Hi,

I attached the template and recourses as well,

please use the instructor provided template

2

To:

ADD names Comment by Rose, Sharon K.: Use down arrow to expand all comments below.
APA format reminders
Write in Third Person
Do not ask questions
Text with quotes require page or paragraph # in Citation.
Comment by Rose, Sharon K.: Use down arrow to expand all comments below.
Remove all comments in paper before submitting to earn a better grade. One way to do this, right click on each comment, select ‘Delete Comment’.
Replace Latin text with your writing for this assignment. Enter your content where the Latin text appears.
All Papers will be checked using SafeAssign. Please focus on keeping the SafeAssign percentage to approximately 20%.
Comment by James Manning:
From: ADD name
Date: ADD date
Subject: ADD title
Introduction Comment by James Manning: The Introduction is a short overview of your memo.
The CIO asked you to read Connelly (2016) to think about what resources you’ll need to get your new information system up and running. Please also review the five case studies in (Basu 2015, p. 32-35) so you can recommend a change management pattern for your company to follow.
Comment by James Manning:

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum et nisl ante. Etiam pulvinar fringilla ipsum facilisis efficitur. Maecenas volutpat risus dignissim dui euismod auctor. Nulla facilisi. Mauris euismod tellus malesuada dolor egestas, ac vulputate odio suscipit.

Sed pellentesque sagittis diam, sit amet faucibus diam lobortis quis. Sed mattis turpis ligula, in accumsan ante pellentesque eu. Quisque ut nisl leo. Nullam ipsum odio, eleifend non orcinon, volutpat sollicitudin lacus (Cuddy, 2002).

Implementation of Proposed Information System Comment by Rose, Sharon K.: How much of the implementation work are you able to handle? What additional resources (people, information, time, money, etc.) will expedite the process so you don’t end up like Susie Jeffer
Comment by Rose, Sharon K.: To earn an ‘A’ in this section you must (From Grading Rubric):
Described professional strengths and limitations
Identified additional resources needed based on limitations, described how process will be expedited
Provided thorough understanding of the case study and applied lessons learned to the information system

Donec tincidunt ligula eget sollicitudin vehicula. Proin pharetra tellus id lectus mollis sollicitudin. Etiam auctor ligula a nulla posuere, consequat feugiat ex lobortis. Duis eu cursus arcu, congue luctus turpis. Sed dapibus turpis ac diam viverra consectetur.

Aliquam placerat molestie eros vel posuere.

This Photo

by Unknown Author is licensed under

CC BY-SA

Figure 1. Title (Source:

www.source-of-graphic.edu

) Comment by Rose, Sharon K.: Include source if applicable, remove when diagram is original)

Project Risks and Scope Creep Comment by Rose, Sharon K.: To earn an ‘A’ in this section you must (From Grading Rubric):
Identified project risks and scope creep, offered advice on mitigating both

Sed facilisis, lacus vel accumsan convallis, massa est ullamcorper mauris, quis feugiat eros ligula eget est. Vivamus nunc turpis, lobortis et magna a, convallis aliquam diam. Lorem ipsum dolor sit amet, consectetur adipiscing elit.

Figure 2. Title (Source of data citation) Comment by Rose, Sharon K.: Include source if applicable, remove when diagram is original)

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum et nisl ante. Etiam pulvinar fringilla ipsum facilisis efficitur. Maecenas volutpat risus dignissim dui euismod auctor. Nulla facilisi. Mauris euismod tellus malesuada dolor egestas, ac vulputate odio suscipit.

Change Management Strategy Comment by Rose, Sharon K.: Outline a change management strategy:
What new equipment and software are necessary?
What training and support will the staff need? How will the staff complete their work during the transition period?
Are there other areas of resistance that you anticipate? 
Comment by Rose, Sharon K.: Explained why new hardware and software are needed
Proposed staff training
Explained how staff would continue work during transition
Anticipated areas of resistance
Comment by Rose, Sharon K.: Connected need for change management to business needs
Organized structure for staff training on implementation strategy
Recommended approaches to address resistance

Donec tincidunt ligula eget sollicitudin vehicula. Proin pharetra tellus id lectus mollis sollicitudin. Etiam auctor ligula a nulla posuere, consequat feugiat ex lobortis. Duis eu cursus arcu, congue luctus turpis. Sed dapibus turpis ac diam viverra consectetur.

