Issued January 9, 2024 — Day 100 post-close (October 2, 2023 + 100 calendar days). This is the first major checkpoint after cutover. The program assesses operational stability, migration progress, and readiness for continued TSA exit. The decision here is whether to maintain the TSA wind-down schedule or escalate needs.
Operational Stability Checkpoint & TSA Exit Readiness Review
Contents
1. Summary & Overall Status
At Day 100, the integration program has achieved operational stability on all critical systems. Member-facing services (enrollment, claims processing, provider network) are processing transactions reliably and at planned volumes. Data quality issues identified at cutover have been isolated and are being worked in parallel with operational wind-down.
Overall assessment: ON TRACK. The program is meeting its Day 100 checkpoint objectives. No critical blockers to TSA exit are present. The program remains on schedule for target TSA exit on September 30, 2024 (planned 12-month wind-down; maximum 18 months per the TSA agreement).
Key milestone completed: Parallel operations (running both legacy and integrated systems simultaneously) concluded on Day 30, November 1, 2023, as scheduled. All production traffic shifted fully to the integrated platform on Day 31, November 2, 2023, as scheduled. No reverting to legacy systems has been required.
2. Operational Performance Metrics
| Metric | Target | Day 100 Actual | Status |
|---|---|---|---|
| Claims adjudication uptime | 99.5% | 99.7% | ✓ Exceeds |
| Enrollment processing SLA (24-hour) | 95% | 96.2% | ✓ Exceeds |
| Member support response time (Tier 1) | <2 hours | 1.8 hours avg | ✓ Meets |
| Provider network file accuracy | 99%+ | 99.4% | ✓ Exceeds |
| Internal duplicate detection (post-merge) | <0.1% of records | 0.08% | ✓ Exceeds |
| Deterministic merge audit — challenges upheld | <0.5% of sampled merges | 0.3% | ✓ Meets |
All six critical operational metrics are meeting or exceeding targets. This indicates the platform is performing reliably and the integration is stable.
3. Migration & Integration Progress
Wave 1 Completion (Schedule Day 1–30): All member data (1.8M ACME + 420K CVHP), claims history (in-flight and closed), and provider network records were migrated during the cutover window and parallel testing phase. Deterministic and probabilistic EMPI matching completed; clerical review band populated and steward team began work.
Interim Systems (TSA-Provided): Three interim systems remain active and operating under the TSA agreement: host claims processing, EDI translation (inbound and outbound), and claims-attachment storage. These are scheduled to retire as the integrated platform scales to handle all volume. Current status:
- Host claims processing: Receiving 3–5% of volume as fallback for edge cases. Planned retirement: planned for April 30, 2024, after platform hardening.
- EDI translation: Dual-running with integrated layer. No issues. Can retire after a 30-day period with zero errors from integrated translation (currently tracking toward target).
- Claims attachments: Successfully transitioned to archive storage; no access issues. Retirement scheduled for Q3 2024, planned, as part of final TSA wind-down.
Knowledge Transfer (Reverse Shadowing): TSA provider staff shadowed ACME operations staff on critical procedures (cutover management, incident response, backup/restore, month-end close) from Day 1 through Day 60. Knowledge transfer complete and documented. No outstanding knowledge gaps identified.
On the reverse-shadowing methodology: This phase involved ACME staff performing critical operations while TSA staff observed and asked questions, rather than the more conventional approach of the outgoing provider demonstrating to the incoming team. This inverted model forces the new organization to learn by doing (with a safety net) and surfaces knowledge gaps that the conventional model would hide. As a result, ACME staff have demonstrable competence, not just observed familiarity.
4. Known Issues & Mitigation
Issue 1: EMPI Review Population Still Unquantified — The deterministic pass ran at cutover and its merges are in production. Everything below that bar is held as separate records carrying duplicate-candidate flags, which is operationally safe — claims pay correctly against each record and no member is missing — but it means the size of the clerical review population is still the deal-model estimate of 8%, unmeasured. Full profiling across the combined estate is scheduled as the next substantive data activity once reference data stabilizes and the warehouse load completes. Until it runs, the steward capacity plan rests on a number nobody has verified.
