Case Study

Background

A 3-million-member health insurer expanded over 5 years through a series of mergers, acquisitions and expansions. While the organization and the market had changed, there wasn’t a thoughtful change of process for their team that focused on providers, contracting and continuing network expansion.

Solution

Leveraging our team’s significant experience with process excellence in managed care, we performed an assessment and led projects for their network team to transform it into a modern, provider-centric team. The assessment provided recommendations in both quick hits and longer-term time frames. Our team drove projects focused on project prioritization management, reduced transactional waste and improved root cause analysis for provider claims issues.

Results

Two quick hits were implemented to reduce administrative time on key processes by 75%, increasing the provider network team’s engagement scores by 2X. A strategic prioritization method was implemented to focus the team on critical projects and minimize team member overallocation to projects. In addition, a project focused on claims escalation significantly improved response times to providers’ claim complaints and increased provider satisfaction.

Want to see results like this at your company? Contact our team to learn more.