HPSAI Transformation

WHPS AI Transformation · August 2026

The transformation is operating across products, platforms, and member service.

The current portfolio spans regulated enrollment, contact-center operations, reconciliation, and platform modernization. This is where value is operating, where delivery is moving, and where a leadership decision controls the next step.

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Current portfolio position Where value is operating, moving, waiting on decisions, and sequenced next.
  • 22 Initiatives in the transformation portfolio Member service · regulated delivery · modernization · operations
  • 2 Live or operational Operating capability with support still attached
  • 11 Active delivery Build, testing, remediation, or implementation moving now
  • 2 Decision-dependent Modernization direction and contact-center platform choice
  • 8 Queued Sequenced work kept visible without being called active

Position as of August 5, 2026. Categories overlap and do not sum to the total.

Executive portfolio view

What has landed. What is moving. What leadership must unlock.

Delivery, risk, and named decisions show where leadership intervention changes the outcome. Initiative detail carries the accountable next move and dependency.

Loading the latest reviewed portfolio position.

Loading the current portfolio position.

Statuses are dated. Categories overlap; selection does not imply priority or completion.

Initiative decision map

Connect every initiative to its outcome, blocking dependency, and evidence obligation.

Select an initiative to trace what is happening now, what controls its next move, and what must be proven before it advances. The map makes the intervention point explicit without assigning an invented priority.

Current position loading Latest reviewed update

Initiative decision map Loading current initiative positions

Outcome now blocking dependency evidence required.

Layer 01

Outcome now

—

Loading current initiative positions.

Layer 02

Blocking dependency

Named next constraint
Select an initiative

Its named dependency or decision will appear here.

Layer 03

Evidence required

Open obligations
Outcome + next move0/5
Accountability + control0/3
Evidence link0/1

Select an initiative to review its outcome, next move, dependency, and evidence boundary.

Statuses are dated; selection does not imply priority, maturity, or completion.

Review all initiative details →

The transformation in practice

Four proof points make the strategy tangible.

Lane 03 · Production operations

Contact Center AI

A business-case-reported operating stack and a documented human-controlled service architecture, with the next expansion choices carried in the governed register.

Operating Expansion in progress
Operating context
The January 2026 business case reports a late-2025 production stack, 3.6M interactions, and 99.99% uptime. Those figures are context, not independently validated product KPIs.
Claims expansion
CCAI Claims (PMO 3684) retains an end-of-August readiness position; Operations round-one testing opens a client and customer approval cycle forecast to exceed four weeks.
Platform decision
Benefits and Enrollment voice assist (PMO 2202) remains dependent on the Cisco WebEx or AWS call-centre platform direction.
Quality pipeline
VOC QA and transcription automation are in discovery with October 2026 targets; ET-log automation retains its named Verint dependency.
  • Now Complete Claims Operations testing round one and conclude the call-centre platform direction.
  • Next Open the Claims approval cycle; complete VOC and transcription discovery toward the October phase targets.
  • Risk held openly Approval duration, platform choice, Verint dependency, and the 48-hour ET-log KPI remain named constraints.
Open the dossier
Also delivered

ICHRA · ServiceLink Portal

ICHRA Phase 1 delivered inside the existing ServiceLink Portal — new regulated product capability shipped into a live platform rather than a parallel build.

Phase 1 delivered
Operational tools

The supporting cast

Smaller tools shipped along the way: an image-to-text converter now operational in document processing, a natural-language query tool for membership data in business testing, and a prior authorization MVP on the proof record.

Image-to-Text operationalSQL Talk in business UAT

Full initiative portfolio

Twenty-two initiatives. The next move is named for each.

The full portfolio as recorded August 5, 2026 — each initiative’s current standing, next action, and named dependency or decision. Risk remains visible because it identifies where leadership must intervene.

Measurement contract to approve

Define the proof before funding the next move.

These are proposed measures, not reported results. Approval would set an accountable owner, baseline and comparison window, source system, acceptance threshold, and review cadence for each product.

  1. 01

    MarketLink

    Proposed measure setVerified enrollment completion, evidence-package completeness, exception age, and time from CMS response to controlled disposition.

    Decision to set · product and compliance ownership
  2. 02

    Contact Center AI

    Proposed measure setFirst-contact resolution, transfer accuracy, after-call work time, quality-review pass rate, and unit cost by call type.

    Decision to set · operations and quality ownership
  3. 03

    GroupLink

    Proposed measure setClient-journey completion, processing error rate, IBM Change Data Capture parity, cutover exceptions, and time to resolve coexistence defects.

