Molina Healthcare transforms it's contract management workflows

Gains efficiency, reduces risk and improves the healthcare provider engagement experience
Nurse speaking to patient

Molina Healthcare is a California-based Fortune 500 managed care organization that provides health insurance to people through government programs such as Medicaid and Medicare. Molina set out to transform its contract management workflows to gain efficiency, reduce risk, and improve the provider engagement experience.

Challenge

Molina identified the following key factors that led to provider contract management process changes: 

  • Contracting Inefficiencies​
  • Business and Regulatory Compliance Risk​
  • High Cost of Maintaining Legacy Systems​

With multiple siloed legacy contract lifecycle management (CLM) systems, Molina encountered huge barriers when it came to accessing provider demographic information to use on agreements and transmit to downstream systems. Administrators had to duplicate efforts and manually re-enter existing demographic data into contracts because of a lack of connectivity.

As agreements were not centralized in one location but spread across multiple systems and locations, searching for trends, obligations, risk exposure clauses across agreements became extremely cumbersome, exposing Molina to business and regulatory compliance risk. Transparency continued to be an issue, as Molina had no ability to track frequently used language, and they had no visibility into different risk language that might have been negotiated.

Another major hurdle was maintaining consistency in approvals.   After authoring and negotiating a provider contract, health plan leaders and their teams would rely on their own judgement and manually route agreements for approval. This made governance and compliance requirements cumbersome to track and manage. 

Finally, the high cost of managing the legacy system, as well as time, were both major driving factors for looking for a new solution. It would take 35 to 40 days just to update and roll out a provider contract template. New templates would take as many as 60 days. Considering that Molina operates across 14 states, the number of templates requiring administration was significant. 

“That’s not moving at the speed of business,” said Donna Caldwell, Molina director of provider contracts. “It was a huge administrative burden, and it was slow to our users. That was a lot of work, and it was a very manual process.”

Solution

Enter: Conga CLM. 

With Conga’s contract management and lifecycle solutions, Molina was able to leverage capabilities they only dreamed were possible and realize benefits and outcomes that spoke directly to the challenges they found above.

With Conga CLM, Molina could add business terms and contract language that could be changed frequently and easily, without the massive administrative buden. Conga CLM provided Molina with a standard set of default state-specific legal language and terms, so the end user doesn’t have to click multiples times to manually copy relevant terms and generate a contract. Conga CLM auto-populates the state-specific accurate language, every single time.

Now, Molina has a single source of truth for their contracts. Each contract is built and stored within Conga, giving them a centralized enterprise-wide view to better identify business trends, obligations, and clauses exposing Molina to risk. 

Not only that, but Molina gained a lot of efficiency with Conga CLM. What once took 45 to 60 days to create one template now takes less than 2 weeks, and this includes testing functionality.

“This increased efficiency really helped us manage the busy open enrollment season for a better experience for providers and members,” Caldwell said.

Conga CLM is built on the Salesforce platform. Molina continues to harness the power of the Salesforce platform to manage tasks for internal and downstream teams, and capture key information in the form of metadata, which is then automatically transmitted to downstream systems like claims validation and payments systems.  

Conga CLM reduced risk of regulatory non-compliance, and Molina can take comfort knowing that legal language is accurate in each contract. Now, there’s no more manual keying of information between systems, and  Molina is starting to gain traction on the CLM maturity scale through monthly reports that provide visibility into CLM efficiency metrics and allow Molina to examine process bottlenecks for ongoing improvement. 

Business outcomes

  • Generation of contract templates up to 3 times faster
  • Achieved data integrity across systems, and claims validation and payment accuracy
  • Increased regulatory compliance and process governance 
  • Improved provider engagement experience and satisfaction scores

“The learning curve was pretty steep for us but moving to Conga really opened up the world and the possibilities. I knew what we should be able to do in managing our contracts, and I now know we actually can do it. That’s really exciting.

Donna Caldwell
Director Provider Contracts
Molina Healthcare

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