Evidence of Feasibility Comment by Rose, Sharon K.: The CIO is very skeptical, so offer evidence that your assessment is accurate and complete. It can be difficult to admit to personal limitations! Comment by Rose, Sharon K.: Evaluated alternative assessments
Explained why alternative assessments are not as accurate or complete

Provided evidence that the assessment is accurate and complete
Comment by Rose, Sharon K.: Proposed how to mitigate personal and team limitations
Proposed considerations that would interest other members of the C-suite

Sed facilisis, lacus vel accumsan convallis, massa est ullamcorper mauris, quis feugiat eros ligula eget est. Vivamus nunc turpis, lobortis et magna a, convallis aliquam diam. Lorem ipsum dolor sit amet, consectetur adipiscing elit.

References

Basu, K. K. (2015). The Leader’s Role in Managing Change: Five Cases of Technology-Enabled Business Transformation. Global Business & Organizational Excellence, 34(3), 28-42. doi:10.1002/joe.21602.

Connelly, B., Dalton, T., Murphy, D., Rosales, D., Sudlow, D., & Havelka, D. (2016). Too Much of a Good Thing: User Leadership at TPAC. Information Systems Education Journal, 14(2), 34-42.

Rouse, M. (2018). Changed Block Tracking. Retrieved from Techtarget Network: https://searchvmware.techtarget.com/definition/Changed-Block-Tracking-CBT

Change the Chart Title to Fit Your Needs

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CIS 500 – Information Systems for Decision-Making

© 2018 Strayer University. All Rights Reserved. This document contains Strayer University Confidential and Proprietary information
and may not be copied, further distributed, or otherwise disclosed in whole or in part, without the expressed written permission of
Strayer University.

CIS 500 FACULTY GUIDE 1182 (12-04-2017) Page 1 of 1

Case Study 1: Transforming the Organization

Due Week 5 and worth 175 points

Congratulations! The executives are taking your information system proposal seriously. In fact, they think
it has the potential to transform the way the organization works.

The CIO asked you to read Connelly (2016) to think about what resources you’ll need to get your new
information system up and running. Please also review the five case studies in (Basu 2015, p. 32-35) so
you can recommend a change management pattern for your company to follow.

Write a memo to the CIO that describes how to implement your information system into the organization.
Please focus on these topics:

1. How much of the implementation work can you handle? What additional resources (people,

information, time, money, etc.) will expedite the process so you don’t end up like Susie Jeffer?

2. Outline a change management strategy: What new equipment and software are necessary? What

training and support will the staff need? How will the staff complete their work during the transition

period? Do you anticipate other areas of resistance?

3. The CIO is very skeptical, so provide evidence that your assessment is accurate and complete. It

can be difficult to admit to personal limitations!

Your memo should be 3–5 pages long.

References:
Basu, K. K. (2015). The Leader’s Role in Managing Change: Five Cases of Technology-Enabled

Business Transformation. Global Business & Organizational Excellence, 34(3), 28-42.
doi:10.1002/joe.21602.

Connelly, B., Dalton, T., Murphy, D., Rosales, D., Sudlow, D., & Havelka, D. (2016). Too Much of a Good
Thing: User Leadership at TPAC. Information Systems Education Journal, 14(2), 34-42.

https://files.eric.ed.gov/fulltext/EJ1136256

http://libdatab.strayer.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=101113779&site=eds-live&scope=site

Information Systems Education Journal (ISEDJ) 14 (2)

ISSN: 1545-679X March 2016

©2016 ISCAP (Information Systems and Computing Academic Professionals) Page 34
http://www.isedj.org; http://iscap.info

Teaching Case

Too Much of a Good Thing:

