Fictitious Org: Care Delivery Corp. US (Caduceus)


In order to ensure you can demonstrate capabilities in the real world it is important to have a company that can help with this, in the 1990's Microsoft did this with Contoso Corporation and it has kept this fictitious org going ever since to fit its wide variety for product demonstrations. We wanted to ensure there was a real world market focus to build out relevant demonstrations and workshops for the frameworks, reference architectures and design patterns enabled by Connected Health / iDAAS. To support this we created a multi-faceted fictitious healthcare company named Care Delivery Corp US, it’s acronym is CADUCEUS (the medical symbol). The sole intent of our doing this is to have practical healthcare enterprise scenarios that we can consistently build content around that can resonate within the healthcare market.

CADUCEUS Vision Statement:

“ Provide our members easy access to the highest performing providers at an affordable cost.”

CADUCEUS Mission Statement:

“ Transform healthcare to a focus on wellness from a focus on sickness.”

CADUCEUS is a regional healthcare player that supports medical, dental, stop-loss, vision and it also has a TPA. The company focuses on small group medical fee-for-service, but also administers large group ASO, and capitation. The current medical membership exceeds 2 million members. Currently, CADUCEUS is dealing with large healthcare insurer entrants, which are eroding its market share in the core. In order to stave off the entrants, the company is offsetting rate concessions by tapping into its reserves, but that is not feasible long-term. The company’s brand is strong in the core. It is the preferred carrier for most companies in the area. It partners with several community hospitals and also focuses on recruiting and maintaining a high-performing network of specialists. CADUCEUS is purchasing primary care provider practices and as such entered the vertical integration market. The company attempted and failed a digital transformation. The initiative was tepidly embraced by the executive team and managed as a “check-list” project. Staff was not dedicated to the initiative and team members had to balance transformation tasks with their day job. It was terminated. However, after several lost RFPs and COVID-19 the executive team realized they must transform. Archaic practices, redundant systems and lack of insights are harming the company’s ability to proactively address situations. A dedicated team is being formed to determine what digital transformation actually is and what it means to the organization. Regardless of the outcome, the company realizes the transformation must be driven from the CEO down. Revisiting transformation is also heavily influenced by CADUCEUS’ need to prepare for upcoming government mandates around interoperability requirements specific to data access, not only for their patients but also their other businesses as well. Through the journey of their re-evaluation of capabilities they have identified some very consistent challenges: lack of ability to innovate, vendor lock in, data interoperability incapabilities, experience problems from partner to customer to patient to clinician to technologist. Quick-Hit solutions were not possible which reinforced the core debt problem: technical, operational and functional in the way they operate as a corporation. Based on all these findings, Care Delivery Corp has decided to start their digital transformation. Care Deliver Corp. desires to implement a universal platform for all lines of business. They are looking to rationalize processes and technology and improve the experience for all stakeholders, including employees. The aspirational enterprise solutions include myEMR, a digital clinical platform for the provider offices, used by clinicians in both the practice and payer organization. myOps encompasses the processes and applications from the point a client buys insurance through management of the clients’ care lifecycle. Most everything else will be included in the Care Kiosk, the digital engagement platform. Care Kiosk is an omni-channel solution for all lines of business to provide seamless real-time and near real-time communication to consumers, clinicians and caregivers.

BUSINESS CHALLENGES

A cross-functional task force was convened to determine key use cases the transformation needed to address. The team agreed that a data driven approach was required. That decision forced CADUCEUS to address their data access issues immediately. Given the disparate architectures, numerous systems and business units several organizations are responsible for data. Reporting, Analytics, Data Science, Actuarial and IT resources were required to extract, transform and rationalize the data.