The Claims Department of a large health insurance plan was facing challenges including poor performance, high inventory levels, and failing audits. A new leadership team developed a strategy map and Balanced Scorecard to improve performance, with a vision of "Get Compliant." They initially used spreadsheets but transitioned to ActiveStrategy software for better management. This helped reveal underlying issues and drive initiatives. Within a year, they achieved an 85% increase in employee satisfaction, 93% increase in claims timeliness, and estimated $30 million in savings. By 2009, total savings exceeded $150 million, and performance exceeded toughened targets. The department became a model for performance management.
Design a arte de materializar as decisoes de negociostdc-globalcode
"Esta é uma decisão de negócio ou de design?" Alguém poderia pensar em ambos como campos separados, dada a forma como as decisões são tomadas no dia-a-dia, o analista de negócios (ou equivalente) geralmente sendo o responsável por definir como uma empresa irá criar valor para seus clientes. Sendo um Designer para a UX, como posso materializar essas decisões na forma de interfaces, navegações ou mecânica de produtos? Vou ter que ceder quanto aos princípios de design? Qual é a relação custo-benefício? Podemos co-criar com "pessoas de negócios" desde o início? Nesta palestra, eu vou mostrar casos em que tanto o design e negócios se fundiram quase tornando-se indistinguíveis.
Design a arte de materializar as decisoes de negociostdc-globalcode
"Esta é uma decisão de negócio ou de design?" Alguém poderia pensar em ambos como campos separados, dada a forma como as decisões são tomadas no dia-a-dia, o analista de negócios (ou equivalente) geralmente sendo o responsável por definir como uma empresa irá criar valor para seus clientes. Sendo um Designer para a UX, como posso materializar essas decisões na forma de interfaces, navegações ou mecânica de produtos? Vou ter que ceder quanto aos princípios de design? Qual é a relação custo-benefício? Podemos co-criar com "pessoas de negócios" desde o início? Nesta palestra, eu vou mostrar casos em que tanto o design e negócios se fundiram quase tornando-se indistinguíveis.
How to Build a Healthcare Analytics Team and Solve Strategic ProblemsHealth Catalyst
Health systems have vast amounts of data, but frequently struggle to use that data to solve strategic problems in a timely fashion. A healthcare analytics team, made up of the right people with the right tools and skillsets, can help address these challenges. This article walks through the steps organizations need to take to put an effective analytics team in place. These include the following:
Recognizing the need for change.
Demonstrating the value of an analytics team.
Conducting a current state assessment.
Identifying solutions.
Implementing a phased approach.
Building a roadmap.
Making the pitch.
Putting the roadmap into action.
The article also includes the foundation skills to look for when putting together the team and tips on how best to organize.
Executing the StrategyLearning ObjectivesAfter reading.docxcravennichole326
Executing the Strategy
Learning Objectives
After reading this chapter, you should be able to:
• Distinguish good operational plans from weak ones.
• Detail the value of tracking progress on all operational plans.
• Discuss why emergent strategies occur and how they might affect an organization’s
current strategy.
• Implement the ten basic steps of a generic strategic formulation process.
• Manage, improve, and evaluate an existing strategic management process.
Chapter 9
Neil Webb/Ikon Images/Getty Images
spa81202_09_c09.indd 247 1/16/14 10:08 AM
CHAPTER 9Section 9.1 Managing Operational Plans
Implementing a strategy (see Figure 1.1) in the real world is not a leisurely swim across
a calm pond on a sunny day, but rather like crossing from one bank of a raging river to
the other, encountering hidden eddies, fog, driving rain, lightning, and riptides along the
way. While it is not impossible to reach the other bank (the goal), the task often becomes
one of overcoming obstacles and making constant adjustments without losing sight of the
goal. Implementation is like that. Even the most brilliant strategy is worthless if it cannot
be implemented.
This chapter focuses on strategy execution and its difficulties. Part of the chapter is devoted
to assessing, improving, and managing the strategy formulation process itself.
9.1 Managing Operational Plans
The process for obtaining board approval of operational plans is covered in this chapter.
Exactly what is it that gets approved? An operational plan is a document that specifies the
projects or tasks that must be accomplished to achieve particular operational objectives.
Many of these plans will contain activities that are ongoing. Some will include plans for
enhanced or new services. Details specified in operational plans include the names of those
who will be involved and the indi-
vidual responsible for each one, what
equipment will be needed, when each
will start and end, and the estimated
costs for each activity. Given the level
of detail required, it should come as
no surprise that an operational plan
for a large functional unit, such as the
nursing department in a hospital, can
run to many pages, as there are lots of
activities to be detailed. Operational
plans for small HSOs such as physi-
cian clinics and community health
centers may be just a few pages long
unless new strategic initiatives are to
be undertaken.
