National Healthcare Payer | $15B Cost Reduction Effort
Creating next-level efficiencies while maintaining a high level of customer satisfaction is no easy task – but digitizing back-office operations can unlock powerful savings while also allowing employees to focus on value added services to customers.
That’s what a major national health plan hoped to achieve with its $15B enterprise cost reduction effort.
Our partnership included:
When cost-reduction efforts include a focus on customer and employee experience, they can achieve transformational improvements in satisfaction and loyalty—positioning the organization to thrive.
Providing excellent customer experiences AND having the flexibility to reallocate business resources. That was the opportunity that our client hoped to realize.
It was clear that achieving this goal would take more than a strategic reorganization of the back-office provider support network. It would require rethinking its back-office operations to be more digital – to help better align workload while maintaining best-in-class service levels.
Drawing from deep experience in health plan operations and technology, our cross-disciplinary team knew we needed a people-first approach. Through collaborative workshops, stakeholder discussions and over 500 hours of job shadowing, our team qualitatively mapped workflows and responsibilities for each role. We then used statistical analysis on task-level data to determine high-impact activities and define role-based expectations.
The result? Over 100 process improvement opportunities identified where we could automate manual, paper-based processes, remove redundancies, and redeploy and upskill resources based on skillset.
Next we created a resource capacity planning solution (based on predictable, trackable demand drivers) that calculated the required hours and full-time equivalent resources by department, allowing the client to reallocate people in response to work volume changes.
Finally, we implemented a series of trainings through small focus groups, town hall meetings, and QA sessions with leadership and staff to drive engagement. These helped to foster a digital mindset – flexible, agile and customer-focused – across the organization to ensured lasting impact.
Our client was looking to reduce costs, increase flexibility and provide excellent customer experiences. The engagement delivered, translating into real business value – fast.
For our client, improving provider experience was critical to market differentiation – as well as an opportunity to reduce cost by automating manual activity and creating a more digital operating model.
Responding to feedback from its provider network, it was clear that the onboarding process (including activities such as enrollment, credentialing, contracting, orientation, and updates) needed to be overhauled. The system took up to five times longer than the industry average of 15 to 20 days, which could lead to delayed patient care, since some doctors could not see patients until the process was completed.
With the end-goal of shifting onboarding from a 100% manual to an 80% digital and automated activity top of mind, our approach focused on delivering short-term results while preparing for the longer-term technology and organizational impact of the digital journey.
Our multidisciplinary teams relied on customer experience, technology, operations and healthcare expertise and worked with flexibility and speed, focusing on quick wins. This helped to spark enthusiasm and belief in the engagement – critical to its success.
We worked closely with providers to better understand their experience – both online and off, and designed a data-driven model, based on personas and journey maps, to help key internal stakeholders align on a comprehensive onboarding strategy. Next, we created the architecture to bring this vision to life, and ensured that analytics were in place so that the company could use operational data to create differentiated digital experiences. Finally, we helped create a three-year implementation plan to achieve the 80% automated onboarding goal.
To further support the organization’s mind shift from simply doing digital, to truly being digital, we set up a business transformation office dedicated to implementing the process, technology, and organization structure changes, while we continued to provide change management support and lead certain initiatives.
This project went far beyond just automation , it helped the health plan adopt a digital operating model – and busted the myth that reducing cost and improving experience is an either/or proposition along the way.
The company can onboard providers 95% faster – beating the best-in-class competitor and allowing providers to begin delivering patient care faster. As the 80% automated journey continues, more and more self-service options are available for providers. This makes providers happy, allows client staff to focus on higher-value work, and is expected to reduce process costs by 44% over five years. The benefits will only continue to grow as the organization plans to expand this initiative to include ancillary specialists such as physical therapy and behavioral health providers.