The current prescriber update process at TRC-CC PBS is cumbersome and costly, resulting in $3.9 million in lost revenue annually. A Six Sigma project was conducted to analyze the process, collect data, and identify areas for improvement. Key findings included inaccurate prescriber data in eSD, agents spending too much time off phone calls to update prescribers, and a lack of process standardization and monitoring. Recommendations included designating specialists to validate prescriber updates instead of individual agents, electronically submitting requests, and establishing performance metrics to track outcomes. Implementing these changes improved adherence and reduced errors while allowing agents to focus on calls, capturing an estimated $860,000 in additional value annually.

1. SIX SIGMA LEAN PRESENTATION
JERRY ABRAMS
July 2012

2. Introduction…..
TRC-CC PBS’s goal is to drive prescriptions into the business by
means of telephone outreach to current ESI members.
Outreach includes reviewing members medications and costs
involved at the retail pharmacy, then comparing them to the savings
built into their plan if the member selects to utilize their full benefits
and receive their meds from the ESI pharmacy.
Once the member agrees to take advantage of their plan, and utilize
the ESI Pharmacy, then the agent, with the members approval
launches a fax prescription request directly to the members
prescriber.

3. Problem Statement…..
Over the past 3 years the ESI TRC-CC Prescriber update
process has been cumbersome, and costly. Prescriber
information in eSD is inaccurate thus resulting in an agent not
being able to launch his prescription request, resulting in an
estimated $3.9 million dollars in lost or reduced revenue, which
incurs increased costs passed onto our clients and delayed and
poor services delivered to our members.

4. Introduction…..
Overview
Data Collection
Voice of the customer
What is Analyzed
Making the change

5. Overview…..
 Prescriber updates is a process to review, validate and activate







a prescriber within eSD.
PBS agents require active prescribers within eSD to process
and launch faxes.
Updates require verbal communication between ESI and the
prescribers office.
Agent is required to log off J-Phone and conduct prescriber
validation on an individual basis.
Business unit’s growth opportunity potential was estimated
Business data was captured over a 7 month period
Benefits were realized
Actionable results realized benefits for business unit TRC-CC
PBS

6. Scope…..
 Data Control & Analysis
-Currently no form of prescriber data collection or analysis is in place.
 Evaluation Spreadsheets
 Evaluation Methods
 Customer Requirements (Internal & External)
 Quality Control

7. Data Collection…..
 The data collected over the past 7 months is used to :
- Measure the VOC
-Recognize growth and development opportunities
-Provide factual data stating whether the process
improvement is effective or not.

8. Data Control…..
What is our overall start total? Utilize data gathered over the past 7
months to measure total weekly prescriber updates and revenue
generated.
- How many departments were monitored
- How many agents per department
Create a process to consolidate prescriber updates and monitor
quality
-Variations in agent submissions are monitored

9. Data Control, cont…..
 Measure current submission levels.
-How many prescriber updates are being submitted by agents per week?
-Create a reporting system to validate submissions
-What is the estimated revenue generated per week?
-Create a flow chart to track ebbs and tides of revenue generation
on a daily basis.

10. Voice of the Customer
Customer
Input
VOC Tool
Process Statement
Requestes medications to be
ESI Member
Order placement
eSD
Process Requirement
Verbal approval for ESI
Agent to contact prescriber
delivered to their home from the
via fax.
ESI Pharmacy
Active prescribers within
Agent must be able to toggle
eSD.
Designated prescriber to launch
PBS Agent
Members Called
eSD
Prescription request fax.
Verbal out-reach to prescriber.
Validation of secured fax.
TRC must receive a valid excel
Submission to TRC for
request to have a prescriber
updated
TRC
Prescriber update
eSD/ Excel
prescriber activation in eSD.
within eSD
to PBS Agent.
Activation email delivered

11. Measuring……
Time Management
Average Process Time
Variables In The Mix
Forms –Research-Departmental RequirementsSearch Times-Systems Issues
Best Practices
Organization-Quality Control-Time ManagementProcess Flow

12. Presenting Data…..
Pareto Chart
3000
98.14%
98.89%
99.61%
99.84%
100.00%
93.95%
1
0.9
2500
0.8
# Observations
0.7
2000
0.6
0.5
1500
0.4
1000
0.3
0.2
500
0.1
0
0
Non Secure Fax
New Address
Prescriber Not in
System
Group
No Telephone
Number
Not updated in
sysytem
Wrong Address

13. Presenting Data cont….
Count
Prescriber Not in
System
Non Secure Fax
New Address
No Telephone
Number
Not updated in
sysytem
Wrong Address

14. Data Analysis…..
Once data is collected, how is it translated?
Optimizing the Failure Mode Effects Analysis Process we
can easily identify:
 Process Functions
 Process Failures
 Effects of potential failures
 Clearly evaluate process controls
 Recommend achievable actions to secure positive results

