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Case #9930: Health Care Provider Organization – Network Operations and Care Management Service Improvement and Cost Reduction

The Health Care Provider Organization (HCPO) of a leading Health Insurance and Managed Care company was performing below par. Costs were high, processes and procedures were inconsistent, and alignment with corporate goals was limited.

We were called upon to analyze and improve each of HCPO’s five major operational components: Intake, Pre-certification and Review, Disease Management, Case Management, Credentialing and Provider Database. In addition, the engagement included an overall review of Management Spans of Control.

Following and in-depth Analysis and Design phase which identified a range of improvement opportunities and savings, a client team was established to work with us to implement the identified changes in an intensive six-month period. These changes helped increase staff productivity and service, and delivered annual savings in excess of $10 million.

Engagement Highlights

  • Industry:
  • Health Insurancei and Managed Care
  • Client:
  • A Leading Insurance and Managed Care Company +/- $4 Billion Annual Revenue and +/- 6,000 Associates

  • Assignment:
  • Reengineer Processes to Improve Quality and Cost of Care
  • Reduce Resource Needs and Generate Savings of At Least $2 Million
  • Implement Standard Metrics and Reporting
  • Optimize Management Spans of Control
  • Approach:
  • Current-state Appraisal/Best Practice Implementation
  • Cross-functional, Team Centered Focus
  • Identify Process and Performance Gaps Across Locations
  • Structured Management and Employee Interviews
  • Consolidate Facilities and Locations
  • Duration:
  • 34 Weeks (8-week Assessment & Design, 26-week Implementation)


  • Achieved Annual Savings in Excess of $10 Million
  • Pre-Certification and Referral Calls Reduced over 70%
  • Case Management Workloads Balanced and On-Site Visits Reduced
  • Average Management Span of Control Raised from 4.5 to 10

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