American Healthcare Insurance Company Goes from 65th to 4th Position in Six Months

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CLIENT

 

The client is a large American healthcare insurance company, with $10 billion revenue and approximately three million members. The insurance giant is an independent member of the Blue Cross Blue Shield Association (BCBSA), with 65 Blue Cross plans serving across the United States (US). The client wished to change its blue exchange score, which was at an all-time low.

BUSINESS CHALLENGE

 

The client had a low score of 79.84 against the green target of 96, placing it in the last (65th) position on the Blue Cross Blue Shield Association’s (BCBSA) blue exchange score (transaction response among blues). As a result, the client faced penalization from the BCBSA. However, the client’s resources were constrained by parallel mandates and upgrade releases. In addition, its cost deficiency was further aggravated by its costly, captive level 3 support onshore with limited operational flexibility.

SOLUTION

 

Our team used Lean diagnostics to identify and solve the following problems: repeated issues across systems, outdated manual monitoring and reporting that required automation, and ineffective co-ordination among the operations, development, and testing teams. Our solution included:

• Lean diagnostics to identify and solve problems

• Transition from captive support to an offshore level 3 team

BENEFITS

Our solution enabled the client to:

 

• Increase its blue exchange score to 99.82 percent in just six months

• Get ranked fourth among 65 blues

• Ensure no impact to releases and mandate timelines

• Improve customer satisfaction with 100 percent real-time eligibility responses generated within five seconds

• Save approximately $0.5 million in costs

• Free resources to focus on further system improvements