blue slate winning strategies for healthcare payers

Winning StrategiesWinning Strategies

How healthcare payers are using process, technology, and data solutions to get ahead

© Blue Slate Solutions 2009

Health IT Insight SummitSavannah, GASeptember 21, 2009

About Blue Slate Solutions

I ti ti i• Improve operations - optimize processes, connect disparate systems, introduce relevant technologies, manage data

• Clients include 2 of the top 3 and 4 of the top 20 h lth i l di 7 BCBS l

Technology

20 health payers including 7 BCBS plans • More than 80 healthcare-specific projects

spanning more than 20 different healthcare entities, mostly private and government payers

Solutions

DataProcess

• Experience across the full spectrum of healthcare payer functions and departments

Li G d David Scholl

Project & Change Management

Liz Gaudet• 20 years experience across

three healthcare payers prior to BSS

David Scholl• 20 years general

management and business leadership at GE

• 30 projects involving 10+ payers over last 5 years

• Strategy focused MBA, certified in Conflict

• Certified Master Black Belt in Six Sigma (process quality)

• PM/BA on 9 workflow automation programs within h lth


Resolution and Process Mapping

healthcare payers

Disruption and challenges facing payers

• PoliticalObama administration and its ripple effect on all things healthcare has every constituent concerned and bracing forhealthcare has every constituent concerned and bracing for change – whatever that change may be

• EconomicCosts to deliver quality healthcare and costs to insure are all on the rise – exponentially

• SocialSocialDemographic of US population is that more care will be needed in upcoming decades, not lessT h l i l• TechnologicalIntroducing new systems into an aging infrastructure to meet above challenges


g

At A GlanceCase Study 1 – Getting into the race

Problem

Our Client, a Government Fiscal Intermediary is in competitive bid to become a Medicare Administrative

Solutions• Cost Driven Program

Strategy

Problem• Client estimated they needed >30% reduction in

cost/claim while taking on 2X workload

Medicare Administrative Contractor (MAC).

Strategy• Prioritized program

elements• Detailed requirements• Impactful solutionsImpactful solutions• Client self-sufficiency


Case Study 1 – Getting into the raceAt A Glance


1 Define the Strategy• Become paperless• Optimize Key Business Processes


Strategy


Optimize Key Business Processes• Leverage legacy systems and technologies• Joint ownership between IT and Business






2 Prioritize the Program Elements


Strategy


2 Prioritize the Program Elements• Used a Six Sigma approach (QFD) in planning• Focus on Centralized processes and paper-

heavy processes


elements• Detailed requirements• Impactful solutionsheavy processes

• Implemented Governance at all levels

Impactful solutions• Client self-sufficiency





Strategy


3 Gather Detailed Requirements• Involved Technical team from the start


elements• Detailed requirements• Impactful solutions• Involved Technical team from the start

• Used ROI and Productivity metrics to drive the To-Be solutions

• Detailed Use Cases / Business Rules

Impactful solutions• Client self-sufficiency

Detailed Use Cases / Business Rules



Our Client, a Government Fiscal Intermediary is in competitive bid to become a Medicare AdministrativeMedicare Administrative Contractor (MAC).Solutions• Cost Driven Program

StrategyStrategy• Prioritized program

elements• Detailed requirements• Impactful solutions4 Built Impactful Solutions Impactful solutions• Client self-sufficiency

4 p• 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


5 Enable Client self-sufficiencyContinual mentoring and technical guidance to

Our Client, a Government Fiscal Intermediary is in competitive bid to become a Medicare Administrative• Continual mentoring and technical guidance to

Client IT team • Developed systematic Knowledge Transfer

sessions


Strategy


sessions• Continue to provide tier 3 support to client







Strategy



elements• Detailed requirements• Impactful solutions

Client Successfully Awarded the Contract !• Measured cost reductions of 25% to 40% in

automated departments with seamless transition to Impactful solutions• Client self-sufficiency

pnew level of workload (2X)

• Improved Caller (customer) experience• Change Management mindset starting to take hold

throughout organization - Workforce less intimidated by continuous market dynamics / changing requirements


At A GlanceCase Study 2 – Improving on past performance

Problem

Our Client, one of the fastest growing privately held companies in the US operates an innovativeProblem

• Increasing claims expense threatened profitability operates an innovative insurance model for dual eligibles – people who qualify for both Medicare and Medicaid.