It takes contributions from everyone
who will be involved in that HSO’s
operations to create such plans. They
will make sure that continuing cur-
rent operations are included in the plans, which is easily done. What adds a level of com-
plexity and difficulty is incorporating additional tasks demanded by a change in strategy.
Consider the following scenarios, which illustrate the difficulty in creating operational
plans that involve more than simply repeating what was done the previous year:
Javier Larrea/age fotostock/Getty Ima.
Executing the StrategyLearning ObjectivesAfter reading.docxSANSKAR20
Executing the Strategy
Learning Objectives
After reading this chapter, you should be able to:
• Distinguish good operational plans from weak ones.
• Detail the value of tracking progress on all operational plans.
• Discuss why emergent strategies occur and how they might affect an organization’s
current strategy.
• Implement the ten basic steps of a generic strategic formulation process.
• Manage, improve, and evaluate an existing strategic management process.
Chapter 9
Neil Webb/Ikon Images/Getty Images
spa81202_09_c09.indd 247 1/16/14 10:08 AM
CHAPTER 9Section 9.1 Managing Operational Plans
Implementing a strategy (see Figure 1.1) in the real world is not a leisurely swim across
a calm pond on a sunny day, but rather like crossing from one bank of a raging river to
the other, encountering hidden eddies, fog, driving rain, lightning, and riptides along the
way. While it is not impossible to reach the other bank (the goal), the task often becomes
one of overcoming obstacles and making constant adjustments without losing sight of the
goal. Implementation is like that. Even the most brilliant strategy is worthless if it cannot
be implemented.
This chapter focuses on strategy execution and its difficulties. Part of the chapter is devoted
to assessing, improving, and managing the strategy formulation process itself.
9.1 Managing Operational Plans
The process for obtaining board approval of operational plans is covered in this chapter.
Exactly what is it that gets approved? An operational plan is a document that specifies the
projects or tasks that must be accomplished to achieve particular operational objectives.
Many of these plans will contain activities that are ongoing. Some will include plans for
enhanced or new services. Details specified in operational plans include the names of those
who will be involved and the indi-
vidual responsible for each one, what
equipment will be needed, when each
will start and end, and the estimated
costs for each activity. Given the level
of detail required, it should come as
no surprise that an operational plan
for a large functional unit, such as the
nursing department in a hospital, can
run to many pages, as there are lots of
activities to be detailed. Operational
plans for small HSOs such as physi-
cian clinics and community health
centers may be just a few pages long
unless new strategic initiatives are to
be undertaken.
It takes contributions from everyone
who will be involved in that HSO’s
operations to create such plans. They
will make sure that continuing cur-
rent operations are included in the plans, which is easily done. What adds a level of com-
plexity and difficulty is incorporating additional tasks demanded by a change in strategy.
Consider the following scenarios, which illustrate the difficulty in creating operational
plans that involve more than simply repeating what was done the previous year:
Javier Larrea/age fotostock/Getty Ima ...
What Are Performance Dashboards By Wayne W. Eckerson.docxhelzerpatrina
What Are Performance Dashboards?
By Wayne W. Eckerson
This article is an excerpt from the book Performance Dashboards: Measuring,
Monitoring, and Managing Your Business by Wayne W. Eckerson, Director of
Research and Services at The Data Warehousing Institute, a worldwide
association of data warehousing and business intelligence professionals.
THE CONTEXT FOR PERFORMANCE DASHBOARDS
The Power of Focus
Executives in Training
This summer I found my 11-year-old son, Harry, and his best pal, Jake, kneeling side by side in
our driveway, peering intensely at the pavement. As I walked over to inspect this curious sight, I
saw little puffs of smoke rising from their huddle. Each had a magnifying glass and was using it
to set fire to clumps of dry grass as well as a few unfortunate ants who had wandered into their
makeshift science experiment.
In this boyhood rite of passage, Harry and Jake learned an important lesson that escapes the
attention of many organizations today: the power of focus. Light rays normally radiate harmlessly
in all directions, bouncing off objects in the atmosphere and the earth’s surface. The boys had
discovered, however, that if they focused light rays onto a single point using a magnifying glass,
they could generate enough energy to burn just about anything and keep themselves entertained
for hours!