User Leadership at TPAC

Brett Connelly

connelbe@miamioh.edu

Tashia Dalton
daltontm@miamioh.edu

Derrick Murphy

murphyd1@miamioh.edu

Daniel Rosales

rosaledh@miamioh.edu

Daniel Sudlow
sudlowdj@miamioh.edu

Douglas Havelka

douglas.havelka@miamioh.edu

Information Systems & Analytics
Miami University

Oxford, Ohio, 45255, USA

Abstract

TPAC is a small third party health claims business that was seeking avenues for revenue growth and
opportunities to increase efficiency. One course of action that management selected to achieve these
goals was a change in the software application used to process claims. The new application was

adopted to increase the speed and accuracy of claims processing. Given the enthusiastic motivation of
the claims department manager, Susie Jeffer, and the importance of the new application to the Claims

department; Susie was selected to lead the project. The case details the challenges the organization
faced by selecting a leader for this critical project that had no project leadership experience or IT
background. The implications of this decision on the business operations are presented and then
solutions to the situation are explored. This case is targeted for an MBA IT management or strategy
course; but could be used in an introductory course, a systems development course, or a senior-level

undergraduate IS/T capstone course.

Keywords: teaching case, systems selection, project management, leadership

http://www.isedj.org/

mailto:connelbe@miamioh.edu

mailto:daltontm@miamioh.edu

mailto:murphyd1@miamioh.edu

mailto:rosaledh@miamioh.edu

mailto:sudlowdj@miamioh.edu

mailto:douglas.havelka@miamioh.edu

Information Systems Education Journal (ISEDJ) 14 (2)
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1. INTRODUCTION

It was a Monday morning in late October, a chill

wind was in the air. Susie Jeffer leaned back in
her chair, reflecting that her over-priced Chai
tea latte and dry scone were not going to be
enough to get her through the difficult meeting
scheduled in the next hour with the company
president.

Recently hired as a claims manager, Susie Jeffer
had joined TPAC after 15 years in the healthcare
industry. TPAC is a small third party health
claims business located in El Paso, Texas. The
company recently hired a new President with

over 20 years’ experience from a large third

party health claims competitor and was planning
to grow the business. To facilitate this growth, a
review of the IT (information technology)
infrastructure had been performed and a
recommendation made to update the claims
processing software application to lower costs
which would allow TPAC to compete with its

larger competitors and attract new customers.

The previous claims processing system did not
have necessary capabilities to meet client needs.
TPAC had become known for its flexibility in
customizing benefit plan designs to help clients
provide their employees an affordable benefit

package that fit within the company’s budget.

The previous system did not have the ability to
auto adjudicate claims without manual
intervention. Auto-adjudication is the ability to
approve (or deny) a claim based on the facts of

the claim and the benefits plan, without needing
a human to validate it. Being a small company,
it was difficult for TPAC to expand business
without a claims system that could auto
adjudicate claims. The primary benefit of having
a system that requires less manual intervention
is to allow the Benefit Administrators (claims

processors) the ability to focus on clients’ higher
value needs; such as reports, claim
adjustments, phone calls and other necessary
tasks. The current system was restricting

TPAC’s potential to capture a larger market.

From Jeffer’s perspective, she had done her level

best to implement the President’s new vision for
TPAC. It had taken great courage volunteering
to take responsibility for the implementation of
the new IT system without any prior background
in IT. Further, she had been the sole TPAC
associate to receive the training on the new

system! Further still, the training had only
lasted two weeks – she was doing her best with

what she’d been given. As far as she was
concerned, her best had been stellar.

However, Jeffer was still fuming over senior
management’s recent criticism concerning the
lack of programming she had put into the new
system. If more capabilities were to be wrung
out of the system, she would need a team to
implement additional upgrades.

