For Immediate Release
September 17, 2015
Contact: Michael Cupps
CareFirst, OpenConnect to Discuss Improvement
of Claims Auto-Adjudication
CareFirst Vice President of Large Group Operations to serve as featured speaker at the
Health Plan Claims & Service Operations Conference
Michael Cupps, OpenConnect Senior Vice President, and Sally Miller, CareFirst BlueCross BlueShield (CareFirst) Senior Vice President of Operations for Large Group Strategic Business Unit, will serve as featured speakers and panelists at this year’s Health Plan Claims & Service Operations Conference on October 26, 2015.
Cupps and Miller’s panel will focus on key areas in which analysis and automation can improve the claims process by reducing costs and decreasing pended claims. Miller will speak to CareFirst’s success in significantly improving operations through the identification and utilization of previously uncaptured data, and the capacity to deploy software robots to process work.
“The opportunity to improve operations first pass rates and to demonstrate significant savings for health plan claims is a prime target for RPA,” said Cupps. “Utilizing analytics to target the most costly claims or edit codes, then automating them allows organizations – as CareFirst has demonstrated – to optimize human capital, improve customer service and lower administrative costs in an increasingly competitive market.”
WHAT: Health Plan Claims & Service Operations Conference
WHO: Sally Miller, CareFirst Vice President of Operations, Large Group Strategic Business Unit and Michael Cupps, OpenConnect Senior Vice President.
WHERE: Westin Las Vegas Hotel, 160 E Flamingo Rd, Las Vegas, NV 89109.
WHEN: Monday, October 26 – Tuesday, October 27, 2015. Miller and Cupps will speak on October 26 at 1:10 p.m.
CONTACT: Michael Cupps at (972) 523-6690 or firstname.lastname@example.org.
Recently my colleagues and I were discussing the ‘old days’. Several memories came back to us. They included having only 2–3 channels on the TV, and for some of us old enough to remember color vs. black & white screens. At the time there was no remote control, progressing to today where we have too many on the coffee table. Now we have access to any show, any time, streaming anywhere we want.
Banking was more difficult than today. Back then the only way to conduct business was with a human at a branch. Then came the ATM which revolutionized self service. Now we have on-line capabilities to pay on demand and schedule payments on a recurring basis, eliminating the requirement to involve human activities.
Letters turned to faxes, faxes turned to emails, emails are now being taken over by texts, Skype and other IM software.
We’ve come along way since those days, and technology continues to improve our lives. The same can be done for automating your operations. The back office of Health Plans has volumes of repetitive work to be completed in Claims and Enrollment. In most cases today, this work is all manual. With the increasing volume due to ACA many plans are being forced to pay significant overtime or outsource more work. Due to this demand new people make mistakes and those easy tasks turn into more rework events. It is time to evolve in the back office much like the TV and banking.
Robotic Process Automation (RPA) has improved the first pass rates of insurance companies in astounding numbers. One customer saw their auto adjudication increased from 77% to 92.4% in just a few years. They are saving millions annually by controlling labor costs. Because robots work 24 hours they are processing more claims per day. Large or small firms producing repetitive work can benefit from RPA by augmenting with Robots. Imagine what that could mean in your organization.
When you think about all that technology has done for us in our personal lives, why not improve our corporate lives too? It’s worth looking into automation, analysis and overall improvement of your organization.
5 reasons Back Office Operations are interested in workforce analytics & automation
- Measure in Real-Time
On average US employees waste 2 hours a day beyond breaks and lunch hour. Real-time workforce analytics will capture activity in real-time of all associates, even those at-home, to identify productive and unproductive practices. WorkiQ captures all counts, time, and outcomes of activity so work can be categorized and managed.
- Manage in Real-Time
Employees perform at varying levels of productivity and efficiency based on training, engagement, experience, and even acute situations in their personal life. Effective managers need reliable operational intelligence to identify if workers need training or if they are not optimizing work hours. WorkiQ provides the operational intelligence needed to identify, improve, and reward employees through real-time management dashboards.
- Improve in Real-Time
Dramatic productivity improvements start with increased engagement. Through awareness, scorecards and gamification; WorkiQ workforce analytics delivers a wide range of reports that empower people at every level of the company to compete and engage. Through real-time metrics, as opposed to infrequent performance reviews, associates know how they are performing in comparison to their peers, where they excel, and where they can improve. Managers can compare employees with accurate standards, reward superstar performers, and see where their team ranks against other groups or departments.
- Optimizing labor costs
Companies using data-driven decision-making were, on average, 5% more productive and 6% more profitable than their competitors. Back office operations largest cost is labor. By using WorkiQ, you are able to identify empty labor and recapture productive hours, identify the true need for overtime costs, and utilize real-time data to measure the ability to work the inventory.
