Success
Stories
from the Healthcare
Industry
Problem:
Our client is a multi million member BlueCross BlueShield
Health Insurance Plan with multiple locations across the
state. The plan was dealing with low customer service
levels; high defect rates in Open Enrollment; claims resolution
issues; systems problems and had difficulty exchanging
information with their Providers. The challenge was to
quickly bring the Plan to an acceptable performance level
and then put the necessary systems in place to drive improvement
to best-in-class levels.
What We Did:
- Reengineered the Business Acquisition and Renewal
process. Utilized cellular processes and operations
management concepts to reduce non-value added activities,
effectively increasing transaction capacity, and quality.
As an interim measure, during the engagement, created
an “Open Enrollment Tiger Team,” consisting
of a mix of consultants and BlueCross BlueShield employees
dedicated to the success of Open Enrollment. The team’s
charter was to take any action necessary to ensure that
the large volume of enrollment transactions were accurately
processed on-time in spite of information systems and
process issues.
- Restructured the operations of the Provider Services
Division, with the objective of providing a single point
of contact and “one stop shopping” for doctors,
hospitals and specialists, while reducing hand-offs
within the Plan. This was accomplished by implementing
regional service cells supported by work flow and document
management systems, resulting in improved responsiveness
to Provider inquiries.
- Reengineered the Provider Data Entry Operation responsible
for processing insurance claims from doctors and hospitals.
Used process reengineering and flow manufacturing concepts
to reduce non-value added process steps, improve service
level and decrease the defect rate of the organization.
Also implemented operations management tools (forecasting,
inventory management, and capacity planning) to manage
volume variability and optimize capacity.
Impact:
- Increased Open Enrollment quality from 60+% to over
95% and avoided incurring performance penalties during
the engagement.
- Reduced Open Enrollment cycle time by 80+%, while
increasing transaction capacity by 50%.
- Reduced the time to resolve Provider issues from
weeks to hours.
- Increased Claims input accuracy from around 50% to
99%+.
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