Jeffer’s upcoming meeting with company
president Sandy Davis had her worried, since
Davis had become critical of Jeffer’s handling of
the implementation. Davis unabashedly voiced
the opinion that TPAC now found itself back in

the same spot they had been with the old

system: it needed manual intervention, it was
error prone, and it slowed claims turnaround. As
she sipped at her Chai tea, Jeffer contemplated
the long hours of work ahead. How will her
employees adapt? Will her customers see a
benefit? Or, will the company lose customers
rather than grow the business?

2. THE ROLE OF A TPA

The traditional value stream (Exhibit 1) within
the health care industry was for an employer to
find a health care insurance company like Blue
Cross, Anthem, or United Health Care to provide

health benefits, assume payment risk, and

process claims and payments for employees and
service providers. This value chain came at a
very expensive premium cost to the employer.
As health care costs continue to rise, employers
have been searching for ways to reduce the cost

of employee healthcare.

A recent change in the value stream (Exhibit 2)
in the administration of health care for
employees has been for the employer to assume
all payment risk as a self-insured company and
contract a Third Party Administrator (TPA) that

will handle the health claims and payments.

The TPA is neither the insurer nor the insured.
Their task is to handle the administration of an

agreed upon benefits plan that includes the
processing, adjudication, and negotiation of
claims. They also provide record keeping and

general maintenance of the plan. The only
difference in a TPA role versus a fully insured
carrier is the TPA doesn’t fund the payment of
the claims; rather, the payment of claims is
funded by the client.

The two main drivers for the use of third party
administrators is lowering health care costs and

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better plan design for company specific
employee demographics and needs. Savings are
significant because the company only pays for
the administration of actual claim costs versus

an insurance benefits’ offerings that may or may
not be used. Insurance company administration
of claims is also much higher than a specialized
TPA (whose focus is only on creating and
administering the plan).

The TPA’s have specialized software and

processes that allow for timely and less
expensive alternatives than the insurance
companies. Typical cost savings a company can
expect when moving from a fully insured plan to
a self-insured plan with a TPA can be seen in

Exhibit 3. An added benefit to the TPA business

model is that it shelters the company from any
concern of HIPAA (privacy) violations.

3. TPA PROCESSES

The claims system is programmed to process
claims according to the plan design. One of the

major benefits of being self-insured is that each
client (employer) can customize their healthcare
plan based on the needs of their company and
their budget. This means clients are not sold
“cookie cutter” plans that may include features
that are not needed or may not include features
that are very desirable. As each client’s plan is

designed uniquely for them, the claims

processing system needs to be a robust system
without plan setup limitations.

Every client has a different plan design which
includes items such as:

 Eligibility – Determines the requirements

of the employer regarding the number of
hours an employee must work to receive
benefits.

 Dependent Age.

 Timely Filing – Each employer

determines the length of time within
which a claim must be filed in order to

be considered for processing (standard 1
year).

 Plan Design – This includes deductible,
copays, and coinsurance

 Benefit Structure – this includes the
definition of services that are covered or
excluded and defines visit maximums on

necessary services (physical,

occupational, and speech therapy; and
chiropractic services).

The goal of the system is to auto-adjudicate as

many claims as possible, thus limiting the need
for manual intervention while maintaining the
quality guidelines. Auto-adjudication simply
involves checking each of the claims for required
information and restrictions and determining the
amounts to be paid.

Also, the system needs to be able to
accommodate any client’s “reasonable” request.
The more adaptive the system, the more able
the claims administrator is to retain clients and
increase future business. Providing quality

healthcare for employees is expensive;

therefore, employers need to rely on innovative
TPA companies to assist in cost containment
solutions.

4. NEW CLAIMS SOFTWARE APPLICATION

SELECTION PROCESS

As TPAC’s new president, Sandy Davis’ first
decision was to upgrade the IT infrastructure;
and specifically the claims processing
application. Davis convinced the board that a
new system was necessary to achieve revenue
growth and capture top-tier clients. A new
application would increase flexibility for creating

benefit plans and offer scalability allowing TPAC

to grow by capturing larger volume clients.

