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Healthcare organizations must embrace change to meet the demands of new industry regulations, competitors and consumer expectations — and do so swiftly, with optimized effort and costs. Yet, large digital modernization projects often go over budget, beyond schedule and deliver fewer benefits than expected. On average, for every $1 billion invested in large digital projects, organizations waste $166 million. In our analysis, a major reason why projects go over budget and under deliver is the lack of line of sight from strategy to execution. The obscured vision results in the following:

  • Employees and vendors work with little comprehension of how their projects support broader objectives, so they generally do the minimum required.
  • Teams often set inappropriate priorities and miss opportunities to add value and proactively support the larger enterprise vision.
  • Project and operational leaders end up trying to manage resources and vendors instead of managing the process.

Adopting a business value realization (BVR) methodology changes this scenario. BVR holistically bridges the gap between strategy definition and program execution to ensure project-specific activities and day-to-day operations map to business priorities for maximum return. It combines C-suite strategic thinking, domain expertise and specific functional expertise. It then goes beyond the typical project management office (PMO) approach to status, issue, risk and budget management to ensure projects deliver expected benefits while containing their costs.

How it works

BVR is built on four key tenets to ensure that value is identified, managed and realized as a program is envisioned and operationalized.

  • Objective point of view. For optimal results, provide for independent assessments of all the pros and cons of key decisions and manage enterprise priorities among clients, vendors and implementation partners.
  • Smart program management. Encompass strategic thinking, extensive healthcare experience and operational expertise to help incorporate value management into all aspects of the program.
  • Data-driven decisions. Use real-time data and metrics to continuously measure project progress against program goals and value realization.
  • Dynamic program improvement. Employ functional expertise to rapidly diagnose risks and issues at all stages that could challenge value realization and provide immediate course corrections based on best practices. The BVR team helps align internal and external stakeholders to that ensure program strategic goals are accomplished.

A strong BVR governance structure is also vital to validating the impact of data on project objectives and priorities and measuring the value achieved. The structure helps translate strategic directives into tangible goals and actions. This governance model, along with BVR dashboards, templates and processes, helps data and results from operations and development teams percolate upward so executive teams and business leaders understand the effects of their decisions and where additional guidance is necessary.

By tracking these metrics, an organization has the data it needs for strong decision-making in alignment with project timelines and objectives. When an organization needs to prioritize capabilities during the initiative, BVR dashboards can provide the data to show which activity has the greater ROI and can be delivered in the required timeframe. Decision-making becomes objective and data-driven, and the impact of those decisions is made clear.



BVR in the real world

The following examples drawn from our client work highlight three of the essential ways in which BVR delivers ROI during transformation projects.

  • Aligning operations activities to executive leadership vision.

A large payer client tried for nearly two years to modernize a legacy claims system to improve user experience and stakeholder relations. The executive team had identified specific target metrics, including a 2% increase in the auto-adjudication rate, a 10% increase in operational efficiency and a 15% reduction in total cost of ownership for IT operations. While these objectives were clear, development and operations teams faced competing deadlines. Most decisions about which activities to prioritize were also ad hoc rather than aligned with the project business case and program roadmap. 

Our team measured the legacy system performance to provide clear evidence to the client teams of the gaps between the current state and management’s targets. Then, we collaborated with the client teams about how to achieve those targets. It was critical to coordinate dependencies across workstreams, as each affected a different aspect of the healthcare claim lifecycle. 

For example, in the current state, the intake team was responsible only for the initial security and structural edits for claims transactions. In the future state, the intake team was responsible for additional checks to prevent bad claims from entering the core adjudication system. This required the intake team to work closely with product, member and provider workstreams to ensure they had the right data available to do all edit checks at the point of intake. The BVR team helped facilitate this collaboration and ensured that all dependencies were identified and addressed.


  • Correcting the course.

A large national payer client shifted a set of development work to a captive/internal group, expecting to realize substantial cost savings. However, executives did not consider the impact of this shift on quality or account for the time required to enable new teams to deliver with the same velocity. The external vendor teams were delivering story points in three weeks or less. The new captive teams, spread over several time zones and still coming up to speed, could not match that performance. The BVR dashboards that our team developed clearly captured this disparity. When senior executives questioned why the cost savings were below projections, the operations manager was armed with data clearly depicting where the issues were and how to mitigate them efficiently.

  • Driving new value from existing capabilities. 

Another important feature of BVR is continually reviewing data to reveal additional project-related opportunities to generate value. One of our durable medical equipment clients used its revenue cycle management solution to perform denials management. The metrics showed that denials were continuing to rise. On investigation, our team realized the client was not using all the data generated by the system to understand the root causes of denied claims. For example, the team identified that when a specific field was skipped on the form, a denial was triggered. As a mitigation, the team made the field mandatory, leading to substantially decreased denials, increased cash flow and reduced costs.


Within a program, BVR leads should be directly involved in all day-to-day leadership and management activities. They should provide independent, objective advice to client leaders for all key decisions. Some instances of this collaboration include creation of RFPs, vendor selection, budget planning/requests and executive readouts. On one of our BVR programs for a large-scale claims system implementation, the BVR team evolved into a trusted advisor for the client. We supported the client in making key program decisions, including but not limited to insourcing, outsourcing, vendor management, roadmap prioritization, go-to-market strategies and training programs.

Establishing a BVR program

Launching a successful BVR program that aids in developing, tracking and managing value requires key actions, processes and unique tools. BVR teams should include healthcare, business and technical expertise. The team must be clear about the organization’s business priorities and should be objective about which activities to prioritize; a third-party, BVR perspective can be invaluable here. The BVR team also must understand how to leverage employee engagement and resources to optimize ROI throughout a project. Here are potential steps the team should take:

  • Assess. Review the enterprise goals, current program portfolio and future roadmap. Identify the key value drivers and areas of opportunity and categorize the enterprise portfolio into in-flight, new and future programs.
  • Evaluate. Evaluate the different programs to determine the optimal team structure, identify program goals and map business value. Capture all intended and unintended program benefits.
  • Operationalize. Implement the new value-driven approach, engage the right teams and measure, analyze and recalibrate value at every phase of the program engagement. Continue efforts by developing and implementing plans to sustain business value.

When incorporated at the outset of a project, BVR methods help map activities to strategy and gather data to quickly indicate whether initial priorities are successful or need to be refined to accomplish the desired outcome. When implemented midstream, BVR data can capture gaps between goals and current performance so problem areas and their causes become clear. Yet BVR is always more than tactical. It keeps a healthcare organization’s strategic vision in clear view for development and operations teams so they see the importance of their work to achieve a greater whole. In our experience, that leads to greater engagement, superior work and better outcomes for the organization and its stakeholders.

This article was written by Nikhil Sarathi, Vice President, Cognizant Consulting; Ruchi Mishra, Director, Cognizant Healthcare practice; Justin Amaker, Manager, Cognizant Healthcare practice; Jacqueline Zelener, Manager, Cognizant Healthcare practice.

To learn more, visit the Healthcare section of our website or contact us.