By the time Harry and Jake enter the business world (if they do), they will probably have
forgotten this simple lesson. They will have become steeped in corporate cultures that excel at
losing focus and dissipating energy far and wide. Most organizations have multiple business
units, divisions, and departments, each with their own products, strategies, initiatives,
applications, and systems to support them. A good portion of these activities are redundant at best
and conflicting at worst. The organization as a whole spins off in multiple directions at once
without a clear strategy. Changes in leadership, mergers, acquisitions, and reorganizations
amplify the chaos.
Organizational Magnifying Glass
To rectify this problem, companies need an “organizational magnifying glass”—something that
focuses the work of employees so everyone is going in the same direction. Strong leaders do this.
However, even the voice of a charismatic executive is sometimes drowned out by organizational
inertia.
Strong leaders need more than just the force of their personality and experience to focus an
organization. They need an information system that helps them clearly and concisely
communicate key strategies and goals to all employees on a personal basis every day. The system
should focus workers on tasks and activities that best advance the organization’s strategies and
goals. It should measure performance, reward positive contributions, and align efforts so that
workers in every group and level of the organization are marching together toward the same
destination.
Performance Management System ...
Hcad 660 group 2 team final paper for individual participationModupe Sarratt
The Individual part that gave me the opportunity to receive a 90% for a final grade in the team project that was conspired by the team leader to obscure my work. I won because I chose not to allow anyone to use his or her position to take advantage of my work for their credit or as well I will not allow anyone to obscure or misrepresent my work. Ashley Ricker with her dubious name for Ashley Heffelfinger made copycats of my work for a claim that she is the group leader.
White Paper: Predictability Through Planning AgilityHost Analytics
Outperform your competition by making financial processes more relevant in driving organizational excellence, efficiency and informed decision-making, while improving forecast and budget accuracy.
Class and Comp Study Gloucester County, VirginiaChuck Thompson
Gloucester, VA Documentation showing very flawed study to justify pay increases for government employees. Document being used for news story on Gloucester, Virginia Links and News website.
EquityEquity calculations are not discussed in any detail he.docxrusselldayna
Equity
Equity calculations are not discussed in any detail here. It is enough
for our purposes to recognize that equity is a derived figure. Equity
must equal total assets less liabilities. In our Williams Convalescent
Center example, this generates values of $2,562 for the constant
dollar method and $2,867 for the current cost method.
SUMMARY
Financial reporting suffers from its current reliance on the HC
valuation concept. Inflation has made many of the reported values in
current financial reports meaningless to decision makers. The
example used in this chapter illustrates this point. The total asset
investment of Williams Convalescent Center is approximately 100%
larger when adjusted for inflation under the current cost or constant
dollar method. Net income, however, decreased. The result is a
dramatic deterioration in return on investment––the single most
important test of business success. Table 10–11 summarizes
(Cleverley 227-237)
Cleverley, William O. Essentials of Health Care Finance, 7th Edition.
Jones & Bartlett Learning, 20101022. VitalBook file..
Chapter 11 Analyzing Financial Position
LEARNING OBJECTIVES
After studying this chapter, you should be able to do the following:
• 1.Describe the balanced scorecard and dashboard
reporting.
• 2.Describe the four key elements of dashboard reporting.
Increase in
specific prices
over general
price level
($3,783 less
$3,791)
($8)
• 3.Explain what is most important in long-term financial
success.
• 4.Explain the primary financial objective of a healthcare
firm.
• 5.Describe the critical drivers of financial performance.
• 6.Discuss the importance and types of performance
measures.
• 7.Introduce the hospital cost index measure.
REAL-WORLD SCENARIO
Michael Dean has been recently appointed to the board of Kenyon
Medical Center, a 300-bed, not-for-profit community hospital. Mike is
an attorney who specializes in labor law and is the firm’s primary
litigation expert in this area. He is reviewing the financial information
that was sent to him this morning in preparation for his first board
meeting this evening. His total financial package includes 28 pages of
financial information consisting of current monthly income statements,
a balance sheet, and other monthly actual-to-budget comparisons of
performance with some selected financial ratios.
Tonight’s meeting is critical because the board’s major item for
discussion is related to a proposed bond issue to finance major
hospital renovation. Mike recognizes that he has a fiduciary
responsibility to protect the assets of the hospital and to ensure its
continued financial viability, but he does not know how to determine
whether the hospital can afford to take on this additional debt. There is
so much information and no apparent pattern as to what really is
important. He is also concerned about assessing how the proposed
financing would impact the hospital’s financial performance and thus
its ability to.
