Large U.S. Independent Practice Association Improves Service, Efficiency and Compliance

IMPROVE SERVICE to health plan participants, ensure compliance with health plan contract SLA’s, and increase the efficiency of IPA and member-physician operations

Project Focus

• Customer Service, Medical Affairs, and Claims Departments in Health Plan Association and Member Clinics
• Assess, redesign, and implement new workflows, processes, policies, procedures and operational structures
• Improve service and performance

Client Gains: Financial and Operating Benefits

• Attained health plans’ standards of performance
• 83% improvement in processing time on incomplete claims
• 27% increase in claims completed, without increasing staffing levels
• 50% savings on materials costs for filing claims
• Reduced new-processor training time and costs from 12 weeks to six
• Increased calls handled per customer service rep by 33%
• Reduced abandoned call rate by 26%
• Cut correspondence turnaround time by 67%
• Improved authorization processing turnaround time by 25-30%
• Improved turnaround time on system updates by 93%
• 60% reduction in time spent routing mail
• Redeployed eight FTEs to new analysis unit at no additional cost
• Improved employee skills and management performance
• Saved 1.9% of total labor budget in first year

Key Changes that Supported Client Goals

• Centralized admissions and authorizations
• Integrated four specialized processing units into regular claims flow
• Consolidated provider and customer service functions, reducing staff requirements by four FTEs
• Improved tracking of authorizations
• Reduced amount of nurses’ time spent on clerical tasks
• Consolidated nine reports into a daily Key Indicator Report
• Redesigned wage and incentive plan
• Implemented streamlined and consistent practices and procedures
• Improved internal communications
• Improved staffing and scheduling to meet customer demand
• Developed employee skill assessment, evaluation and training tools

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