Managed Healthcare Plan Leverages Lean Six Sigma To Navigate Rapid Growth

Background

A $8B managed healthcare firm had experienced rapid growth over a 10-year period, doubling in size and membership in the previous 2 years. Processes had evolved over time, but the organization was struggling to keep up with new membership, provider and regulatory requirements. The CEO wanted to move from “constantly fighting fires” to “proactive process management and design” using a more process, customer and data driven methodology.

Solution

We performed a top-down assessment of the organization, to identify and quantify improvement opportunities. Some of these turned into projects for Black Belts and Green Belt that we trained and coached through implementation. Others were larger projects we managed, focusing on streamlining the claims error process, on-boarding new providers, as well as creating robust workforce planning models for every department.

Over the course of this engagement, we led projects in most major areas of the business, including provider data management, network development, provider setup, provider relations, claims resolution, call center, member enrollment, medical management, case management, and service coordination.

Results

The program has had greater than 10X ROI since inception. Training has included multiple waves of Green Belts, with a Black Belt wave as well. Executives were trained as Yellow Belts, and 30 VPs and Directors have been trained in BPM methods. Assessment work throughout the engagement identified significant opportunity. For example, a $3.5M opportunity was identified in call center optimization. The Firefly team also led consulting projects that created significant ROI, and built rapid momentum for the continuous improvement efforts.

Additionally, the team developed a complete end-to-end workforce determination model for the 3600+ positions across the entire organization. The model, with over 3200 variables, gives leadership the ability to consider outcomes of various changes before they are implemented. It projects staffing growth, identifies improvement opportunities, and shows collateral relationships. It was built to reflect product vs. organization linkages in order to be robust to organizational changes. It was instrumental in accelerating the annual operating planning cycle from weeks to days.

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

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We have consulting experience with engagements as diverse as mergers and acquisitions, operations strategy, supply chain acceleration, shop-floor process improvements, and call center efficiency improvement.

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