Blue slate winning strategies for healthcare payers

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Blue slate winning strategies for healthcare payers

  1. 1. Winning Strategies How healthcare payers are using process, technology, and data solutions to get ahead Health IT Insight Summit Savannah, GA September 21, 2009 © Blue Slate Solutions 2009
  2. 2. About Blue Slate Solutions • Improve operations - optimize processes, I ti ti i connect disparate systems, introduce relevant Technology technologies, manage data • Clients include 2 of the top 3 and 4 of the top 20 health payers including 7 BCBS plans h lth i l di l Solutions • More than 80 healthcare-specific projects Process Data spanning more than 20 different healthcare entities, mostly private and government payers • Experience across the full spectrum of Project & Change healthcare payer functions and departments Management Liz G d Li Gaudet David Scholl • 20 years experience across • 20 years general three healthcare payers management and business prior to BSS leadership at GE • 30 projects involving 10+ • Certified Master Black Belt in payers over last 5 years Six Sigma (process quality) • Strategy focused MBA, • PM/BA on 9 workflow certified in Conflict automation programs within Resolution and Process healthcare payers h lth Mapping © Blue Slate Solutions 2009 1
  3. 3. Disruption and challenges facing payers • Political Obama administration and its ripple effect on all things healthcare has every constituent concerned and bracing for change – whatever that change may be • Economic Costs to deliver quality healthcare and costs to insure are all on the rise – exponentially • Social Demographic of US population is that more care will be needed in upcoming decades, not less • T h l i l Technological Introducing new systems into an aging infrastructure to meet g above challenges © Blue Slate Solutions 2009 2
  4. 4. Case Study 1 – Getting into the race At A Glance Our Client, a Government Fiscal Intermediary is in competitive bid to become a Problem Medicare Administrative Contractor (MAC). • Client estimated they needed >30% reduction in cost/claim while taking on 2X workload Solutions • Cost Driven Program Strategy • Prioritized program elements • Detailed requirements • Impactful solutions • Client self-sufficiency © Blue Slate Solutions 2009 3
  5. 5. Case Study 1 – Getting into the race At A Glance Our Client, a Government Fiscal Intermediary is in competitive bid to become a Medicare Administrative 1 Define the Strategy Contractor (MAC). Solutions • Become paperless • Cost Driven Program • Optimize Key Business Processes Strategy • Leverage legacy systems and technologies • Prioritized program elements • Joint ownership between IT and Business • Detailed requirements • Impactful solutions • Client self-sufficiency © Blue Slate Solutions 2009 4
  6. 6. Case Study 1 – Getting into the race At A Glance Our Client, a Government Fiscal Intermediary is in competitive bid to become a Medicare Administrative Contractor (MAC). Solutions • Cost Driven Program 2 Prioritize the Program Elements Strategy • Prioritized program • Used a Six Sigma approach (QFD) in planning elements • Focus on Centralized processes and paper- • Detailed requirements heavy processes • Impactful solutions • Client self-sufficiency • Implemented Governance at all levels © Blue Slate Solutions 2009 5
  7. 7. Case Study 1 – Getting into the race At A Glance Our Client, a Government Fiscal Intermediary is in competitive bid to become a Medicare Administrative Contractor (MAC). Solutions • Cost Driven Program Strategy • Prioritized program elements 3 Gather Detailed Requirements • Detailed requirements • Impactful solutions • Involved Technical team from the start • Client self-sufficiency • Used ROI and Productivity metrics to drive the To-Be solutions • Detailed Use Cases / Business Rules © Blue Slate Solutions 2009 6
  8. 8. Case Study 1 – Getting into the race At A Glance Our Client, a Government Fiscal Intermediary is in competitive bid to become a Medicare Administrative Contractor (MAC). Solutions • Cost Driven Program Strategy • Prioritized program elements • Detailed requirements 4 Built Impactful Solutions p • Impactful solutions • Client self-sufficiency • BPM/workflow to streamline high impact processes • Leveraged legacy DBs and data warehouse. • ECM implemented to directly launch new workflow p y • IVR feeds workflow - improved caller experience • Data masking tool to allow developers/testers to work with non-production data (security) • Manager portal provide real time view of inventory © Blue Slate Solutions 2009 7
