Health Care Case Study
Case #3955: Dental and Vision Operations - Regional Consolidation
A leading Health Insurance and Managed Care company required assistance to prepare for the consolidation of its multi-state dental and vision operations to one regional location. The increased dental and vision membership in the one selected location would require a 300% increase in current site capacity.
This initiative focused on a review of current processes, staffing models, operational metrics, service levels, leadership training, forecasting, reporting and current infrastructure to plan, migrate, report and operate a consolidated regional operating center. It also included identification and prioritization of longer-term process improvement opportunities, and alignment of leadership styles with the parent organization's approach to help further position the dental and vision organization for future growth.
The scope of the initiative spanned Claims, Membership, Billing, Customer Service and Provider Relations.
Engagement Highlights
- Industry:
- Health Insurance - Dental and Vision Operations
- Client:
- A Multi-state, Leading Insurance and Managed Care Company focused in the dental and vision operations
- Assignment:
- Gain an understanding of the Dental and Vision organization, metrics, processes, reporting, performance attainment, staffing models, challenges, and current infrastructure for growth
- Conduct interviews with area leadership and content experts, and conduct process observations to identify service and process improvement priorities and opportunities
- Develop a gap analysis of current and future state improvement opportunities
- Assess current staffing models and staffing levels by functional areas to prioritize improvement opportunities
- Develop staffing and business forecasting model templates to project resource requirements.
- Establish current work volumes and associated staffing levels as a baseline for comparison of improvements
- Identify and assist implementation of immediate process changes to improve service performance, metrics, reporting and service delivery
- Identify, document and prioritize longer-term process and service improvement opportunities for future review, assessment and implementation
- Evaluate and enhance current performance management tools including: inventory management, employee performance reporting, accuracy reporting and inventory aging
- Approach:
- Detailed Appraisal/Accelerated Implementation
- Designed Infrastructure Tools and Techniques for Uniformity with Other Corporate Initiatives
- Embrace and Integrate Internally Generated Initiatives
- Duration:
- 4 weeks (spanning 6 calendar weeks)
Results
- Development of aggregate and unit baseline staffing, and Telephone Tiering models
- Identification of 17% to 27% of additional processing capacity
- Development of Claims, Customer Service, Membership and Billing baselines and staffing models, along with a focus on attainment of improved claims performance
- Development and documentation of infrastructure tools, and the ongoing reporting necessary to monitor the full and consistent implementation of improved processes