With the prior system, each claim was manually
processed by a Benefits Administrator. Since
there was no auto processing of claims, the old

system allowed room for more errors and
inconsistency. There were instances where
claims for the same procedure were handled
differently: one claim was entirely covered,
another partially covered, and a third denied.
Ultimately, this slowed the process of claims
processing and inflated the claims error

percentage.

Davis tasked the Executive Management Team
to narrow the choices for the new system. An

industry consultant was retained to assist the
Executive Management Team in exploring the
alternative software solutions that would

adequately fit their needs. Following weeks of
debate, the options for the new application had
been narrowed down to two: TreatFirst’s
Excaliber system and BigHealth’s Benefitica IT
suite.

The system finalists were very comparable.
They both met the requirements for benefit plan

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design flexibility and allowed for Consumer
Driven Service products to be linked to each
client rather than requiring a separate
application to administer Health Savings

Accounts, Flexible Spending Accounts, and
COBRA (COBRA is health insurance that must be
provided to employees when they are
terminated).

TreatFirst’s main disadvantage was that
Excaliber took more time to set-up each benefit

plan. However, this was mainly true because
the application allowed the benefit plan design to
be more detailed, thus increasing the accuracy
rate of claims processing as well as tightening
up measures to increase the auto adjudication

rate. With the Excaliber system, TPAC could

place more clients on the system without having
to hire more Benefits Administrators to handle
the additional work load.

On the other hand, BigHealth’s Benefitica
application was easier to use when building the
benefit plans. There was less coding to be done

which resulted in less time setting up a plan.
The Benefitica system still increased efficiencies
and also had a higher auto-adjudication rate.
However, the integrated details in TreatFirst’s
Excaliber were marketed as having a higher
accuracy rate.

The Executive Team invited the five Team Leads

from each department to test the applications.
After each lead was given a demonstration of
both systems’ capabilities, the Executive Team
interviewed them for feedback. Team Leads
cast their vote on which application they thought

would best deliver functionality and
performance.

Despite their desire to get broad-based input
from all of the departments that would be
affected by the new application, the voting was
rigged. Although each Team Lead had their

opportunity to vote, the voting wasn’t kept
confidential. Since the Executive Management
Team had already cast their votes, the decision
came down to the five Team Leads. Jeffer, the

Claims Lead made no qualms about her choice.
(Jeffer would have primary oversight of the
application, it is a claims application and she is

the claims manager.) She cajoled the four other
leads to vote for her choice. The persuasion
worked, as they felt pressured to vote for her
preferred system.

The voting over, Davis revealed that TPAC would

pursue Jeffer’s choice: the BigHealth system.
Feeling confident by her win and eager for a

promotion, Jeffer volunteered to take on the
configuration and implementation of the
Benefitica IT application. Seeing potential in
Jeffer, Davis tasked her with creating a roadmap

for configuration and implementation of the new
software.

5. TRAINING AND IMPLEMENTATION

The following week, Jeffer was on a plane to
New York to receive training at BigHealth’s

corporate office. She received training on all of
Benefitica’s functionality, as well as how to
configure the software to best fit TPAC’s
customized needs. Two weeks later, on the
plane ride back to El Paso, Jeffer quickly

sketched a roadmap for master data conversion,

training, and implementation of Benefitica IT.

Concerning an implementation plan, Jeffer
ranked the clients on a schedule based on their
size (A-D, A being largest, D being smallest),
and planned to convert the larger clients first
hoping to realize improvements in productivity

as quickly as possible. The conversion process
involved duplicating all the unique attributes for
each client’s Summary Plan Description into a
unique plan profile in Benefitica IT.

Jeffer was excited from her training and ready to
get started on data conversion. She began the

process of taking the Summary Plan Description,

the guidelines of each client’s plan, and
translating the data into Benefitica’s plan profile
manager. After working 70 hours the first week,
Jeffer’ enthusiasm quickly waned as she realized
the magnitude of the workload.

As the Claims department manager, Jeffer
oversaw 10 Benefit Administrators (BA). She
changed her conversion strategy, delegating the
benefit plan set-up and data entry load to the
BAs. Over the next week she scheduled several
lunch-and-learns to familiarize the BAs with this

additional responsibility.