Solutions• Data aggregation• Data normalization and

tagging

and Medicaid.

tagging• Rules harvesting• Data Analysis• Identification of

corrective actionscorrective actions


Case Study 2 – Improving on past performanceAt A Glance

1 Assemble Team

Our Client, one of the fastest growing privately held companies in the US operates an innovative1 Assemble Team

• Internal subject matter expertise• External data expertise• Joint Security expertise

operates an innovative insurance model for dual eligibles – people who qualify for both Medicare and Medicaid.Joint Security expertise

• External rules harvesting and business analysis expertise


tagging

and Medicaid.





Our Client, one of the fastest growing privately held companies in the US operates an innovative

2 Aggregate Data

operates an innovative insurance model for dual eligibles – people who qualify for both Medicare and Medicaid.2 Aggregate Data

• Collect data files (4 sources) in a secure manner

• Identify relevant data components and relational


tagging

and Medicaid.

• Identify relevant data components and relational elements

• Build ‘data warehouse’





Our Client, one of the fastest growing privately held companies in the US operates an innovativeoperates an innovative insurance model for dual eligibles – people who qualify for both Medicare and Medicaid.

3 Harvest Rules• Examine high level questions to be answered


tagging

and Medicaid.

g q• Identify relevant data elements and formulas• Translate needs into a series of rule sets







tagging

and Medicaid.

4 Analyze DataB ild d l t i


corrective actions• Build and run rule set queries• Validate results with internal team

corrective actions



Our Client, one of the fastest growing privately held companies in the US operates an innovative

5 Results translation• Tie results back to original high level questions

operates an innovative insurance model for dual eligibles – people who qualify for both Medicare and Medicaid.

• Assemble report and recommendationsSolutions• Data aggregation• Data normalization and

tagging

and Medicaid.







tagging

and Medicaid.

Actionable recommendations and results• Expenses and historical business decisions better

understood


corrective actionsunderstood• 19.3% administrative PMPM cost reduction• 2500% ROI• Future business decisions informed

corrective actions


• Future business decisions informed

At A GlanceCase Study 3 – Passing the competition

Problem

Our Client, one of the top three health insurers in the US serving 18 million members across 50 states

• Functionality not yet existent promised to a new customer

members across 50 states

Problem• New customer service

functionality required for y qa large client in less than 6 months

Solutions• Existing technology• Existing technology

extended to include new features

• Two key service t h l i li k dtechnologies linked


Case Study 3 – Passing the competitionAt A Glance

1 Reprioritize technology initiatives

Our Client, one of the top three health insurers in the US serving 18 million members across 50 states1 Reprioritize technology initiatives

• Examine existing workload • Reshuffle to incorporate new client needs• Non-critical initiative timelines moved back



functionality required for Non critical initiative timelines moved back y qa large client in less than 6 months






Our Client, one of the top three health insurers in the US serving 18 million members across 50 states

2 Assemble team



functionality required for 2 Assemble team• Extended internal team technology expertise • Augment internal team leadership strength

y qa large client in less than 6 months






Our Client, one of the top three health insurers in the US serving 18 million members across 50 statesmembers across 50 states


functionality required for

3 Design Solution approach• Immediate CSR recognition of new members

y qa large client in less than 6 months

Solutions• Existing technologyg

• Customer Portal Online Chat capability• Storage of chat content

• Existing technology extended to include new features







Solutions• Existing technology

4 Execute• Existing CPM system extended to identify new

member callers alerting CSRs


• Two key service t h l i li k dmember callers alerting CSRs

• Chat dialogue text integrated into legacy call center database

technologies linked






Solutions• Existing technology

Functionality deployed• Aggressive timeline achieved• Service functionality met Customer expectations


• Two key service t h l i li k d• Service functionality met Customer expectations

• Existing technology investment leveraged• Two legacy call center applications linked for the first

time ever

technologies linked


time, ever

Results we’ve seen

• Reduction of Cost per Claim and PMPM Cost• Increased throughput with minimal impact on• Increased throughput with minimal impact on

operational cost• Leveraging existing technology investmentsLeveraging existing technology investments

through multi-tiered architectures and web services• New technologies increase competitive position byNew 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


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

Let’s talk some more…

Liz Gaudet• [email protected]

David Scholl• [email protected] @

• 518.428.4569@

• 321.626.3918

Jill BJill Burger• [email protected]• 518.225.7385

Joe Raiti• [email protected]• 518.461.1861


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