How to Build a Healthcare Analytics Team and Solve Strategic ProblemsHealth Catalyst
Health systems have vast amounts of data, but frequently struggle to use that data to solve strategic problems in a timely fashion. A healthcare analytics team, made up of the right people with the right tools and skillsets, can help address these challenges. This article walks through the steps organizations need to take to put an effective analytics team in place. These include the following:
Recognizing the need for change.
Demonstrating the value of an analytics team.
Conducting a current state assessment.
Identifying solutions.
Implementing a phased approach.
Building a roadmap.
Making the pitch.
Putting the roadmap into action.
The article also includes the foundation skills to look for when putting together the team and tips on how best to organize.
Executing the StrategyLearning ObjectivesAfter reading.docxcravennichole326
Executing the Strategy
Learning Objectives
After reading this chapter, you should be able to:
• Distinguish good operational plans from weak ones.
• Detail the value of tracking progress on all operational plans.
• Discuss why emergent strategies occur and how they might affect an organization’s
current strategy.
• Implement the ten basic steps of a generic strategic formulation process.
• Manage, improve, and evaluate an existing strategic management process.
Chapter 9
Neil Webb/Ikon Images/Getty Images
spa81202_09_c09.indd 247 1/16/14 10:08 AM
CHAPTER 9Section 9.1 Managing Operational Plans
Implementing a strategy (see Figure 1.1) in the real world is not a leisurely swim across
a calm pond on a sunny day, but rather like crossing from one bank of a raging river to
the other, encountering hidden eddies, fog, driving rain, lightning, and riptides along the
way. While it is not impossible to reach the other bank (the goal), the task often becomes
one of overcoming obstacles and making constant adjustments without losing sight of the
goal. Implementation is like that. Even the most brilliant strategy is worthless if it cannot
be implemented.
This chapter focuses on strategy execution and its difficulties. Part of the chapter is devoted
to assessing, improving, and managing the strategy formulation process itself.
9.1 Managing Operational Plans
The process for obtaining board approval of operational plans is covered in this chapter.
Exactly what is it that gets approved? An operational plan is a document that specifies the
projects or tasks that must be accomplished to achieve particular operational objectives.
Many of these plans will contain activities that are ongoing. Some will include plans for
enhanced or new services. Details specified in operational plans include the names of those
who will be involved and the indi-
vidual responsible for each one, what
equipment will be needed, when each
will start and end, and the estimated
costs for each activity. Given the level
of detail required, it should come as
no surprise that an operational plan
for a large functional unit, such as the
nursing department in a hospital, can
run to many pages, as there are lots of
activities to be detailed. Operational
plans for small HSOs such as physi-
cian clinics and community health
centers may be just a few pages long
unless new strategic initiatives are to
be undertaken.
It takes contributions from everyone
who will be involved in that HSO’s
operations to create such plans. They
will make sure that continuing cur-
rent operations are included in the plans, which is easily done. What adds a level of com-
plexity and difficulty is incorporating additional tasks demanded by a change in strategy.
Consider the following scenarios, which illustrate the difficulty in creating operational
plans that involve more than simply repeating what was done the previous year:
Javier Larrea/age fotostock/Getty Ima.
Executing the StrategyLearning ObjectivesAfter reading.docxSANSKAR20
Executing the Strategy
Learning Objectives
After reading this chapter, you should be able to:
• Distinguish good operational plans from weak ones.
• Detail the value of tracking progress on all operational plans.
• Discuss why emergent strategies occur and how they might affect an organization’s
current strategy.
• Implement the ten basic steps of a generic strategic formulation process.
• Manage, improve, and evaluate an existing strategic management process.
Chapter 9
Neil Webb/Ikon Images/Getty Images
spa81202_09_c09.indd 247 1/16/14 10:08 AM
CHAPTER 9Section 9.1 Managing Operational Plans
Implementing a strategy (see Figure 1.1) in the real world is not a leisurely swim across
a calm pond on a sunny day, but rather like crossing from one bank of a raging river to
the other, encountering hidden eddies, fog, driving rain, lightning, and riptides along the
way. While it is not impossible to reach the other bank (the goal), the task often becomes
one of overcoming obstacles and making constant adjustments without losing sight of the
goal. Implementation is like that. Even the most brilliant strategy is worthless if it cannot
be implemented.
This chapter focuses on strategy execution and its difficulties. Part of the chapter is devoted
to assessing, improving, and managing the strategy formulation process itself.
9.1 Managing Operational Plans
The process for obtaining board approval of operational plans is covered in this chapter.
Exactly what is it that gets approved? An operational plan is a document that specifies the
projects or tasks that must be accomplished to achieve particular operational objectives.
