Millions in revenue unaccounted for 9+ months

For PDS, the ultimate vision was to have the ability to see – and trust – what was happening within their claims processing operations at any given moment. While tech teams have implemented observability at various levels of their tech stack, the team wanted a holistic view of the health of their systems and the impact of issues when they occurred. PDS wanted to eliminate surprises, reduce revenue leakage, and provide both business and IT teams with insights and confidence in the systems supporting critical operations.

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The long term vision is a platform where:

• Process breakdowns are caught automatically, not by chance.
• The right people are alerted early, with the right context to act quickly.
• Business leaders can self-serve key metrics without needing to pull in technical teams.
• Existing tools and technology investments like an enterprise data warehouse and platform monitoring capabilities work in concert instead of isolation.

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The primary goal of the Assess phase was to chart a path toward that vision while staying grounded in the realities of PDS’s current systems, constraints, and priorities. The Protagona team set out to:

• Understand the current and future state claims processing workflows across systems and teams
• Identify the technical and organizational gaps limiting visibility.
• Highlight high-impact opportunities to introduce observability.
• Create a shared future-state roadmap to guide next steps with confidence.

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Throughout discovery, we heard consistent themes from both business and IT stakeholders. While PDS teams had done a lot of work to implement certain observability solutions, there were a handful of pervasive challenges:

• Limited proactive alerting: Teams often didn’t realize something was broken until a vendor reported missing claims. In some cases, small issues could go undetected until they snowballed into a larger issue and were only discovered after revenue was lost.
• Highly manual investigation: When issues were detected, it fell on experienced managers or individual contributors to dig through reports, verify against schedules, and troubleshoot with IT – an effort that took a significant amount of time and distracted from other initiatives.
• Fragmented ownership and tooling: Issues might originate in Epic, in file transfers via MoveIt, or in downstream systems – but there was no central visibility to identify or resolve them.

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Teams were working hard but without a holistic view of the issues they were trying to solve.

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To tackle these challenges, we took a human-centered, cross-functional approach:

• Stakeholder Interviews: We met with leaders and SMEs across Revenue Cycle, Platform Engineering, IT Infrastructure, Data Management, and Product. These conversations surfaced both pain points and aspirations.
• Workflow Mapping: We reviewed the end-to-end claims lifecycle, highlighting common failure points and dependencies across systems and teams.
• Incident Review: We walked through past incidents to understand detection timelines, investigation effort, and gaps in tooling or process.
• Use Case Identification: We identified and prioritized specific observability use cases tied to measurable business outcomes—like detecting missed claims, validating processing volumes, and accelerating root cause analysis.
• Future-State Roadmap: We aligned stakeholders around a proposed observability framework that could evolve over time

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