Maximize value both internally and externally through integrated IT capabilities and advanced software solutions.

The need for technology innovation in health plans stifled by legacy environment and culture.

Health plans have struggled to move beyond legacy technology and as a result are incurring technological debt with each passing day. Meanwhile, the need to innovate to meet the demands of a dynamic and customer-centric marketplace is only growing. To remain competitive, health plans must shift away from transactional claims processors to focus on managing member health, delivering digital experiences, and improving overall care outcomes through innovative technology solutions paired with business sensibility.

This shift is challenging for organizations with a deep-rooted legacy environment, and IT leaders and the systems they govern are at the epicenter of a successful transition from transactional to transformative. This disruption in focus requires overcoming common obstacles:

  • Limited business and IT alignment of enterprise strategic plans and goals
  • Poor coordination across organizational siloes and systems
  • Costly current-state legacy systems and processes
  • Talent dedicated to maintaining and operating legacy technology
  • Lack of enterprise-level services and integration capabilities
  • Disparate data sources and no holistic view of the organization’s information
  • Ineffective business reporting and predictive analytics

Tackling these systemic challenges requires business and IT functions to operate together. West Monroe’s blend of business and industry experts with deep technologists is uniquely suited for helping organizations master the shift and capitalize on opportunities.

Assess current capabilities and recommend solutions to bridge the gap between the business vision and IT execution.

West Monroe’s primary focus is to partner with clients to help them prepare for the shift and create an integrated and strategic path toward true technology transformation at health plans.

Vision and Strategic Alignment 

  • Align broad health plan business objectives and strategic priorities with future-state technology, digital, and analytics strategy
  • Complete a competitive analysis and identify market differentiation opportunities

Current Capabilities Assessment 

  • Assess existing capability maturity and identify capability gaps
  • Review existing business strategy and understand role IT and data play in achieving vision
  • Assign gaps to value drivers and strategic priorities to support prioritization

Shift Enablement 

  • Develop prioritized roadmap based on organizational and strategic market needs
  • Build targeted business cases including evaluation of effort, value, and priority
  • Develop project management and governance structures to drive execution
  • Offer recommendations for effective organizational change, project execution, and adoption

Accelerate the speed of buy-in and delivery of new technologies, catalyzing operating performance and reducing long-term costs.

West Monroe’s aligned business and technology approach delivers real impact and real change to organizations. Our technology and health plan teams provide solution offerings that expand upon our approach, making West Monroe a single partner to drive change within an organization. We’ve partnered with major health plans in the areas of:

CIO Advisory

  • Showcased business value through synergizing IT solutions
  • Architected nimble IT solutions to address dynamic market needs
  • Defined measures that reflected the organization’s business need
  • Proposed organizational structures to address relative business needs

Application Integration Optimization

  • Optimized high-preforming legacy applications while allowing for core internal system integration
  • Aligned legacy systems and third-party applications for complete enterprise integration through Business Process Management (BPM) to expand current capabilities
  • Limited the need for integration architecture support for internal and external cloud-based services

Transformational Change Management 

  • Identified specific optimization opportunities that permit regulatory automations, freeing up focus on differentiators
  • Secured consensus and cooperation through key stakeholder oversight
  • Transformed organizational operations through innovative technologies
  • Rejuvenated high-preforming legacy applications to cut costs and drive efficiencies

Healthcare Analytics 

  • Identified opportunities for new revenue streams
  • Improved data management and reporting to support better care coordination outcomes for patients and providers
  • Lowered costs through effective application of analytics and improved data management to address true business needs
  • Improved value chain workflow process and ability to remediate more effectively and timely


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