Each BA was tasked with completing benefit plan
profiles for clients according to the client’s

personalized Summary Plan Description. As
each plan profile consisted of numerous
attributes and settings the data entry was time

consuming and prone to user error. The process
was rushed because the number of clients
assigned to each Benefits Administrator was
roughly 15 to 1, with daily work still needing to
be completed. As accuracy was vital, any
incorrect setups resulted in claims being

processed incorrectly.

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6. PROBLEMS ARISE

Problems started to arise when the first batch of
clients; i.e. Group A, the largest clients TPAC

had, went live on Benefitica. Each client
transferred to the new system without incident;
however, the process was so quick that there
was not enough time to iron out any issues
before the next client went live.

With the new claims processing system, the auto

adjudication rate was expected to increase to at
least 90%. When a claim is auto-adjudicated
through the system, the claim should be
processed and paid correctly with no errors. If a
claim doesn’t meet all the requirements to go

through the adjudication process, then it is

pended for manual intervention.

During the benefit plan set-up these tight
measures were not configured, which allowed
more claims to adjudicate through the system
and led to more errors. The industry accuracy
rate was 96%, a metric shared with every

prospective or current client. The increase in
errors meant an increase in manual intervention
for claims adjustment. It also resulted in
increased calls from members, clients, and
providers concerning incorrect claim processing.

Because of the extra errors and an already

heavy workload, the BAs grew agitated with

claims manager Susie Jeffer. Since the Benefits
Administrators had daily contact with the clients
and their employees, this required each BA to
take extra time out of the day to explain to
upset clients why there were errors.

This created friction internally from senior
management all the way through the company.
David, a Senior Benefits Administrator, could not
understand why after so much time and effort
there were so many issues and increased work.
The new claims application was presented to his

team as a change that would make their lives
easier. Instead, the team received an increased
work load which required more and more
overtime. When Susie approached David about

the amount of overtime the team was using,
David could not control his emotions. David
could not understand why Susie did not

comprehend the volume of errors and problems
with the new system. As David continued to
document the errors and issues, Susie did not
believe these errors were due to the new
application and denied that they were due to any
type of implementation error. She flatly stated

these were not system related errors. Instead
of reviewing the issue log, Susie ignored the

errors. Instead she continued to forge ahead
with the remaining client benefit plans. She was
adamant that her project plan would meet the
original deadlines.

Due to the deteriorating climate in the claims
department, the Director of Operations decided
it was time to take part in the weekly BA
meetings. She hoped to drill down to the
underlying problem and to understand what was
happening from the source. Although she quickly

realized the issue was related to the
implementation of the new application; she
added fuel to the fire by defending Susie. The
team was furious.

7. THE FALLOUT

The Director of Operations began “mentoring”
Susie to help fix issues, but glossed over the
gravity of the situation to Senior Leadership to
protect Susie’s job (and her own reputation as
well, she had been a supporter of Susie as a
promising manager). Although system

implementation was completed after nine
months, issues were still being addressed and
claim adjustment rates were at an all-time high.
This had ramifications throughout the entire
company. Phone calls for adjustments were
increasing, Account Management was receiving
requests for meetings by unsatisfied clients, and

the overall morale was very poor.

In spite of it all, TPAC managed to retain its
current clients and actually added new ones. As
the company grew, the need for additional IT
support was recognized and a new system

administrator was hired. Jeff, the new system
administrator, spent 6 months working with
Susie to learn the system. After that time, Jeff
was still not confident in her ability to manage,
maintain, and enhance the system’s
performance.

Jeff finally convinced the Director of Operations
to fund him for Benefitica training. He received
training for four weeks. From this, he realized
that there were many capabilities of the system

that were not being used. In fact, the way TPAC
was currently using the new application was not
an improvement from the old system. Website

functionality for employee self-service was not
being utilized to its full capacity to allow clients
to enroll employees online. This lack of
functionality was creating problems on the
eligibility side. While claims should be processed
at a 90% auto-adjudication rate with a 98%

accuracy rate, instead they were experiencing
rates under 50% with 60% accuracy; this was

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occurring primarily because the employee
enrollments were not accurate and up-to-date.

