A video parody on YouTube is getting laughs from insurers who can relate to some of the issues being discussed during fictional payer Dynamite Health Plan’s quarterly report.
The video was developed by Catalyst Solutions, a consulting company that helps payers assess, implement, upgrade and enhance core and ancillary systems and processes. It seems to have resonated with some of the company’s clients. Kirk Rasmussen, EVP of Consulting at Catalyst, says several have made tongue-in-cheek remarks about Catalyst having cameras in their meeting rooms.
Here are some of the top challenges discussed in the video and strategies for success:
Customer service
In the video, a staff member reported that Dynamite’s call times had dropped from an hour and 40 minutes to just under 30 minutes. “Anything over a 15-20 minute wait time is too long,” says Rasmussen. “Over an hour is way out there.”
Here are some suggestions from Talkdesk on improving call times:
- Look for inefficiencies in your call queue configuration.
- Configure your settings and features to:
- Give callers the option of having someone return their call.
- Give callers the option of leaving a voicemail.
- Redirect callers to voicemail when a certain number of callers or a maximum wait time has been reached.
- Monitor wait times.
- Make sure call centers are appropriately staffed.
Claims operations
Dynamite’s claims operations staff member seemed proud the company’s auto-adjudication rate had climbed from 42% to an all-time high of 49%. “When we developed the script for the video, we thought we were choosing an auto-adjudication rate that was so low a payer would no longer be in business,” Rasmussen says. “Since the video came out, we talked to one client that wasn’t even tracking its rate. Another had an auto-adjudication rate of 27%.”
Sungard offers the following strategies for improving your auto-adjudication rate:
- Streamline your claim intake process.
- Automate claims with pend-codes that have repeatable rules-driven cleanup processes.
- Automatically analyze, update, and post corrections to claims that were “dropped out”.
- Organize pended claims for staff correction.
Configurations
Some providers were listed in Dynamite’s system up to eight times and staff was making a contest out of manually trying to find the matching NPI. Rasmussen says provider data is “notoriously bad” and that there “should be an auto match on names.”
Beginning this year, CMS will impose fines on insurers that provide Medicare Advantage or government marketplace plans for failing to keep up-to-date provider data.
Here are some tips for updating provider data from Healthcare Finance News:
- Keep all provider records in one place.
- Develop standardized processes for collecting and correcting data (e.g., drop down lists for physician specialties, hospitals and network and product names).
- Make sure processes are in place to correctly validate, record, check and correct data.
- Ensure software is compatible with workflow.
- Train employees to detect and fix errors.
Information technology
In the Catalyst video, the IT guy reported Dynamite’s claims system had 1,042 customizations and was very high maintenance. “The thing with claims is that you want to minimize interfaces and customizations,” says Rasmussen. “A system with more than 1,000 customizations would be literally unworkable.”
Dynamite also had a potential security issue, as its chief security officer was working for the Russians.
InformationWeek has developed the following strategies for strengthening healthcare security:
- Hire a CSO and empower that person to take action.
- Take inventory of everything you own and use.
- Cover the basics (e.g., encrypted laptops, patches, secure passwords).
- Regularly meet with healthcare users to discuss their pain points, wishes and preferences.
- Build a security culture.
- Investigate best practices.
- Take precautions with BYOD (e.g., virtual data infrastructure or mobile device management software).
- Secure wireless networks.
Operations
The staff member from Dynamite’s operations department reported that the company had reduced its administrative burden from 20% to 19%. Their goal was 5%. “That’s a laughably small change, especially when you’re that much over where you should be,” Rasmussen says.
To reduce administrative waste, AHIP suggests that the following key administrative functions be standardized and automated:
- Claims submissions
- Eligibility
- Claims status
- Payment
- Remittance
Rasmussen says some of the CEOs he’s talked to that have been hired as “turnaround artists” have shown up to meetings that are similar to the ones in the video parody. He also says he’s not sure how some health plans have been able to operate so long with the same type of numbers that were being reported in the video. “The market is changing at lightning speed,” he says. “Being good at what you do is no longer good enough. You have to be great to be successful.”