The Pressure On Payers Is Relentless
Source: Payers and Providers – Volume 4, Issue 24 – June 21, 2012
By: Michael Frank, Chief Executive Officer of Blue Cross Blue Shield Montana
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Costs Must be Kept Down While Efficiencies Rise
No matter the outcome of the Affordable Care Act, the long-term picture for payers remains uncertain. Even if all the ACA provisions are enforced by the Supreme Court, there are still many issues to sort out. If some of the provisions are struck down, then other issues will be encountered.
There is one thing for sure, however, amidst all this uncertainty: though we can’t know exactly what changes we will face, none of them are going to ease the pressure on cost reduction and improved performance.
In an unpredictable business environment, Blue Cross Blue Shield Montana decided to give itself a physical and make process improvements to control what we could control. Over the past two years, we have reduced costs in a number of critical operational areas at the same time that we made it easier and faster for customers to do business with us.
One of the biggest challenges at BCBSMT was the increasing complexity of customer service. Our internal process improvement team collaborated with our customer service area implementing six sigma principles. As a result of these efforts, BCBSMT reached each customer service process improvement goal that we set: The average speed of answering the phone is now 10 seconds or less. Abandon call rates are down to less than 1%. A 50% improvement in the number of calls handled by a customer service representative each day.
While we had success performing process improvement with our own team, we recognized that we needed to establish more rigor around our improvement efforts and increase our scope to include more areas in our company. We partnered with Guidon Performance Solutions, which deployed experienced process improvement Black Belts or coaches who helped us involve all employees in embracing and applying lean six sigma improvements. Guidon conducted an initial assessment of our company by interviewing approximately a third of our employees to identify areas that would most benefit from process improvement.
They then set up a number of kaizens (highly focused process improvement work sessions that included a cross section of employees) to focus on solving the most obvious roadblocks and waste points quickly.
One of the first projects was improving the claims processing workflow in our medical management area. We physically moved all the departments to a single location to create real time, face-to-face collaboration. Previously, the teams were divided into separate areas, which hampered their ability to make decisions on treatment and reimbursement. We also trained employees on multiple system software and programs so that they could recognize efficiency improvements between the different divisions. Taking a more collaborative approach and applying data methods has:
- Reduced the claims processing backlog
- Reduced the appeals backlog
- Resulted in double digit improvement in productivity and responsiveness.
Other departments followed suit and realized similar improvements. These are exactly the kinds of gains that all healthcare insurers must achieve given regulatory demands and the likely increase in insurance choices for consumers. Continuing market changes provides a clarion call to act pre-emptively to improve cost, quality, and responsiveness as well as mobilize employees to raise their improvement consciousness and customer centricity.
Michael Frank is the Chief Executive Officer of Blue Cross Blue Shield Montana.
All contents © 2012 Payers and Providers Publishing, LLC. All Rights Reserved.
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