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

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

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Client: A prominent not-for-profit healthcare insurance organization
Industry: Insurance, Healthcare
Service: Workforce Management, High Performance Culture, Knowledge Transfer

Challenge:

Demand for improved revenue and margin performance in billing and payment services division of a not-for-profit health care organization
Delivering superior service across a spectrum of increasingly complex product offerings to growing membership
A desire to more fully engage the workforce to seize revenue opportunities

Solutions:

Process workflow and organizational improvement / redesign
Workforce management evaluation for total organization and each of the functional areas/cells
Collaborated with associates and leadership in the development of metrics, performance tracking mechanisms, communication protocol and a rewards program
Mentor/mentee relationship established with selected client team members allowing them to manage their own continuous improvement initiatives

Results:

Increased incremental revenue by $1.2 million
Increased revenue at the department level by 51%
More flexible staffing
Higher performing culture foundation established through the creation of standard metrics with increased individual accountability

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.

Guidon’s analysis revealed four key issues:

A misalignment of member volume and staffing numbers
Process inefficiencies that added excess time and cost to the operations
Gaps in skills that created inefficiencies
Lack of a foundation to achieve and maintain higher performance

To address the first issue, Guidon created a Workforce Management model that allowed the client to look at current state staffing levels and understand the impact of anticipated changes. The calculations revealed an initial staffing level 15% over the required FTE levels, which provided the company with the flexibility to shift staff, delay hiring, or reduce the workforce as needed.

Client teams then worked with Guidon to conduct rapid process improvement (Kaizen) events in each functional area, applying tools to improve process flow (via redesigned, streamlined processes). The resulting changes reduced lead time by as much as 50%, and decreased work queues (typically thought of as “backlog” in paperwork processes) by as much as 50%. The work areas also switched to a “cellular” work model, in which multiple process steps are handled in a single location rather than spread out at different work stations. This eliminated all daily transportation of work orders, and reduced the number of steps and handoffs between 35% and 50%.

Guidon helped the client address the third issue by developing a Skills Assessment Tool and Cross Training Matrix. The analysis helped them understand skill gaps that limited the workforce’s ability to quickly address member needs. Closing the gaps helped the division respond more quickly to members and handle work volume changes without increasing FTE or temporary workers.

The last issue was addressed through a High Performance Culture (HPC) strategy. Guidon worked one-on-one with team members and leaders to develop their skills, and develop metrics for each functional area that could be used for improved communication both up and down the corporate ladder. Guidon also created and implemented High Performance Culture tools such as Communication Boards and daily huddles, ensuring active, engaged participation at all levels of the organization.

The company credits these changes with:

Increasing incremental revenue by $1.2 million
Increasing revenue at the department level by 51%