Diagnose · Establish Operational Truth
Turn healthcare mandates into executable, auditable operational change.
In 3 to 4 weeks, we connect policy requirements to workflows, systems, controls, owners, and evidence. You receive an obligation register, gap and ownership matrix, executable backlog, and executive readiness scorecard.
3–4 weeks
$15,000 fixed · 3–4 weeks
One principal · Scope agreed in writing
Who it’s for
When this is the right step.
For health plan COOs, CIOs, VPs of Operations, VPs of Transformation, and regulatory-program sponsors facing CMS-0057-F, state prior-authorization mandates, or core platform migrations.
- A regulatory deadline (such as CMS-0057-F or state PA rules) has created multiple projects but no single readiness view.
- Compliance, operations, technology, product, and vendors have each interpreted the mandate differently.
- A prior-authorization, interoperability, or policy change looks technically on track but operationally unclear.
- Leadership needs an independent answer before declaring readiness, funding more work, or escalating a vendor.
- Testing is planned at the application level, but no one has defined the end-to-end operational scenarios and evidence that matter.
Outputs
What you get.
- Obligation Register & Impact Map: traceable from policy to capability, workflow, system, control, owner, evidence, and outcome
- Gap, Dependency, and Accountable Ownership Assessment across operations, IT, and delegated vendors
- Executable Implementation Backlog with explicit business rules, exceptions, and acceptance criteria
- Executive Readiness Scorecard showing what is proven, what remains open, and what needs a leadership decision
- Readout and alignment session with accountable workstream owners
Week 1
Map Obligations & Authorities
Translate the approved mandate into concrete obligations across member eligibility, benefits, clinical policy, provider programs, UM orchestration, and claims controls.
Week 2
Inspect Systems & Handoffs
Walk through the operational and technology handoffs with workstream leads and vendors. Find where unmodeled exceptions and hidden manual workarounds exist.
Week 3–4
Structure Backlog & Executive Scorecard
Deliver the prioritized gap and ownership matrix, the executable backlog, and the executive readiness scorecard with a sponsor readout.
Pricing
Boundaries
The fine print, up front.
Stated before any contract, so scope and expectations are clear.
- Grounded in operational and technical architecture; not legal, clinical, actuarial, or regulatory advice.
- Does not replace accountable client executives, compliance owners, architects, or delivery teams.
- Not a generic PMO status report, software implementation, or formal compliance certification.
- Bounded to one defined mandate, program surface, or regulatory package.
What comes next: Client delivery teams execute the backlog. If independent execution authority or integration governance across vendors is required, follow-on advisory is separately scoped.
Typical work
What this usually involves.
Does this replace our legal counsel or compliance team?+
No. Your compliance and legal teams interpret the rule. The sprint takes their approved interpretation and translates it into operational behavior, system controls, and evidence.
What systems and workflows do you inspect?+
Intake channels, UM platforms, clinical rules engines, claims adjudication, provider data, and partner APIs across the end-to-end operational path.
How does this differ from our internal PMO status reports?+
A PMO collects reported status from workstreams. The readiness sprint tests whether the links between policy, workflow, and systems actually connect with demonstrable evidence.
The other steps
Start with the smallest step that answers the question.
One principal · Priced up front
Tell me what's stuck.
Bring one workflow that keeps slowing you down, or an AI idea you want to put to work. In 30 minutes, we will talk through the problem, the tools involved, and whether a diagnostic or a scoped build is the right next step.