  9. 9. Case Study 1 – Getting into the race At A Glance Our Client, a Government Fiscal Intermediary is in 5 Enable Client self-sufficiency competitive bid to become a Medicare Administrative • Continual mentoring and technical guidance to Contractor (MAC). Client IT team Solutions • Developed systematic Knowledge Transfer • Cost Driven Program sessions Strategy • Continue to provide tier 3 support to client • Prioritized program elements • Detailed requirements • Impactful solutions • Client self-sufficiency © Blue Slate Solutions 2009 8
  10. 10. Case Study 1 – Getting into the race At A Glance Our Client, a Government Fiscal Intermediary is in competitive bid to become a Medicare Administrative Contractor (MAC). Solutions • Cost Driven Program Strategy Client Successfully Awarded the Contract ! • Prioritized program elements • Measured cost reductions of 25% to 40% in • Detailed requirements automated departments with seamless transition to p • Impactful solutions new level of workload (2X) • Client self-sufficiency • Improved Caller (customer) experience • Change Management mindset starting to take hold throughout organization - Workforce less intimidated by continuous market dynamics / changing requirements © Blue Slate Solutions 2009 9
  11. 11. Case Study 2 – Improving on past performance At A Glance Our Client, one of the fastest growing privately held companies in the US Problem operates an innovative • Increasing claims expense threatened profitability insurance model for dual eligibles – people who qualify for both Medicare and Medicaid. Solutions • Data aggregation • Data normalization and tagging • Rules harvesting • Data Analysis • Identification of corrective actions © Blue Slate Solutions 2009 10
  12. 12. Case Study 2 – Improving on past performance At A Glance Our Client, one of the fastest growing privately held companies in the US 1 Assemble Team operates an innovative insurance model for dual • Internal subject matter expertise eligibles – people who • External data expertise qualify for both Medicare • Joint Security expertise and Medicaid. • External rules harvesting and business analysis Solutions expertise • Data aggregation • Data normalization and tagging • Rules harvesting • Data Analysis • Identification of corrective actions © Blue Slate Solutions 2009 11
  13. 13. Case Study 2 – Improving on past performance At A Glance Our Client, one of the fastest growing privately held companies in the US operates an innovative insurance model for dual eligibles – people who qualify for both Medicare 2 Aggregate Data and Medicaid. Solutions • Collect data files (4 sources) in a secure manner • Data aggregation • Data normalization and • Identify relevant data components and relational tagging elements • Rules harvesting • Build ‘data warehouse’ • Data Analysis • Identification of corrective actions © Blue Slate Solutions 2009 12
  14. 14. Case Study 2 – Improving on past performance At A Glance Our Client, one of the fastest growing privately held companies in the US operates an innovative insurance model for dual eligibles – people who qualify for both Medicare and Medicaid. Solutions 3 Harvest Rules • Data aggregation • Data normalization and • Examine high level q g questions to be answered tagging • Identify relevant data elements and formulas • Rules harvesting • Translate needs into a series of rule sets • Data Analysis • Identification of corrective actions © Blue Slate Solutions 2009 13
  15. 15. Case Study 2 – Improving on past performance At A Glance Our Client, one of the fastest growing privately held companies in the US operates an innovative insurance model for dual eligibles – people who qualify for both Medicare and Medicaid. Solutions • Data aggregation • Data normalization and tagging • Rules harvesting • Data Analysis 4 Analyze Data • Identification of corrective actions • Build d B ild and run rule set queries l t i • Validate results with internal team © Blue Slate Solutions 2009 14
  16. 16. Case Study 2 – Improving on past performance At A Glance Our Client, one of the fastest growing privately held companies in the US operates an innovative insurance model for dual 5 Results translation eligibles – people who qualify for both Medicare • Tie results back to original high level questions and Medicaid. • Assemble report and recommendations Solutions • Data aggregation • Data normalization and tagging • Rules harvesting • Data Analysis • Identification of corrective actions © Blue Slate Solutions 2009 15
  17. 17. Case Study 2 – Improving on past performance At A Glance Our Client, one of the fastest growing privately held companies in the US operates an innovative insurance model for dual eligibles – people who qualify for both Medicare and Medicaid. Solutions • Data aggregation • Data normalization and tagging Actionable recommendations and results • Rules harvesting • Data Analysis • Expenses and historical business decisions better • Identification of understood corrective actions • 19.3% administrative PMPM cost reduction • 2500% ROI • Future business decisions informed © Blue Slate Solutions 2009 16