Many of these plans will contain activities that are ongoing. Some will include plans for
enhanced or new services. Details specified in operational plans include the names of those
who will be involved and the indi-
vidual responsible for each one, what
equipment will be needed, when each
will start and end, and the estimated
costs for each activity. Given the level
of detail required, it should come as
no surprise that an operational plan
for a large functional unit, such as the
nursing department in a hospital, can
run to many pages, as there are lots of
activities to be detailed. Operational
plans for small HSOs such as physi-
cian clinics and community health
centers may be just a few pages long
unless new strategic initiatives are to
be undertaken.
It takes contributions from everyone
who will be involved in that HSO’s
operations to create such plans. They
will make sure that continuing cur-
rent operations are included in the plans, which is easily done. What adds a level of com-
plexity and difficulty is incorporating additional tasks demanded by a change in strategy.
Consider the following scenarios, which illustrate the difficulty in creating operational
plans that involve more than simply repeating what was done the previous year:
Javier Larrea/age fotostock/Getty Ima ...
What Are Performance Dashboards By Wayne W. Eckerson.docxhelzerpatrina
What Are Performance Dashboards?
By Wayne W. Eckerson
This article is an excerpt from the book Performance Dashboards: Measuring,
Monitoring, and Managing Your Business by Wayne W. Eckerson, Director of
Research and Services at The Data Warehousing Institute, a worldwide
association of data warehousing and business intelligence professionals.
THE CONTEXT FOR PERFORMANCE DASHBOARDS
The Power of Focus
Executives in Training
This summer I found my 11-year-old son, Harry, and his best pal, Jake, kneeling side by side in
our driveway, peering intensely at the pavement. As I walked over to inspect this curious sight, I
saw little puffs of smoke rising from their huddle. Each had a magnifying glass and was using it
to set fire to clumps of dry grass as well as a few unfortunate ants who had wandered into their
makeshift science experiment.
In this boyhood rite of passage, Harry and Jake learned an important lesson that escapes the
attention of many organizations today: the power of focus. Light rays normally radiate harmlessly
in all directions, bouncing off objects in the atmosphere and the earth’s surface. The boys had
discovered, however, that if they focused light rays onto a single point using a magnifying glass,
they could generate enough energy to burn just about anything and keep themselves entertained
for hours!
By the time Harry and Jake enter the business world (if they do), they will probably have
forgotten this simple lesson. They will have become steeped in corporate cultures that excel at
losing focus and dissipating energy far and wide. Most organizations have multiple business
units, divisions, and departments, each with their own products, strategies, initiatives,
applications, and systems to support them. A good portion of these activities are redundant at best
and conflicting at worst. The organization as a whole spins off in multiple directions at once
without a clear strategy. Changes in leadership, mergers, acquisitions, and reorganizations
amplify the chaos.
Organizational Magnifying Glass
To rectify this problem, companies need an “organizational magnifying glass”—something that
focuses the work of employees so everyone is going in the same direction. Strong leaders do this.
However, even the voice of a charismatic executive is sometimes drowned out by organizational
inertia.
Strong leaders need more than just the force of their personality and experience to focus an
organization. They need an information system that helps them clearly and concisely
communicate key strategies and goals to all employees on a personal basis every day. The system
should focus workers on tasks and activities that best advance the organization’s strategies and
goals. It should measure performance, reward positive contributions, and align efforts so that
workers in every group and level of the organization are marching together toward the same
destination.
Performance Management System ...
Hcad 660 group 2 team final paper for individual participationModupe Sarratt
The Individual part that gave me the opportunity to receive a 90% for a final grade in the team project that was conspired by the team leader to obscure my work. I won because I chose not to allow anyone to use his or her position to take advantage of my work for their credit or as well I will not allow anyone to obscure or misrepresent my work. Ashley Ricker with her dubious name for Ashley Heffelfinger made copycats of my work for a claim that she is the group leader.
White Paper: Predictability Through Planning AgilityHost Analytics
Outperform your competition by making financial processes more relevant in driving organizational excellence, efficiency and informed decision-making, while improving forecast and budget accuracy.
Class and Comp Study Gloucester County, VirginiaChuck Thompson
Gloucester, VA Documentation showing very flawed study to justify pay increases for government employees. Document being used for news story on Gloucester, Virginia Links and News website.
EquityEquity calculations are not discussed in any detail he.docxrusselldayna
Equity
Equity calculations are not discussed in any detail here. It is enough
for our purposes to recognize that equity is a derived figure. Equity
must equal total assets less liabilities. In our Williams Convalescent
Center example, this generates values of $2,562 for the constant
dollar method and $2,867 for the current cost method.
