Lean Process Improvement in Health Care Insurance Claims (A Case Study)
 |
Project: Our client, a major national health care insurance corporation, asked us to reduce written inquiry inventory from 10,000 to 3,000 in an efficient and speedy manner as well as create a new workflow process to prevent the inventory build-up in the future. Our scope included the following:
|
|---|
- Understand what kind of inquiries are being received and why telephone write-ups are so high
- Perform a current state process analysis including workflow, customer interaction and roles of personnel
- Provide recommendations on process improvement
- Assist in implementation of those ideas
- Establish a personnel training plan and skills assessment
- Consolidate management reports
- Perform time studies to determine rates of work
- Determine operator metrics to encourage accountability
- Perform organizational structure benchmarking research
- Determine how to best eliminate overtime
OPPORTUNITY: The objectives of this project were to increase customer satisfaction, lower costs and acquire more business due to quick inquiry turn-around times. The client wanted to reduce overall operating costs, including overtime hours and office supply expenses, along with reduction in inquiry processing time.
APPROACH: In order to accomplish the goals above, we formed a cross-functional team to conduct a walk-around analysis and then confirmed the current state in a workshop with all the customer service representatives. Problematic issues within the process were identified and methods to address the issues were listed. This developed into a four phase future-state implementation approach. SIMUL8 simulation software was used to simulate the future state and a bottleneck analysis was performed to identify the problems to attack first. Data were collected on productivity, closed cases, number of hand over cases and overall time-in-process. It was very important to keep the workgroups involved in this process to ensure success with the new process.
SOLUTION: Our solution included several lean principles including visual workplace, error proofing, just-in-time processing and other management tools such as organizational structure, roles and responsibilities and real-time data reporting. The solution included four phases of implementation (immediate phase, phase 1, phase 2 and phase 3).
BENEFIT: The client was able to accept more business as a result of faster turn-around times. Overtime costs were reduced and significant processing time was saved. Higher customer satisfaction ratings were noted due to more accurate and efficient inquiry processing.