CASE STUDY

Using BPM to Stabilize the Processes in a New Managed Healthcare Provider

Background

A two year old managed healthcare provider has gone through a rapid standup growth phase. Membership has stabilized and management has observed that the processes they started with are now out of date and in some cases out of control. Departments were very insular with no end to end process measurement or ownership. The CEO and COO want to breakdown departmental barriers and define core processes and process owners.

Solution

Starting with a pilot project in contracting, the organization gained confidence in a basic process management approach, implementing process ownership, and process metrics. The next work was focused on Medical Management and Claims. On going, we will be building capability in the organization to improve performance of the organization’s core processes.

Results

The original contracting process reduced cycle time by 20%, with the potential of reducing it by an additional 20% with corporate involvement. Visual management boards have been designed and implemented for Medical Management. Many personnel have developed new skills in process management, measurement, and control and implemented these in their area.

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