Improving Quality and Productivity through BA/QA Integration

A diversified, top 5 U.S. health insurance provider, which began selling health insurance in the 19th century and today has 46 million members, has utilized emids for BA and QA services as they have had to shift focus in recent years.


The company developed population health applications for members, nurses and physicians to help engage and monitor patients as a means to take a proactive role in the health of its members, reduce the cost of care and improve outcomes. The mobile apps enable patients to track their own progress against health goals while giving caregivers easy tools to manage individual treatment plans and follow up with patients. So far, these applications are monitoring 64 million patients and resulting in some impressive improvements: savings of $1,856 per nurse-engaged member per year and a 6.1 percent reduction in highly impactable admissions for disease management participants. The company has for many years contracted with an offshore vendor in India to support product development. To reduce risk and improve quality and time to market, the subsidiary’s CIO brought on board a second offshore provider, also located in India, in 2014. Coordination between the client and multiple vendors proved to be challenging.


The CIO initially opted to split product development responsibilities between the two vendors with the original vendor doing development and emids providing BA and QA services. Instead of having three separate groups to coordinate, emids suggested integrating BA and QA roles to streamline development, co-locate two critical roles and, ultimately, improve the company’s Agile development practice.

Proof of Success

Implementing the new model for development went smoothly, given a few key variables: development of a detailed transition plan and the assignment of a transition manager who was an effective mediator between the India teams and the company in the United States. The transition manager also facilitated knowledge transfer between the vendors and instituted governance processes, including daily and weekly updates to the transition team on progress and issues. The company discovered that BA/QA integration has improved facilitation between team members around the use cases, testing strategy and working within Agile and continuous development workflows. More importantly, the integrated team has been able to identify metrics that contribute to the overall quality of the product and which can be managed effectively by this integrated model. The BA/QA integration has also enabled the company to identify defects early in the process and remediate them much more inexpensively. There is now more contextual knowledge among the team members and they are able to propose ideas for improvement related to functionality, compliance and quality. Previously, teams worked in silos and did not understand the effects of their changes on other teams or the overall quality of the products.

  • Testing coverage: Increase from 28.5 test cases written per person, per release to 310
  • Test automation: From zero automation to 79% automation of test scripts resulting in 60% effort savings across three applications
  • Defects leakage: Decrease in percentage of defects not caught before production from .67 percent to .23 percent
  • Severe defects: Decrease in the number of Sev1/Sev2 defects identified in production from 5 to 1 per release
  • User story quality: Increased the quality of user stories by 17%, as measured by client
  • Team productivity: Increased the productivity of teams by 25% Q-on-Q in 2015, as measured by number of test cases executed per release

In time, the teams expect these quality metrics to improve further as processes are refined. The new development model has also resulted in far better collaboration between groups which were previously operating in silos. Both of the offshore vendors participate in regular strategy discussions with the product leadership team at the company, providing critical feedback that influences key development decisions and keeps everyone on the same page.

Learn more about BA/QA integration in healthcare in the emids white paper.

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