This is the program's largest open exposure at Day 100, and it does not look like one. Every operational indicator on this page is green, and they are green honestly — the platform is stable and members are being served. But identity resolution is the one workstream whose scope is not yet known, and the reason it is not known is structural rather than negligent: the profiling could not lawfully run before close and could not usefully run until the platform settled. A reader scanning §2 would conclude the integration is essentially finished. It is not. It is finished in every dimension that was measurable at Day 1 and unmeasured in the one that determines when the TSA can actually be exited. That asymmetry is why this item is carried as a risk register entry rather than an operations note.
Issue 2: Legacy Data Quality Anomalies — Post-cutover data quality analysis revealed three classes of anomalies in the legacy data: (a) duplicate SSN assignments within the Cumberland Valley file (affecting ~1,200 records), (b) conflicting DOBs in claims vs. enrollment (affecting ~800 records), and (c) address records with incomplete zip codes (affecting ~3,000 records). None of these block operations; they are being resolved in parallel via targeted steward review and data corrections. Root cause: the legacy systems accepted data that the integrated platform's validation rules reject. Mitigation: all three issues are tracked in the RAIDD and are scheduled for resolution by end of Q2 2024. Status: UNDER CONTROL.
Issue 3: Member ID Reissuance Communications — The program issued new member ID cards to all members post-close as part of the integration (to reflect the single identity across the merged organization). However, a subset of members (estimated 8,000–12,000) did not receive their cards within the planned 30-day distribution window. Root cause: postal delivery delays and address validation gaps in the file. Mitigation: second mailing wave was executed; targeted outreach to members without cards is underway via phone and email. No service disruption; existing member IDs remain valid for claims processing. Status: RESOLVING (expect 98%+ delivery by end of Q1 2024).
5. TSA Exit Plan Status & Next Gates
The TSA runs twelve months from close against a contractual maximum of eighteen. The program's planned exit remains September 30, 2024, with a planned outer limit of March 31, 2025. The following milestones must be met to stay on that schedule:
| Gate | Target Date | Status | Owner |
|---|---|---|---|
| Host claims processing retirement | April 30, 2024 (planned) | On track | W. Ferriday (Core Admin) |
| EDI translation cutover (integrated only) | May 31, 2024 (planned) | On track | W. Ferriday |
| Full EMPI profiling run and review queue sized | Planned Q2 2024 | Not started | Dr. A. Ravindran (Data & EMPI) |
| EMPI clerical review completion | Cannot be committed until profiling completes | Undated | Dr. A. Ravindran (Data & EMPI) |
| TSA final procedures rehearsal | Planned, one month before exit | Not yet dated | C. Tyrrell (Program Manager) |
| TSA exit approval (Steering Committee) | September 20, 2024 (planned) | Scheduled | D. Ashmore (Sponsor) |
| Target TSA exit date | September 30, 2024 (planned) | On track | G. Threadgill (TSA Provider) |
The planned exit date is intact, but it is not yet defensible. Every gate that can be evidenced at Day 100 is on track, and the operational picture supports the 12-month exit. What the program cannot say is that no factor exists which would require extension — because the one workstream capable of forcing it has not been measured. If profiling returns a review population near the assumed 8%, the September date holds comfortably. If it returns materially wider, the gap lands on the critical path with no lever except time, since offshore support is barred by the DOI condition, steward throughput cannot be raised without manufacturing false merges, and hiring runs weeks. An extension is a negotiation with the divesting parent, not a scheduling adjustment, so it needs roughly six weeks of lead time before the exit date to be actionable at all — which means profiling results have to be in hand, and their consequences understood, well before the summer.
Where this is next tested: the exposure in §4 is carried in the risk register and reviewed on the standing monthly Steering cycle rather than at a special gate. The decisive input is the profiling run itself: until it returns, no review can do more than restate that the number is unknown. The first Steering meeting after those results is the one that matters, and it is the meeting at which the September exit date is either confirmed or escalated.
Related artifacts: 22 — TSA Schedule & Exit Plan · 23 — Data Migration & EMPI Results · 41 — Synergy Realization Tracker · 30 — Day 1 Go/No-Go Decision