Client : Large Health Payer reduces cycle times and improves quality creating a more efficient open enrollment process

Business Issue:

Having struggled the previous year to effectively monitor the open enrollment process, this large healthcare payer wanted to not only improve the monitoring capability but also eliminate waste and make the overall process more efficient.  Having worked with Himes Consulting Group (HCG) successfully in the past, HCG was asked to create a strategy that would address all these needs and be ready for implementation during this years’ open enrollment.  Working with HCG, the organization recognized reduced cycle times of their renewal process by 50% and improved quality of their single record data source which saved money on faster more accurate processing. 

Client

The organizations goal was to develop, implement, and train on an integrated process, people, and technology solution prior to the next open enrollment season.  HCG was engaged to accomplish the following key outcomes:

• Define the most efficient and technology-supported end-to-end Group Implementation business process
• Define the requirements for and lead the solution of the technology to be used to support the newly defined process
• Implement the overall program associated with the process change, technology change, data migration and change management needed.

 Challenge

The organization needed to:

• Define a strategy to overcome several issues with the current new group and renewal process
• Have a solution implemented prior to their next open enrollment season
• Overcome manual processes that were prone to errors, contained multiple handoffs, and excessive rework within the processes
• Create an audit trail so the organization could be efficient and place and hold accountability where appropriate
• Define a single source of truth that would be the master record for any group in the process

Solution:

HCG performed the following activities to achieve these outcomes:

• Developed and gained approval from the Executive team on a redesigned strategy for New and Renewal Group Implementation: 
  • Process, Technology, and Organization redesign
  • Detailed Cost Benefit Analysis
  • Prioritized Implementation Plan
• Led the definition of need and the selection process for the necessary supporting technologies
• Conducted training and rollout of the new process, roles, and technology for over 700 users.
• Performed overall Program Management to ensure successful initiative by providing:
  • Communication
  • Executive reporting
  • Issue management
  • Cross-project risk mitigation
• Performed Process Assurance activities to ensure adoption of the new process and technology across the user base