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Remembering Mike

December 21, 1954-
August 9, 2012

 

New Blog Post

Four Themes to Successfully Navigating the Supreme Court Decision

The decision by the U.S. Supreme Court to uphold the controversial Patient Protection and Affordable Care Act confirms the direction of healthcare reform that had already begun a few years ago.  Many payers and providers, responding to the slowly emerging regulatory architecture of the law, have embarked on large scale transformational initiatives which will fundamentally change their business models forever.

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New Article

Payers and Providers: The Pressure On Payers Is Relentless

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. 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.

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Insurance Case Studies

Optimized Allocation of Improvement Resources

A healthcare insurance company that was deeply involved in improvement found that it had reached the point of project overload, and didn’t have enough resources to complete all the projects it wanted. Plus, there was a need to cut expenses in the current year.

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Improving Disability Claims Processing

The disability claims department of a Canadian insurance company, that served primarily small to medium-sized businesses, was concerned about how long it took to process claims from notification to decision. Customers were unhappy and the company was putting its ability to purchase reinsurance at risk.

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Reducing Backlog and Improving Underwriting Performance

For more than a year prior to April 2011, this large health insurer located in the Mountain West Region, had seen a growing backlog of applications in the Individual Underwriting department. Agents and potential customers alike were unhappy, and the company put a priority on solving the problem before its reputation suffered.

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Process Optimization in Patient Financial Services

As a revolutionary healthcare organization of the 21st century, Kaiser Permanente’s mission is to provide quality care for their members and families.  Committed to this vision, the Patient Financial Services division identified potential areas for improvement in the back-end revenue cycle for five major service lines.  Due to the complexity of the processes in these service lines, it was an ideal area of the business to begin a structured improvement initiative.

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Improving Member Experience with a Health Insurance Call Center

A call center for a large national health benefits company had been adding staff rapidly in response to their business growth and increased volume, which had reached about 2 million calls a year. Though the “throw bodies at it” approach was expedient, it ultimately created some problems, chief among them poor member and provider service along with excessive costs. To position the company better for continued growth, senior leadership asked Guidon to help them simplify their approach to servicing members and providers while bringing down operating expense.

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Achieving Performance, Cost Reduction and Revenue Goals in a Health Insurance Organization

The financial services division of a not-for-profit health insurance company was struggling to continue to provide superior service in the face of an increasingly complex product line and growing membership. The company turned to Guidon to help it achieve performance, cost reduction, and revenue goals.

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Improving Recruiting and Hiring Process

A major financial services company was having people trouble. The company wanted to scale and add services without adding more complexity to its human resources department. However, its hiring process had several inefficiencies.

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Streamlining Work Flow in Insurance Operations

The company's management sought to engage employees in business process management and find ways ways to standardize work, enforce standards, and create a more effective work flow. The team's objective was to be 100 percent compliant with facility standards and increase capacity by as much as 20 percent.

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Reducing Time and Expense To Underwrite and Issue New Business

One of the world’s largest insurance groups, with 57,000 employees serving 45 million customers in 27 countries, was struggling with its North American New Life Business Operations. The company found itself celebrating the prospect of a 100-percent increase in business, but stressing over the challenge to grow profitably with the current operating model.

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Payer and Insurance Provider Work Together for Joint Porcess Improvement

A $57 billion health insurance provider wanted to pay claims faster, reduce the number of denied claims and mistakes and find a method to propel continuous improvement of the payment process. Guidon helped the company do this and reach its overall goal of creating a better payment and revenue-cycle experience for both patients and healthcare service providers that participate in its insurance programs.

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Contact us or call us at 1.866.986.4414 or 480.986.4414 (for international callers) for more information regarding how a Guidon solution can help your organization.