    Decision to set · product and data ownership
  4. 04

    ReconLink

    Proposed measure setAutomated match rate, unresolved exception age, reviewer effort per case, financial parity, and business-acceptance cycle time.

    Decision to set · business and reconciliation ownership
WHPS AI portfolio register · as of August 5, 2026
Initiative Domain Health Status & next action
AI Transformation & Platform ModernizationProgram Enterprise modernization strategy Active decision AWS proposal preview reviewed June 24; the formal proposal is the next decision input for approach, sequencing, and economics.
Broker / Agent PathwaysACA / EDE ACA platform and regulated enrollment Active Demo, security architecture, CMS/EDE evidence walkthrough, and traceability ready as the regulated delivery proof point.
GroupLink Portal ModernizationGroup Platform Group administration modernization Active Dual-track lane: modern guided experience in front, database / service / integration modernization behind it.
CCAI ClaimsPMO 3684 Claims contact center At risk Readiness holds for end of August; the approval cycle is forecast to exceed four weeks and is the schedule risk.
SQL Talk for KPPMO 3418 Membership data access On track In business testing with identified gaps being closed; release targeted for September 2026.
ReconLink Platform ModernizationPMO 2764 Reconciliation operations Active Recon Platform Modernization in testing, with a weekly Operations feedback loop tuning the model.
Recon BuddyPMO 2762 Recon inquiry assistant Active Phase 1 live; phase 2 in testing and defect correction with a tentative release date.
CCAI Voice Assist - Benefits & EnrollmentPMO 2202 Benefits and enrollment contact center Active decision Held pending the Cisco WebEx / AWS call centre platform decision.
CCAI Agent Assist ET Log CreationPMO 2022 After-call work automation At risk Design underway; Verint dependency, the 48-hour posting KPI, and log-quality controls are the named risks.
Contact Center VOC QA AI AgentPMO 3636/3938 Quality automation Active Discovery underway with VOC; phase delivery targeted for October 2026.
CCAI Transcription Audit AutomationPMO 3636 Transcription QA Active Off hold and into discovery with VOC; phase delivery targeted for October 2026.
MHC IVR Billing & Enrollment MigrationPMO 3912 IVR modernization Queued Sequenced behind CCAI Claims finalization and an Operations decision on the MHC IVR way forward.
CCAI - Group/Benefits & EnrollmentPMO 4014 Group platform voice AI Queued Awaiting discovery at priority 4; no target date, and a duplicate-PMO consolidation decision is outstanding.
Self-Service / BPaaS Call CenterIndividual and Group Future-state contact center strategy Queued Future-state direction and POC use cases in documentation with the Strategy Office.
Contact Center AI Phase 3Phase 3 Service intelligence expansion Queued Analytics, sentiment, and predictive assist — platform design discussions to be scheduled.
AI Seed Image-to-Text ConverterPMO 3013 Document processing Complete Operational; production support and defect remediation continue as reported by the business.
Call AnalyticsPMO pending Contact centre analytics Queued Carried from the 2024 CCAI plan; needs a business case and a PMO number before it can move.
Repeat Caller Indicator in Agent Screen PopPMO 4013 Contact centre agent experience Active Scope reset by Operations to a repeat-caller indicator instead of Finesse screen-pop content.
CCAI for Group and Legacy CarriersPMO 3953 Group and legacy carrier platforms Queued Needs discovery on portal and GroupLink integration; a duplicate-PMO consolidation decision is outstanding.
ERR CANCEL FRD AIPMO 3977 Operational efficiency Active Discovery and documentation underway to cut manual offshore handling of quadrant 1 CMS codes; November 2026 target is tentative.
HICS ClassificationPMO 2765 Reconciliation and classification Queued Sequenced behind Recon Platform Modernization; no movement this cycle.
ERnRPMO 2908 Reconciliation and classification Queued Sequenced behind Recon Platform Modernization; no movement this cycle.
Portfolio data and update tools
Open Portfolio Update Center Download current status template Download current register CSV Download current register JSON

Health legend: Live / complete   Active / on track   Decision or mixed   At risk / blocked   Queued / held

Leadership agenda

The next wave depends on three choices.

The portfolio is moving. These are the choices that determine how quickly operating proof becomes repeatable transformation capability.

01

Set the modernization direction.

Assess the formal AWS proposal against demonstrated capability, alternatives, sequencing, funding, and the target operating model.

02

Choose the contact-center platform path.

Resolve the Cisco WebEx or AWS direction so the Voice Assist scope and the next implementation wave can be finalized.

03

Require proof before scale.

Complete Operations testing, UAT, evidence capture, and approval gates before expansion or workload-retirement claims.

Architecture and evidence
Executive transformation sequence Download 32-slide PowerPoint