SUMMARY
Financial reporting suffers from its current reliance on the HC
valuation concept. Inflation has made many of the reported values in
current financial reports meaningless to decision makers. The
example used in this chapter illustrates this point. The total asset
investment of Williams Convalescent Center is approximately 100%
larger when adjusted for inflation under the current cost or constant
dollar method. Net income, however, decreased. The result is a
dramatic deterioration in return on investment––the single most
important test of business success. Table 10–11 summarizes
(Cleverley 227-237)
Cleverley, William O. Essentials of Health Care Finance, 7th Edition.
Jones & Bartlett Learning, 20101022. VitalBook file..
Chapter 11 Analyzing Financial Position
LEARNING OBJECTIVES
After studying this chapter, you should be able to do the following:
• 1.Describe the balanced scorecard and dashboard
reporting.
• 2.Describe the four key elements of dashboard reporting.
Increase in
specific prices
over general
price level
($3,783 less
$3,791)
($8)
• 3.Explain what is most important in long-term financial
success.
• 4.Explain the primary financial objective of a healthcare
firm.
• 5.Describe the critical drivers of financial performance.
• 6.Discuss the importance and types of performance
measures.
• 7.Introduce the hospital cost index measure.
REAL-WORLD SCENARIO
Michael Dean has been recently appointed to the board of Kenyon
Medical Center, a 300-bed, not-for-profit community hospital. Mike is
an attorney who specializes in labor law and is the firm’s primary
litigation expert in this area. He is reviewing the financial information
that was sent to him this morning in preparation for his first board
meeting this evening. His total financial package includes 28 pages of
financial information consisting of current monthly income statements,
a balance sheet, and other monthly actual-to-budget comparisons of
performance with some selected financial ratios.
Tonight’s meeting is critical because the board’s major item for
discussion is related to a proposed bond issue to finance major
hospital renovation. Mike recognizes that he has a fiduciary
responsibility to protect the assets of the hospital and to ensure its
continued financial viability, but he does not know how to determine
whether the hospital can afford to take on this additional debt. There is
so much information and no apparent pattern as to what really is
important. He is also concerned about assessing how the proposed
financing would impact the hospital’s financial performance and thus
its ability to.
1. Background & the “burning Platform”
TM
www.activestrategy.com 484.690.0700
Background & the “Burning Platform”
The Claims Department for one of the nation’s largest integrated health plan providers supports 3 million people
through the receipt, processing, and payment of nearly 2 million medical services claims each year.
This department faced serious challenges in the summer of 2005. While the department’s vision was to “deliver
world-class claims administration to providers, regulators, and stakeholders,” it suffered from mediocre
operational performance, which resulted in high inventory levels and inferior claims processing quality. It was no
surprise that the Centers for Medicare & Medicaid Services (CMS) had repeatedly found the department
unprepared for audits and stipulated that it correct its significant deficiencies or face the possibility of non-
reimbursement. Anecdotal evidence also suggested that the health plan’s providers were dissatisfied with the
department’s performance, but there was no real way to measure this.
The following year brought new leadership to the Claims Department and a fresh focus on turning around the
department’s performance. The first task was to develop a primary vision for the department and a clear way to
get there. With senior executive guidance, the vision became “Get Compliant.” While there were other
important goals that had to be met, this directive provided the focus needed to organize the department’s
priorities.
Leadership, recognizing that simply stating a vision was not enough, dedicated resources to the task of developing,
mapping, and executing strategy. One of those resources was a new Office of Strategy Management, responsible
for developing a strategic management roadmap for the department. They determined that they needed three
components to be successful:
1. A clear and simple visual method of communicating strategy (a strategy map)
2. A sustainable way to track progress toward goal achievement (a Balanced Scorecard)
3. Process improvement tools and skills to sustain in success
1
The Beginnings of Strategy ExecutionThe Beginnings of Strategy Execution
How an Automated Balanced Scorecard Has Helped a
Health Plan Achieve More Than $150 Million in Savings
How an Automated Balanced Scorecard Has Helped a
Health Plan Achieve More Than $150 Million in Savings CASE STUDY
With a team comprised of an experienced
manager, an internal process improvement
consultant, and the existing claims leadership,
the vision, “Get Compliant,” evolved into a
simple but powerful strategy map outlining the
key areas that the department needed to focus
on to achieve its vision. It utilized five perspec-
tives, chosen to support all of the department’s
key stakeholders. The map also illustrated the
causal relationships among these stakeholders,
reinforcing critical interdependencies.
