Integrated Process Improvement Plan for HMO
A comprehensive process review produces an action plan for addressing key issues—followed by efficient implementation of several of the highest-priority initiatives.
Date : October 19, 2012
West Monroe reviewed the company's processes, identified and documented key issues and developed 18 action-ready initiatives to address them.
Industry:

The client is one of the largest and most diversified health maintenance organizations in the Midwest.

Solutions for immediate issues.
In early January 2010, the client’s leadership became aware of numerous issues regarding the quality of the benefit plans configured to support the January 2010 renewal groups. Leaders made the decision to suspend all claims payments for January and February renewal groups and launched a full-scale audit.

The client sought to resolve the benefit plan issues that led to suspension of claims payments by conducting an end-to-end review of current processes that touch its benefit plans. These processes included:

  • Benefit product changes
  • Group renewal
  • On-boarding
  • Plan implementation and sustainability

Specifically, the client wanted a solution that created a data store to be used in quoting, rating, benefit set up, and benefit collateral communication, allowing internal and external users to reference and consume data from a single source of truth.

Deep industry expertise and a proven approach

Following a rigorous proposal process, the client chose West Monroe Partners to assist with the initial review. West Monroe Partners offered deep industry knowledge, proven methodology, a solid cultural fit with the organization, and competitive pricing.

From analysis to implementation in three phases.
The first phase of work focused on identifying issues facing the client and on making recommendations to address those issues. To accomplish this, the West Monroe project team mapped the current state of the client’s benefits processes. By reviewing the client’s documents and conducting interviews with the client’s subject matter experts, the project team identified “pain points” that contributed to the January breakdown. Next, the team designed and prioritized 18 initiatives that addressed the pain points by improving the accuracy and efficiency of benefits information related to the processes. Finally, the team mapped what “future state” processes might look like if the initiatives were implemented, illustrating how the initiatives could help.

Based on the success of the first phase and the expertise contributed by the West Monroe project team, the client engaged West Monroe Partners to complete three of the highest priority initiatives:

  • Repository of for-sale, as-sold, and quoted benefits
  • Single entry point for benefit data
  • Analysis of for-sale plans

During the project’s second phase, the West Monroe Partners project team partnered with subject matter experts from each department involved in the benefit information processes to compile a complete list of requirements for maximizing the value of the repository.

Several key findings arose from this process:

  • A search application would be necessary to replace a current-state source of truth
  • Pre-2011 quote data would not be stored because it confused users with out-of-date information that did not provide any value
  • For-sale options should be updated to better align with market trends and corporate strategy
  • Business rules associated with benefit combinations should be compiled in a single location, as there was no formal development or maintenance process

The project team incorporated all findings into mock-ups of the repository, search, and single-entry-point input/edit applications and tested these with subject matter experts. Through a series of in-depth demonstration and feedback sessions, the project team refined the final requirements and created the framework to build the repository.

The third phase of work concentrated on designing and building a production-ready repository. The client originally planned to build the repository in house; however, given a shortage of available technical resources, it chose to have West Monroe Partners complete the work. Using refined mock-ups and requirements documentation developed during phase two, the project team built test versions of the repository and applications. The team then  designed user acceptance testing scenarios that allowed users from each department to assess the test versions. This simulated environment allowed the team to tailor the repository and applications exactly to users’ needs.

After completing the user tests, the team facilitated high-level training for core users and assisted with the company- wide roll out. Finally, the team migrated relevant historical benefit information into the new system. This final step allowed the client’s users to begin utilizing the repository fully as a single source of truth for quoting new and renewal business.

Current benefits, with the potential for further integration.
By working with West Monroe Partners to review and improve its processes, the client gained a number of benefits:

  • Documented key issues and 18 action-ready initiatives to address them
  • Current-state and future-state models for the sales-to- set-up process
  • A comprehensive, live repository of benefit information
  • An enhanced search tool that is faster and easier to use
  • A new modified quote tool that improves accuracy and efficiency by eliminating two manual steps
  • Improved accuracy and efficiency of benefits-related processes

At the same time, the client established a framework for further integration, which could result in additional improvements in accuracy and efficiency and eliminate additional manual process steps.

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Date : May 24, 2017 Time : 05:00 PM PST


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