Provider Data & Network Database Rebuild.

Company Profile

PE-owned digital health marketplace. One of the largest patient-to-provider booking platforms in the country, connecting millions of patients with providers each year. Internal data operations covering provider onboarding, plan attribution, and the insurance database that sits underneath every booking on the platform, supported by a long-tenured offshore Data Operations team.

The Challenge

The marketplace had grown into one of the largest patient-to-provider booking platforms in the country, but underneath the consumer experience the provider-network database had been stitched together over a decade of growth. Providers were attributed to “health plans” in a flat layer that mixed parent companies, subsidiaries, lines of business, and individual benefits plans together.

New provider customers were complaining that onboarding was confusing and manual. Patients were occasionally booking visits believing their plan was in-network when the specific benefits plan was not. The growth team had a top-line problem disguised as a data-architecture problem.

• No real hierarchy. A flat plan list collapsed parent organizations, subsidiaries, lines of business, and benefits plans into a single layer.
• A commercial-LOB blind spot. Public sources (CMS, HealthCare.gov, state exchanges) covered MA, Medicaid, and ACA. Commercial plans had no equivalent feed.
• Manual maintenance running against organic database growth. The offshore Data Operations team was carrying the database forward on hand-tuned judgment as it grew faster than headcount could match.

The 12-Week Engagement

3PS scoped a twelve-week engagement to rebuild the database schematic from the ground up, integrate the Aequalis Payer Insights Platform as the source of truth for public LOBs, partner with a national claims clearinghouse to close the commercial-LOB gap, and lay the foundation for an AI-powered intake and refresh layer the existing data operations team (including the offshore Data Operations partner) would run going forward.

Weeks 1–3: Diagnose

The diagnostic mapped how the database had grown organically, where the hierarchy had collapsed, and what providers and patients were actually seeing as a result.

Database archaeology read every table, every attribution path, every join between provider records and plan records. Hierarchy mapping compared the existing flat structure against the real-world payer hierarchy: parent organization → subsidiary → line of business → benefits plan → network. Source-of-truth audit identified what was publicly available (MA, Medicaid, ACA via CMS and state exchanges) versus what was not (commercial, which lives in carrier-specific contracts and claims data).

Customer-complaint synthesis pulled common recent provider complaints about onboarding friction and mapped each one back to specific database structural issues. A working session with the offshore Data Operations team documented their workflow, their pain points, and where AI augmentation could reduce repetitive work without displacing the team.

The diagnostic delivered a documented attribution map, a proposed five-tier hierarchy with a migration plan, a quantified view of the commercial-LOB gap, and a partnership thesis for closing it.

Weeks 4–10: Build

The build phase ran two parallel tracks: the schematic redesign owned by engineering and data leadership, and the integration layer that 3PS built in partnership with Product, Operations, and the offshore Data Operations team. Each piece had to land without breaking the live marketplace.

Schematic redesign and migration. Built the five-tier hierarchy. Migrated historical provider attributions into the new structure. Ran reconciliation reports against the old structure to confirm no provider records were lost.

Aequalis Payer Insights Platform integration. Wired in the Platform’s rolled-up repository of every MA, Medicaid, and individual exchange plan in the country, organized by parent company and state. The public-LOB layer now mirrors the live state of MA, Medicaid, and ACA plans nationally, refreshed on each LOB’s natural cadence.

Claims clearinghouse partnership. Stood up a data-sharing relationship with a national claims clearinghouse to close the commercial-LOB visibility gap. Translates claims signal into the marketplace’s commercial-LOB layer, identifying which commercial benefits plans are active by region, carrier, and provider. Refreshed monthly.

Refresh cadence design. Built quarterly refresh workflows aligned to how each LOB actually updates: MA at start of plan year, ACA at start of plan year, Medicaid quarterly, commercial monthly off the clearinghouse feed. Data ops reviews and approves each cycle’s refresh package before commit.

Through the build, the offshore Data Operations team’s role was re-scoped around reviewing refresh outputs, handling exceptions, and owning the quarterly QA pass. The team moved from full manual maintenance to high-judgment work the agents could not do.

Weeks 11–12+: Transition and Operate

The system handed to Product, Operations, Engineering, Data, and the offshore Data Operations partner. Quarterly refresh cadence runs on natural rhythms tied to how each LOB actually updates. Data leadership signs off on hierarchy structural changes from the prior cycle.

Results

Functional Areas Touched

The engagement created downstream impact across the product, operations, and data sides of the business. The map below shows a typical digital-marketplace operating structure. Highlighted nodes are where this engagement created downstream impact.