The Claims Department Strategy Map (shown as
a “clickable”Visual Map within ASE software).
STRATEGY BUSINESS REVIEW SCORECARDS INITIATIVES PROCESSES PGM REPORTS ALERTS ASU
Welcome Martha Carr
My Favorites
Refresh Home Chooser Guide Help Logout
VISUAL MAP - Claims Department Strategy Map
Delivering World-Class Claims Administration to Providers, Regulators, and Stakeholders
Meet Regulatory Requirements Improve Provider Satisfaction
Ensure Financial Stewardship
Improve Claim Accuracy Improve Claim Timeliness Improve Service Quality
Enhance Technology Capability
Improve Organizational Awareness Develop Human Capabilities
Customer
Perspective
Financial
Perspective
Internal
Process
Perspective
Innovation
Perspective
People
Perspective
Audit
Readiness
Provider
Disputes
Cost Per
Claim
Address SOX
Deficiencies
PMPM
Cost
Avoidance
Financial Accuracy
Payment Incident
Accuracy
Denial Incident
Accuracy
DROH
Weekly Productivity
DPOH
Call Center Volume
Letter Quality
Contract/Pricing
Quality
EDI Auto Adjudication Pricing
System
System Downtime
CulC
Culture
Alignment
Leadership
Teamwork
Skills Competency
Coverage
2. TM
www.activestrategy.com 484.690.0700
The department then began creating a Balanced Scorecard to help drive the changes to achieve the vision set out
in the new strategy map. The Balanced Scorecard built upon the strategy map, mirroring its perspectives and
objectives, plus adding carefully defined and focused measures. Each measure was assigned an owner to build in
accountability.
Once the strategy map and Balanced Scorecard were built, the department leadership began actively using them
to manage performance and drive toward their goal of getting compliant. But soon into this effort, the limits of the
desktop spreadsheet and presentation tools they were using to manage their Balanced Scorecard became obvious.
The software was cumbersome and ill-suited to managing a real strategy execution deployment.
As the Office of Strategy Management was struggling to effectively organize and deploy the Claims Department’s
Balanced Scorecards within their various spreadsheets, other parts of the health plan organization were being
introduced to ActiveStrategy’s web-based Balanced Scorecard software, ActiveStrategy Enterprise (ASE). One of
the reasons the health plan chose ActiveStrategy was because of its ability to be deployed across a very large
enterprise and to integrate with other performance management initiatives as they arose, such as this work within
the Claims Department. Once the department leadership saw ASE, they began transitioning their newly developed
Balanced Scorecard content into the web-based system.
ASE allowed the Claims Department to
build multiple layers of linked, aligned,
“clickable” Balanced Scorecards, which was
not previously possible. This let the depart-
ment leaders and objective owners delve
deeper into the leading indicators of weak
performance, which exposed the fact that,
while current leaders possessed strong
industry knowledge, unclear goals, policies
and procedures, as well as a general lack of
accountability, was contributing to a poor
overall team culture. Thus a new depart-
mental goal emerged to develop a perfor-
mance-based, quality-focused workforce.
Prior to building their scorecards in ASE,
this important underlying cause was
completely obscured.
With their new significant focus on using
the “People” perspective as a lever to drive
behavioral change, the Claims Department
concentrated on encouraging alignment and
teamwork, and on developing the knowledge and
skills of the group. The belief was that if the department’s employees were more satisfied with their roles and
understood how their individual efforts aligned to the department’s goals, this would lead to beneficial impacts on
other parts of their strategy, such as improving claims accuracy and timeliness, enhancing service quality, lowering
cost per claim, and eventually improving both provider satisfaction and the department’s readiness for audits
whenever they should arise. Fundamentally, it was putting faith in (and effort behind) the causalities they had laid
out in their strategy map.
