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Healthcare Competency Overview
10th May 2011
Corporate Overview
3
About HGS
• Global provider of BPO and customer support solutions
• 37+ years, 250 M calls, 40 M claim transactions per year
• 107 clients, 20,000+ employees, 7 countries, 32 Centers
• $240 million in revenue , Listed Company, S&P CRISIL- AA
• ISO 9001, ISO 27001, HIPAA, GLBA, PCI, eSCM (2012)
Services Where And When You Need Them
USA Canada PhilippinesIndia MauritiusU.K. Jamaica
4
Industries
Healthcare and Insurance
Telecommunications
CP, CG, and CE
Logistics, Transportation, and Others
Banking and Financial Services
Diverse Industry Experience
5
Key Business Drivers
Committed People, Defined Processes, and Cutting-Edge Technology
People
Process
Technology
• Agent Partnership Approach• Tenured global management teams• Bridging Emotions & Economics with local leadership
• Business Excellence (BE) – Dedicated organization• Cross-functional process enhancements – AIM, SPARK• Compliance – HIPAA, SAS 70, GLBA, ISO
• World class and flexible solutions – PMS Systems• Scalable across HGS’ global locations – Inter connected• Secure – Serving data security needs of large payors
6
Industry Recognition
Winner: Most Innovative BPO in 2008
Philippines
Top 10 Employers Employee Satisfaction /
HR Practices
1 of 200 “Best Under a Billion” Forbes Asia
October 2005
Gold MedalistCompetency Development
Gold Medalist Competency Development (2008, 2009, 2010)
Seal of Product Quality National Product Quality
Excellence AwardAugust 2005
Top 20 by Industry Focus – Healthcare
Top 10 – Services Offered Top 10 – By Region Served
Gold Medalist Lean Six
Sigma
No. 30 in the Top 50 Fastest Growing Companies in India 2009
Technology Fast 50 India 2009
No. 16 in the Top 20 BPO Employer for 2010
Top 15 ITES BPO Exporters FY 10-11
One of the Top ITES Companies in India
7
100
75
50
25
50-55%
75.7%
+100
+75
+50
+25
+40-45
+62
4.8-5.5
5.8
7
6
5
4
3
2
1
6
5
5.6
5.69
5.96
5.7 5.7
5.86
5.1
5.56
Industry Average Vs HGS Industry Standard Vs HGS
HGS HealthcareEngagement to
Excellence
9
Payor Expertise
Member Services
Provider Services
Plan Sponsor Services
ClaimExperience
40 Million Claims
High Dollar & Complex
HCFA / UB04
Claims
Calls Experience
Member Calls – 1.5
Million Calls
Provider Calls – 6.5
Million Calls
Operational Expertise
1st in Quality -
All Delivery Centers
99.8% Pay Incidence Accuracy
Compliance
HIPAA
SAS 70
GLBA
Process Enhancements
All Ideas Matter -
AIM
Diet Six Sigma
Sharing Best
Practices - Spark
People& Tenure
200 claim Associates
at 100% QA in 2010
Average Leadership Tenure
of 7 Years
Over a Decade of Healthcare BPO Experience
Scalability
Annual Growth of 60% for Last 10 Years
Blended Shoring
DR & BCP
2000
2011
HGS Healthcare Overview
E n g a g e m e n t E x p e r i e n c e E x p e r t i s e E x c e l l e n c e
Performance Management
System
10
Payor Services Data Transaction
Onshore Calls Function
Plan Administration and Support
SalesSupport
UnderwritingSupport
Plan LoadingAnd Setup
Plan Testing
BillingPremium
450 FTEs
Claim Services and Support
Mailroom andScanning
Claims DataEntry
ReferralEntry
Claim Audit & MedicalTriage
Claim Payment& Review
2100 FTEs
Provider Services and Support
Provider Correspondence
Provider Customer Service
Provider Network Calls
Pre- AuthorizationCalls
Claim Rework Unit
900 FTEs
Member Services and Support
Benefit andEligibilityCalls
Claim DisputeCalls
PremiumPayment
Plan Renewal
WellnessCareSupport
300 FTEs
Research andRecovery
OverpaymentValidation
OverpaymentRefundRequest
OverpaymentRefundPosting
FraudResearch
RefundCalls
500 FTEs
11
Perfect Service – Journey and Milestones
DRC`
Network Mgmt
Delegated
Correspondence
SIU
Under and Over payment
Provider Investigations
Dental FR
19 Processes
Product Implementation
Claims Research / CORR
Underwriting (UAS)
Account Receivables
Case Review Entry
Clinical intake & Provider Loading
Wellness & Point of Care
Fulfillment center
IT infrastructure support
New Business Quoting
34Processes
Batch Suspended Inquiry
Special Projects
Provider Calls & Individual Plans
Dental Claims Rework Unit
Cash Posting
21 Processes
Provider CallsMedical
(Level 1 and L2)65 FTEs
275FTEs
450 FTEs
1820 FTEs
850 FTEs
5 Processe
sProvider Outreach
Medical Claims
Certificates
Dental Claims
2003- 2004 2005-2006 2007-2008 2010 - 20112009
Bangalore Bangalore Bangalore /Chennai India / Philippines India / Philippines/ US
Legacy Platform Mainframe / Windows Platform
