Case Study

Enterprise-Wide Transformation Streamlines Processes

Guidehouse helped a premier Medicaid and health technology solution provider boost performance, employee retention, and customer satisfaction.


A premier Medicaid and government health technology solution provider recently expanded its business capabilities and customer reach through several acquisitions. The rapid expansion led to challenges with meeting deadlines, contract modifications and extensions, customer satisfaction, and an influx of change requests.

The client needed to improve financial efficiency, reduce rework, and prevent delays to boost performance, employee retention, and customer satisfaction.

To achieve those goals, the client sought to:

  • Identify the root causes of historical and ongoing project delays
  • Streamline processes and identify areas for improvement
  • Address systemic issues in its implementation and delivery procedures
  • Implement mitigation strategies for current and future projects



The client engaged Guidehouse in a three-phased initiative to enhance Medicaid Management Information System (MMIS) implementations and launch an integrated rollout. First, Guidehouse evaluated and assessed the client’s current design, development, and implementation (DDI) process to determine its current-state process. Guidehouse found that there were multiple processes to support service delivery across a range of state agencies which created multiple current states. Processes lacked consistency and were not well documented or standardized. Conflicts of understanding and disparate approaches to work among both long-time and newer employees added to inconsistent practices.

Despite the inherent complex challenges, Guidehouse developed an innovative way to approach the overall assessment. Instead of conducting a standard current-state assessment, Guidehouse enabled the client to view its multiple workflows. This helped them pinpoint opportunities to standardize processes and recommend a tailored future-state solution.

In the second phase of work, Guidehouse performed key assessment activities and recommended improvements to create more consistent processes across teams by:

  • Observing and interviewing stakeholders
  • Identifying common aspects of the current process common across projects
  • Determining pain points and challenges
  • Examining architecture and Agile methodology maturity

The Guidehouse team then developed a detailed report that identified current gaps and suggested potential solutions. Among the findings, the Guidehouse report noted that the client was not following Agile processes, and the leadership communication lacked clarity for effective process adherence. Using text and comprehensive process maps, the report delivered projected best practices for upstream activities such as sales/pursuit, execution of state agency work, and development and implementation of systems.

Guidehouse provided key recommendations around fostering a culture of transparency and collaboration, implementing a program management framework, managing product requirements effectively, planning a Scaled Agile Framework (SAFe®) transformation, and more. In addition, Guidehouse advised the client on how to implement these recommendations in the near-term, mid-term, and long-term, following an optimal roadmap of implementation.

This assessment and resulting recommendations aimed to improve efficiency, create transparency between working teams, and drive delivery that is on schedule, on budget, and within scope. To that end, Guidehouse suggested a targeted enterprise transformation to support a more integrated portfolio, value stream, and delivery framework, using SAFe® for large-scale delivery.

In the third phase of this project, Guidehouse helped the client with customer engagements, specifically, in developing requirements validation session (RVS) best practices. Unclear requirements had caused confusion for developers and testers during the development phase, which often resulted in incorrect product delivery and/or developers becoming requirements gatherers, which wasn’t part of their purview. The RVS team focused on facilitation techniques and supported client team members in improving their ability to ask consultative questions of their customers to elicit more detailed and refined requirements. The Guidehouse team recommended the use of fact-based analysis with the product requirements and to avoid assumptions to ensure the purpose of the digital products and thereby proactively identifying pitfalls and issues up front. Guidehouse also recommended that the relevant subject matter experts (SMEs) and technical leads/developers be involved in relevant requirements discussions.


This engagement was complex with a multi-phased assessment that included the DDI process approximation/assessment and ensuing report, and the RVS project. The DDI components served as a basis for how the RVS component could be accomplished and created a strong foundation for the company to build a multi-pronged approach to realizing its objectives.

Members of the client team implemented the strategic approach and organizational design proposed in the detailed report. To do so, the MMIS solution provider created an entirely new department consisting of SMEs from various areas of expertise within the organization to become dedicated requirements analysts. They planned to hire 30 additional professionals to manage requirements for projects moving forward. The client also decided to include additional vital roles in conversations about system requirements, such as testers, business analysts, developers, administrative professionals, technology practitioners, and project staff.

Guidehouse’s three-step implementation process prompted the client to progress in achievable, bite-sized steps that it can use over time to move toward its ideal state. The client moved toward Agile methodology with the Guidehouse team’s support and has improved its potential to provide stability and flexibility to adapt to shifts in markets and customer needs and retain cohesion across projects.

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