2
The Solution: Balanced Scorecard SoftwareThe Solution: Balanced Scorecard Software
CASE STUDY
STRATEGY BUSINESS REVIEW SCORECARDS INITIATIVES PROCESSES PGM REPORTS ALERTS ASU
Welcome Martha Carr
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MEASURE DETAIL - Days Receipts on Hand
Link Edit Heirarchy Add Child Add Action Item
Goal Base
Details Actual Goal Variance Owners
Days Receipts on Hand (DROH) - Weekly 7.3 7.0 (4.3) Steele, Kim
Days Production on Hand (DPOH) 7.3 7.0 (4.3) Steele, Kim
Claims Inventory 52,238 45,000 (7,238) Steele, Kim
Initiatives Budget Timing Owners
Pricing Reconciliation Keefe, Jim
NT Server Remediation Lattanzi, Patti
Automation Update Keefe, Jim
CHARTS AND GRAPHS PERFORMANCE DATA
Days Receipts on Hand (DROH)
10
9.5
9
8.5
8
7.5
7
6.5
6
Jan 2006 W1 Mar 2006 W3 Jun 2006 W1 Aug 2006 W4 Nov 2006 W3
Goal Actual Trend
good direction updated 9/18/2006
OptionsDays Receipts on Hand (DROH)
Period Actual Goal Variance YTD
Jun 2006 W1
Jun 2006 W2
Jun 2006 W3
Jun 2006 W4
July 2006 W1
July 2006 W2
July 2006 W3
July 2006 W4
July 2006 W5
Aug 2006 W1
Aug 2006 W2
Aug 2006 W3
Aug 2006 W4
Sep 2006 W1
7.4
6.8
7.2
7.3
7.9
8.4
7.7
7.4
7.8
8.2
8.0
7.4
8.1
8.2
7.0
7.0
7.0
7.0
7.0
7.0
7.0
7.0
7.0
7.0
7.0
7.0
7.0
7.0
(0.4)
0.2
(0.2)
(0.3)
(0.9)
(1.4)
(0.7)
(0.4)
(0.8)
(1.2)
(1.0)
(0.4)
(1.1)
(1.2)
7.9
7.9
7.9
7.8
7.8
7.9
7.9
7.8
7.8
7.9
7.9
7.8
7.9
7.9
Measure Detail pages allowed department leaders to drill into
performance measures and review and act upon underlying
details, such as child measures, performance trends, and
linked initiatives and projects.
3. TM
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One of the first key improvement initiatives undertaken was an employee satisfaction survey that gave the Office
of Strategy Management a measurement of employee job fulfillment in the areas of culture, leadership, alignment,
and teamwork. Employees were then scored on competency in various areas like communication, service attitude,
subject matter expertise, and project management. As these metrics were tracked in ASE, a spirit of accountability
emerged, and each employee felt personally responsible for the success or failure of the department. Areas that
were below target were addressed through the launch of specific activities, such as regular employee meetings,
topic-specific focus groups, and a new 15-minute daily dialogue to discuss relevant business matters.
In keeping with the new objective to improve the department’s operational performance, process and perfor-
mance improvement concepts were gradually introduced, including Lean Six Sigma training that provided teams
with the skills to identify and improve root causes of strategic performance gaps, which were tracked and
reviewed in ASE. New metrics were also put in place to monitor progress in developing the team’s knowledge,
skills, and abilities.
With its Balanced Scorecard framework fully integrated into ASE, business review meetings began to follow a
new format. The division vice president began leading monthly meetings in “real time” in ASE, rather than using
spreadsheets that were already out of date by the time they were compiled. For the division leader, the meetings
have become a way to efficiently and effectively understand the performance of the department and its progress
toward achieving goals. For the department, business reviews allow further exploration of areas that need
improvement.
The Claims Department achieved tremendous results within its first year of deploying Balanced Scorecards within
ASE. The automated framework clarified departmental objectives and helped management deploy them with
clearly assigned owners, which helped the department achieve its objective to “Get Compliant.” In fact, in August
2007, the department successfully passed a critical milestone audit administered by CMS – a significant testament
to the power of the framework as used by the Claims Department.
Other notable results achieved within the first year of deployment included:
• An 85% increase in employee satisfaction
• A 93% increase in the timeliness of claims processing
• An estimated $30 million company benefit based on cost recovery and avoidance
The Claims Department quickly became an example for how to implement a successful Balanced Scorecard,
both inside and outside the health plan provider. In 2007, the department was the recipient of an analyst firm’s
Operational Performance Leadership Award, which recognized ActiveStrategy’s partnership with the department
as a winning example of how the adoption of best practices and the alignment of people and processes with
technology applications enable performance management. Within the health plan provider, the department is
held up as a role model and benchmark for workforce engagement and the performance management process,
with several areas following the department’s lead.
In 2009, the department is on track to save more than $90 million, bringing total savings as a result of the
Balanced Scorecard and its deployment in ASE to well over $150 million thus far. In addition, claims accuracy
and timeliness measures are both exceeding targets for 2009 -- targets that were made more aggressive twice.
And measures within the Employee Perspective are also ahead of target.
By focusing on the leading drivers in ASE, including an emphasis on people and the prioritization of the right
projects, the department succeeded in driving its most critical regulatory compliance metrics, and continues to
achieve tremendous other tangible business benefits simultaneously.
3
The ResultsThe Results
CASE STUDY