  18. 18. Case Study 3 – Passing the competition At A Glance Our Client, one of the top three health insurers in the US serving 18 million Problem members across 50 states • Functionality not yet existent promised to a new Problem customer • New customer service functionality required for y q a large client in less than 6 months Solutions • Existing technology extended to include new features • Two key service technologies linked t h l i li k d © Blue Slate Solutions 2009 17
  19. 19. Case Study 3 – Passing the competition At A Glance Our Client, one of the top three health insurers in the US serving 18 million 1 Reprioritize technology initiatives members across 50 states • Examine existing workload Problem • Reshuffle to incorporate new client needs • New customer service • Non critical Non-critical initiative timelines moved back functionality required for y q a large client in less than 6 months Solutions • Existing technology extended to include new features • Two key service technologies linked t h l i li k d © Blue Slate Solutions 2009 18
  20. 20. Case Study 3 – Passing the competition At A Glance Our Client, one of the top three health insurers in the US serving 18 million members across 50 states Problem • New customer service 2 functionality required for y q Assemble team a large client in less • Extended internal team technology expertise than 6 months • Augment internal team leadership strength Solutions • Existing technology extended to include new features • Two key service technologies linked t h l i li k d © Blue Slate Solutions 2009 19
  21. 21. Case Study 3 – Passing the competition At A Glance Our Client, one of the top three health insurers in the US serving 18 million members across 50 states Problem • New customer service functionality required for y q a large client in less 3 than 6 months Design Solution approach Solutions • Immediate CSR recognition of new members g • Existing technology • Customer Portal Online Chat capability extended to include new • Storage of chat content features • Two key service technologies linked t h l i li k d © Blue Slate Solutions 2009 20
  22. 22. Case Study 3 – Passing the competition At A Glance Our Client, one of the top three health insurers in the US serving 18 million members across 50 states Problem • New customer service functionality required for y q a large client in less than 6 months Solutions • Existing technology 4 extended to include new Execute features • Existing CPM system extended to identify new • Two key service member callers alerting CSRs technologies linked t h l i li k d • Chat dialogue text integrated into legacy call center database © Blue Slate Solutions 2009 21
  23. 23. Case Study 3 – Passing the competition At A Glance Our Client, one of the top three health insurers in the US serving 18 million members across 50 states Problem • New customer service functionality required for y q a large client in less than 6 months Solutions • Existing technology Functionality deployed extended to include new features • Aggressive timeline achieved • Two key service • Service functionality met Customer expectations technologies linked t h l i li k d • Existing technology investment leveraged • Two legacy call center applications linked for the first time, time ever © Blue Slate Solutions 2009 22
  24. 24. Results we’ve seen • Reduction of Cost per Claim and PMPM Cost • Increased throughput with minimal impact on operational cost • Leveraging existing technology investments through multi-tiered architectures and web services • New technologies increase competitive position by getting closer to providers and members • More secure systems and data improve compliance y p p and minimize corrective actions and fines © Blue Slate Solutions 2009 23
  25. 25. Winning strategies to transform challenges to results • Engage cross-functional teams and establish strong project governance models • Identify and prioritize opportunities, and formalize as projects • Question the status quo – search out redundancies and hidden factories • Leveraging existing technology • Use Business Rules and data (ROI) to automate ( ) • Introduce relevant and appropriate new software for maximum impact p © Blue Slate Solutions 2009 24
  26. 26. Let’s talk some more… Liz Gaudet David Scholl • liz.gaudet@blueslate.net g @ • david.scholl@blueslate.net @ • 518.428.4569 • 321.626.3918 Joe Raiti Jill B Burger • joe.raiti@blueslate.net • jill.burger@blueslate.net • 518.461.1861 • 518.225.7385 © Blue Slate Solutions 2009 25

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