Legacy Platform/Mainframe Platform
Legacy Platform/Mainframe / Windows Platform
Mainframe / Windows Platform
Claims Administration
Eligibility Check Process
Counter Mgmt
Plan Testing
Dental Claims
11 Processes
Product Build
12
Define To reduce the Reroute of claims and thereby reduce cost of claim processing
Measure and Analyze
Percentage of reroutes were measured during transition The categories of edits and reasons were tracked and analyzed
Improve
Incorrect duplicate edits were identified and eliminated Provider function edits and errors were identified and process improvement were recommended Reroutes because of skill set gap were identified & team was trained to eliminate the reroutes System up gradation issues were tracked, and therefore errors reduced
Control
The reroutes reduced from 31. 4% to 0.11% The edits were continuously monitored to identify opportunities for improvement and process
improvement solutions recommended
Impact
Example 1 - Claims Adjudication
Re-Routes Reduction from 31.4% in Dec 2005 to 0.11% in Jan 2011
13
Example 2 – Special Investigations Unit
• Purpose and Objective : To reduce documentation errors and standardize the process
• The Challenge: Incorrect documentation
• The Solution: A documentation tool was developed
• Benefit: Tool has been adopted by the client
0
10
20
30
40
50
60
70
80
Jan Feb Mar Apr May Jun Jul
72
34
13
5 3 3 2 2 2
Task element documented Letter Verbiage correct Task created correctly
Correct Letter Sent Letter sent Other
Denial Code Correct Remarks created correctly Task result correct
Jan ’09
~50%Errors due to
Documentation
Jan ’09 to Jul ’09
72 Errors Reduced to 0
Improving Performance with Focused Process Improvement
14
14
Example 3– Product Build• Purpose and Objective : To automate the initial phase of rider mapping before loading to Dynamic Plan Load.
• The Challenge:
Manual work
Cycle time
Dup Accumm Errors
Complex process logic
• The Solution: “Rider Mapping Automation Template ” was developed
• Reduction in Cycle time
Prerequisites39 mins
COC CR 28 mins
COC NP CR PAR
32 mins
PLYR CR 20 mins
PLYR NP CR PAR
30 mins
Cycle Time 149 mins
Prerequisites39 mins
Automated Output30 mins
Cycle Time 69 mins
Reduction in Rider Mapping Issues from 83.72% to 12.5%!
Business Excellence
16
Business ExcellenceAssurance Control Improvement
Organization CapabilityGroup
Compliance and AuditGroup
Quality Group Continuous ImprovementGroup
• International Standards and Regulations
• Risk Management
• AIM – ALL IDEAS MATTER
• Diet Six Sigma
• Six Sigma Projects
• QPEP — Quality Professional Excellence Program
• Excellence Frameworks
• Perception Management
• Brand Building
• eSCM / COPC
• 5 Business Methodologies
• 250 Processes, Practices and Procedures
• SPARK — Best Practices Repository
• 360 Available Practices
• 6 Papers Published in National and International Forums
• ISO 9000, ISO 2700, HIPAA, GLBA, SAS, PCI
• 2300 Risks and 2500 controls in place
• Internal Auditor program developed, 18 internal auditors trained
• 2 Internal Assessments and Audits • 2 DR Test completed
and reported
• Operations Quality
• Transition Quality
• Shared Services Quality
• Quality Tools and Macros Development
• Quality Forum
• 1000 Operational part of Central repository
• 25 accounts transitioned
• 250 Metrics part of Shared Services
• 100 Automation tools tracked
• 2600 Ideas, 240 Ideas Implemented
• 350 People trained on Diet Six Sigma
• 30 BB Trained
• 60 Projects , 7 completed
• Total saving of $200 K
• 300 QA trained and 75 certified till date
17
Continuous Improvement
QPEP SPARKConceptTraining
Let’s TalkExcellence
PerformanceImprovement
ProductivityTools
ProcessChanges
FinancialBenefits
BusinessGrowth
Voice of Process
BusinessFeedback
Voice ofCustomer/Client
AIM (Kaizen)
PCS
8-D
Diet Six Sigma
Six Sigma
Lean
DFSS
TRIZ
• Idea Generation and Processing Tools• Seven Basic Quality Tools• Seven M&P Tools• Decision Making Tools• Project Management Tools• Statistical Tools
• Lean Tools
• DFSS Tools
• Innovation Tools
18
AIM – All Ideas Matter
• New Ideas: 483 feasible ideas from 2600
• Implemented: 240 of these ideas have been implemented
• Key Impact Ideas:– Reduced rework errors by 40%– Improved CSAT on a Telecom engagement
by 4% within 1 month of implementation– Patient appointment errors reduced by
50% in 4 months– Errors in claim adjudication reduced by
28% in 3 months
Key Improvement and Business Impact
Questions and Answers Wrap-up and Next Steps