These circumstances and other considerations

led the Director of Operations to resign. A new
Director of Operations, Rita, was hired. Rita had
prior experience with another TPA and was very
familiar with the new claims processing
application. Her knowledge and expertise
appeared to be extremely valuable to TPAC.

She was shocked when she discovered the
issues TPAC was having with the software. She
could not believe TPAC was even surviving with
the way the system was functioning. She
immediately brought this knowledge to the

Senior Management team.

In addition, Rita tried to mentor and counsel
Susie. She “confronted” Susie with all of the
issues and her response (or lack of response) to
them. Despite all this, Susie remained confident
and felt she had not made any serious mistakes;
except selecting the wrong system.

Given Rita’s goal to make substantial
improvements in claims processing, specifically
improving the auto-adjudication and accuracy
rates, she worked directly with Jeff. Susie was
still on the project management team, but they
had tasked her with leading the BAs to improve

daily operations rather than any application

related tasks.

8. SEEKING SOLUTIONS

Rita was under pressure from leadership to

terminate Susie. Although unsure, Rita felt this
was a bit of scapegoating by upper
management. She thought they were looking for
someone to blame for the unsuccessful project
to alleviate some of the clients’ concerns. And

Susie did appear to be a bit clueless at this
point.

Rita didn’t feel as if she was in the role long

enough to make the decision to terminate Susie.
Rita contemplated how to handle the situation,
she decided to task Jeff to go back through each
client setup and do a thorough audit of each
plan to ensure they were setup accurately.

Rita spent the weekend in her office trying to

weigh all of her options. The busy season with
open enrollment was just around the corner and
a decision needed to be made Monday morning.
Some of the questions Rita pondered as she
prepared for the meeting with Susie on Monday

included the following questions:

 Should Susie be fired? Was she really a bad

employee or was she just put into a role that
wasn’t compatible for her?

 How could Rita justify this action to

leadership without letting Susie go? Should

she?

 At this point, Susie was still on the project
team and making changes to the software,
she was one of the only people in the
company with deeper knowledge of how the
software worked. Should Susie remain on

the project? Should she be moved? What

role should have?

 Should Rita be concerned that there is a risk

to the company that Susie will sabotage
other areas of the company out of spite and

anger? What should she do to mitigate this
risk?

Editor’s Note:

This paper was selected for inclusion in the journal as the EDSIGCon 2015 Best Case. The
acceptance rate is typically 10% for this category of cases based on blind reviews from six or more

peers.

http://www.isedj.org/

Information Systems Education Journal (ISEDJ) 14 (2)
ISSN: 1545-679X March 2016

©2016 ISCAP (Information Systems and Computing Academic Professionals) Page 40
http://www.isedj.org; http://iscap.info

Exhibit 1 – Traditional Value Stream

Employee Doctor Doctor
Health
Care

Insurance

Employer

Medical

Claim

Payment
Payment

Claim

Makes Insurance Premium Payments

(Insurance makes payments to Health care provider)

http://www.isedj.org/

Information Systems Education Journal (ISEDJ) 14 (2)
ISSN: 1545-679X March 2016

©2016 ISCAP (Information Systems and Computing Academic Professionals) Page 41
http://www.isedj.org; http://iscap.info

Exhibit 2 – New Value Stream: TPA replacing Health Care Insurance

Employee Doctor Doctor
Third Party

Administrator

Employer

Medical
Claim

Payment
Payment
Claim

Employer Pays TPA for claims administration

(Employers makes payments to Health care provider)

http://www.isedj.org/

Information Systems Education Journal (ISEDJ) 14 (2)
ISSN: 1545-679X March 2016

©2016 ISCAP (Information Systems and Computing Academic Professionals) Page 42
http://www.isedj.org; http://iscap.info

Exhibit 3 – Potential savings with a TPA

http://www.isedj.org/