15. Analyze…..
 Simple math…..
Average 72.4 prescriptions per day
145 days (29 weeks) * 72.4 prescriptions per day= 10,498 prescriptions
Weekly average = 362 prescriptions per week
Agents per team=30 * 7 minutes per call (average) = 210 minutes
210 minutes/60 (minutes /Hr) = 3.5 hrs per day on the phone
3.5 Hours * 3 teams = 10.5 hours

16. Additional analysis
Process
Potential
Function
Failure
Potential
Suggested
(Failure Mode Analysis)
Responsibility
Actions Taken
12/1/11 flow chart
Redesign prescriber
Potential
action
Effects
causes
of failure
Agent logs off dialer
to call prescribers for
updated information
Inability to
take new calls
and gain
conversions
Loss of
One agent
eSD not
initiate all
meds
accurate
update process and monitored
12/10/11 encrpted
value of capture, time saved
prescriber
spread sheet beta testing
through having only one person
calls for
entire dept
12/15/12 Launch of
off the dialer and making outreaches to prescribers, thus keeping
new prescriber update
balance of agents focused
process
on receiving additional calls.

17. What’s the problem?
The complexity of the current process has intensified whereas in some cases
Agents are not properly validating a prescriber and are simply pushing it through
Thus causing IHI and HIPAA violations.
(Prescription requests are being faxed to wrong prescribers)
Too many agents are off the dialers at any given time thus not taking calls.
There are no safe-guards in place to monitor the process and validation of data
Received by the agent to update eSD.
Inadequate or no standardization in current process (extreme chaos)

18. Actionable items for
improvement…..
Determine, isolate & reduce all variables.
Calculate value added
Determine and establish best practices (none currently
Exist)
Develop agent accountability standards and quality
Levels.

19. Isolation, reduction
& variable elimination
Create a standardization process whereas all agents are
Compliant and remain on the dialer throughout the
Day and not calling prescribers for updates.
Standardize process flow implementing and adhered
To by all agents
Standardized submission forms

20. Adherence Improvement….
New process improves adherence by allowing agents to
“Hit the Green Light” faster!
Allows for improved accuracy with prescriber updates
And for a reduction in IHA & HIPAA violations.

21. Recommendation…...
Identify areas of opportunity & report data collected
 Prescriber updates (3,900 requests)
 Captured value ($860,000.00)
 Time saved. (Cumulative total 10.5 hrs per day)

22. Data Validation…..
 Established a baseline using requests made each day,
by each agent and the number of meds associated to
the request.
 Averaged baseline and multiplied by the est. value of
each med.
 Factored in the est. time and hourly wage by 80 agents.
 Validated with TRC Management to ensure accurate
results and proper estimates.

23. Productivity…..
Create standardized process for requests and monitor accuracy and validity.
Originally each agent was responsible for out-reach to prescriber.
Management received requests each night
Management sent excel sheet to ESI
(un validated or verified for accuracy)
Eventually ESI would confirm that eSD had Been updated
Management was responsible to notify agents requests were
completed.

24. Productivity cont…..
Now….
All prescriber requests are electronically
submitted by the agent to a specified specialists who
conducts outreaches to each prescriber to verify and
validate address and a secure fax number. (one specialist
reduces IHI and HIPAA violations and agents remain on
the phone)
Specialist reports directly to ESI for prescriber
updates in real time.
Agents receive their updates in a one hour turn
around thus allowing increased production.

25. Time in motion…..
 Continue to monitor and evaluate process
 Train other locations as they utilize the prescriber
update process
 Use new and existing evaluations to plan additional
process flow improvements

26. Performance Metrics…..
Streamline system to monitor and trend further
individual requests:
Production
Completion rate
Denial rate
RPh Verbal completion rate
RPh Verbal denial rate
Incomplete rate

27. Performance Metrics cont.
Added value:
Value gained per med
Value lost per med
Value gained by agent remaining on the dialer
Value lost by agent doing individual out-reaches

28. 5/1/2012
4/26/2012
4/23/2012
4/18/2012
4/13/2012
4/10/2012
4/5/2012
4/2/2012
3/28/2012
3/23/2012
3/20/2012
3/15/2012
3/12/2012
3/7/2012
3/2/2012
2/28/2012
2/23/2012
2/20/2012
2/15/2012
2/10/2012
2/7/2012
2/2/2012
1/30/2012
1/25/2012
1/20/2012
1/17/2012
1/12/2012
1/9/2012
Current financial Performance…..
$25,000.00
$20,000.00
$15,000.00
Series1
$10,000.00
$5,000.00
$0.00

29. Time to Implement…..
 Use current resources to begin gathering historical
data
 Use data to calculate results
 Present results to customers(TRC-CC Management)
 Modify current Request forms
 Update forms to reflect additional information
 Perform tracking and validity of information
 Make impact with results

30. Conclusion…..
2011-2012 Direct benefits
3,900 Prescriber update requests made
3,500 Prescriber update requests completed
10,498 Prescriptions gained
1000 Prescriptions lost