition hindered the progress of individual projects
and posed a risk to overall project success.
2. Dependency Management: Lack of clear identification and management of
dependencies between the Online Claims Submission project and other
concurrent projects resulted in potential delays and conflicts in task execution.
3. Communication Gaps: Inadequate communication channels and mechanisms
led to gaps in information sharing between project teams and stakeholders.
This lack of communication increased the likelihood of misunderstandings,
delays, and inefficiencies.
4. Time Management: With a tight project deadline, effective time management
became crucial. However, inadequate planning and monitoring of project
timelines increased the risk of project delays and compromised the
organization's ability to achieve its objectives within the stipulated timeframe.

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 5. How were the
problems/challenges resolved ?
1. Integrated Project Management Approach: The Project Management Office (PMO)
implemented a plan to integrate all concurrent projects, ensuring alignment of goals,
resources, and timelines. This approach facilitated better coordination and resource allocation,
mitigating the impact of competition for resources.
2. Regular Communication and Coordination: Weekly meetings were conducted to review
and prioritize tasks across all projects. This provided a platform for open communication,
allowing project managers to address dependencies, allocate resources effectively, and resolve
conflicts in a timely manner.
3. Risk Management Strategies: The project team conducted ongoing risk assessments to
identify potential challenges and opportunities. Proactive measures were implemented to
mitigate risks, such as developing contingency plans and reallocating resources as needed to
ensure project success.
4. Time Management and Monitoring: Project schedules were reviewed regularly during team
meetings to keep all stakeholders informed of timelines and milestones. Additional team leads
were employed to provide expertise and ensure that project tasks were completed on time,
contributing to the successful completion of the project within the established deadline.

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 6. Key takeaways from the Case

1. Importance of Project Integration: The case underscores the

critical role of project integration management in navigating
complex projects with competing priorities and resources.
2. Effective Communication is Vital: Clear and regular
communication among project teams and stakeholders is essential
for resolving challenges, managing dependencies, and ensuring
project success.
3. Proactive Risk Management: Implementing proactive risk
management strategies, including ongoing risk assessments and
contingency planning, is crucial for identifying and mitigating
potential challenges that may arise during project execution.
4. Time Management is Paramount: Efficient time management,
coupled with diligent monitoring of project schedules and
milestones, is essential for meeting project deadlines and
achieving objectives within the stipulated timeframe.
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 7. Conclusion and Recommendations
• In conclusion, TLC Family Care Health plan's case demonstrates the crucial role of
effective project management in achieving organizational objectives. By implementing an
Online Claims Submission system with meticulous project integration, proactive risk
management, and clear communication, TLC overcame challenges and achieved
significant benefits. This success highlights the strategic importance of project
management for driving efficiency, enhancing customer satisfaction, and gaining
competitive advantage. Prioritizing project integration, communication, risk management,
and time management enables organizations to navigate complex initiatives successfully.
Recommendations:
• Continuous Improvement: Foster a culture of continuous improvement by
refining project management methodologies.
• Stakeholder Engagement: Maintain alignment and manage expectations
through ongoing dialogue with stakeholders.
• Invest in Training: Enhance project management skills through investment in
training and development.
• Regular Evaluation: Conduct regular project evaluations to identify areas for
improvement.
• Adaptability: Remain flexible and adaptable to optimize project outcomes.

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 8. References
1. Project Management Institute. (2017). A Guide to the
Project Management Body of Knowledge (PMBOK®
Guide) – Sixth Edition. Project Management Institute.
2. Case Study: Healthcare Company Uses Project
Management to Develop Online Claims Program.
(2012). Project Management Institute.
3. TLC Family Care Healthplan Case Study. Retrieved
from
https://www.pmi.org/business-solutions/case-studies/tlc-fa
mily-care-healthplan-uses-pmbok-guide-in-project-to-digiti
ze-claims-process