What We Did

When a major national healthcare payer launched a $15 billion enterprise cost reduction effort, it turned to West Monroe’s cross-disciplinary team to envision new ways of working that would lead to next-level efficiency while maintaining a high-degree of customer satisfaction. 

Our projects included: 

• Reorganizing back-office provider support to empower productivity and free up employees to focus on high-value initiatives
• Redesigning the client’s approach to onboarding new providers that improved provider experience while saving significant time and money  

The Opportunity

When a large national healthcare payer undertook a $15 billion cost reduction initiative, it faced a difficult dilemma: How to reorganize its back-office provider support network to better align with workload while maintaining best-in-class service levels.

But this challenge also posed an opportunity to work smarter and serve better. The healthcare payer teamed up with West Monroe to:

• Empower productivity
• Reduce unnecessary labor
• Free up capacity for high-value initiatives

An Undeniable Approach

Drawing from deep experience in health plan operations and technology, our cross-disciplinary team knew the solution would be in the details. So we got to work:

• Observing: Through workshops, stakeholder discussions and over 500 hours of job shadowing, our team qualitatively mapped workflows and responsibilities for each role
• Analyzing: We then got quantitative, using statistical analysis on task-level data to determine high-impact activities and define role-based expectations
• Optimizing: During our observation and analysis we uncovered over 100 process improvement opportunities
• Training: Finally, we trained client teams through a series of small focus groups, town hall meetings, and QA sessions with leadership and staff

The Output

Our resource capacity planning solution delivered calculated the required hours and full-time equivalent resources by department, allowing the client to reallocate people in response to work volume changes. Each model is based on predictable—and trackable—service demand drivers like call volume, number of doctors added to the database, and errors requiring research, meaning the healthcare payer could live up to its customer service reputation while reallocating business resources when needed.

Returns You Can Measure

A project like this is only meaningful when it translates to real business value. Our collective work delivered:

• 20% lift in productivity—that allows the client to redistribute people and resources toward value-adding projects
• $8 million in annual savings through process improvements—including streamlining operations and deploying robotic process automation
• 100+ additional process improvements identified to yield additional savings

The Opportunity

Responding to feedback from its provider network, the payer needed to overhaul its process for onboarding new providers. Onboarding, which includes activities such as enrollment, credentialing, contracting, orientation, and updates, took up to five times longer than the industry average of 15 to 20 days. This delayed patient care, since some doctors could not see patients until they completed the onboarding process. 

Improving provider experience was critical to market differentiation. But it also presented an opportunity to reduce cost by automating manual activity. Together, our organizations got to work making that happen.

An Undeniable Approach

Our multidisciplinary team of customer experience, technology, operations excellence, and healthcare experts collaborated to improve provider experience – while also reducing process costs significantly. We did this by:

• Observing: We interviewed providers and observed elements of the onboarding approach to understand the current experience. 
• Analyzing: We reviewed primary and secondary data and used that to model various actions that could improve experience.
• Envisioning: We created personas and future journey maps to enable the client’s stakeholders to see and reach consensus on a comprehensive onboarding experience strategy.
• Designing: We developed new process maps and technology architecture for making the vision real.
• Planning: Finally, we created a three-year implementation plan. Our approach focused on delivering short-term results while preparing for the longer-term technology and organizational transformation. 

The Output

• Quick wins: We targeted immediate opportunities to increase provider satisfaction with little to no required technology investment. 
• A longer-term transformation plan: We worked with the payer to create a three-year plan for shifting the process from 100% manual activity to 80% automated activity.
• A dedicated transformation team:  We set up a business transformation office dedicated to implementing the process, technology, and organization structure changes. West Monroe leads the transformation office and certain initiatives and provides change management support.
• Analytics: The technology enhancements create new capabilities for the company to access and use operational data to create differentiated digital experiences. 

Returns You Can Measure

This project busted the myth that reducing cost and improving experience is an either/or proposition. The payer is realizing tangible gains in both areas:

• New remediation steps reduced fallout (providers who don’t successfully move to next step of process) by 10% in the first two months
• First-call resolution rate increased from 73% to 85% after employee training
• Provider satisfaction scores increased by 20% in less than two years
• The company can onboard providers 95% faster – beating the best-in-class competitor and allowing providers to begin delivering patient care faster

As the onboarding process continues to shift from 100% manual activity to 80% automated activity, the client adds more self-service options for providers. This makes providers happy, and it allows client staff to focus on higher-value work. 

The company expects automation to reduce process costs by 44% over five years. And the benefits will only continue to grow. The company plans to expand this initiative to include ancillary specialists such as physical therapy and behavioral health providers.