- Robotic Process Automation
A natural utilization of operational intelligence is identifying opportunities for robotic process automation (RPA). Identifying and replacing routine or repetitive back office work with software robots enables companies to save considerable expense. Insurance companies, for example, use robots for their claims / auto-adjudication improvement. With a complete solution to identify, configure and execute, OpenConnect automation provides a complete solution providing significant savings back to your company.
In a recent article featured in Supply Chain World Magazine, I discussed how manufacturing innovations, specifically large-scale 3D printers, are bringing jobs back home to the US. At the same time, computer-based innovations in process automation and workforce performance management are helping companies to increase productivity of in-house workers and cut the waste of outsourced operations.
Rising Cost of BPO in Offshore
In 2005, a PWC report listed the average salary of US-based call center employees at $19K per year, while their Indian counterparts took home just $7.5K per year. With the allure of low cost of labor, outsourcing operations such as IT, financial services, and technical support have historically allowed companies to reduce fixed costs (fewer FTEs), add flexibility to scale business, and focus on core-competencies at home.
Payscale.com lists a median US-based claims processor salary of $33K/yr., and Outsource2India advertises claims processors between $15K-$22K/yr. per FTE. In a 2010 interview, Phil Fersht, CEO of HfS Research, stated that “in some cases, workers in India are making only about 15 percent less than workers in Nebraska”. Today, [in] “Bangalore many probably earn more.”
While there is still a significant gap in FTE costs between the US and offshore, companies don’t need to look much further than inflation rates to see that the cost advantage of BPO in India is quickly closing. According to World Bank, inflation based on CPI, from 2010 – 2014 in the US was 1.5% compared to 10.9% in India. The cost of an FTE in India is rapidly increasing while US worker compensation has remained fairly stagnant. To further narrow the gap, a rise in the adoption of home workers in the US is helping companies to decrease overhead by as much as 20% when compared to brick and mortar operations (Source: NPR).
As savings decrease, companies are forced to evaluate additional costs/benefits of BPO such as quality difference, lack of direct managerial oversight, frequent labor turnover, brand perception, and IT security. For health plans, the risk of a Protected Health Information (PHI) leak can be catastrophic, and large salary savings are necessary to justify threats.
One of our healthcare payer customers recently replaced 100 outsourced FTEs with 50 US-based direct hires and increased production volumes and quality of work. To maintain competitive advantage, companies need to find lower-cost BPO hubs, automate repetitive processes, or execute operations in-house with greater efficiency and quality.
Enable the Best
Outsourced FTEs are rarely incented to suggest process improvements, lack of direct oversight makes it difficult to identify performance problems, and short-term assignments mean they are not fully invested in your company’s success.
Increasing worker performance is not about adding carrots, finding a bigger stick, or working longer hours. Smarter managers know that to get more work out of a smaller workforce they focus on increasing engagement, maximizing work time, identifying bottlenecks, and training teams based on the actions of top performers.
Whether a company is looking to automate processes or increase workforce performance, the first step should always be measurement. In the AHIP webinar Improving Employee Performance Through Measurement, Ed Peters, Open Connect CEO, and Jim Sinur, formerly Distinguished Analyst Gartner Group, discuss this topic in detail.
Most BPOs provide clients with macro-level production reports pulled from core systems. These reports identify NET production levels, but meaningful workforce performance measurement explains how employees actually spend their work time. Measurement should be automated, and not require laborious self-reporting and activity log. Task-level detail, such as the time spent adding missing details to a customer record, comparing documents in an imaging system, or researching account history can help managers to identify bottlenecks and training opportunities.
Not all processes require a human, but BPOs won’t advertise opportunities to reduce FTEs. Process automation software, such as WorkiQ Automation, has seen drastic improvements over the last decade. Back-office operational tasks that are computer-based and repetitive can be automated. Software robots can now perform online research, compare digital forms, create customer records, and execute artificial-intelligence levels of process complexity. By augmenting a portion of labor force with process automation, companies can reduce NET headcount, improve cycle time, and free up employees for higher value-add activities.
A decade ago, insurance auto-adjudication rates around 90% were unheard of. Now, most of the health plans I work with are automating over 85% of their claims on first pass. Significant advancements in process automation are the result of increased form/document digitization, an overwhelming abundance of real-time online data, and detailed process measurement. Today’s software robots not only follow the steps of pre-scripted workflow, they learn from their human counterparts and build a better workflow.
Again, good automation builds on good measurement. Before companies start to automate any process, they need to have a very good sample of data points that explain how top (human) performers would complete the automated task.
Smarter work is achieved through the continuous analysis of the work activities and processes, to ensure automation and performance management outperforms BPO contracts. For more information about WorkiQ Workforce Analytics or WorkiQ Automation, please visit openconnect.com.