This Is What Success Looks Like…

Last week I had an opportunity to present alongside Sally Miller (VP of Operations at CareFirst) at the Healthcare Claims & Services Conference in Las Vegas.

The basis of the presentation was to review how CareFirst is continuously improving claims operation through the usage of analytics and automation (robots). While I can’t publically detail CareFirst’s outcomes, I will say the results they are receiving are very impressive. From a broad perspective, my observation is that CareFirst has taken action in three key areas that are leading them to exponential operational improvements.

Organizational Alignment

Sally and team are aligned to identify and execute operational improvements. Utilizing OpenConnect analytics, a team evaluates and prioritizes high ROI automation projects.

This team then documents the requirements and hands off to the robot scripting team. Then an operation team pushes the robots into production. This conviction to continue process improvement allows CareFirst to maximize investment in technology and people with a high rate of return.

Focus on high value automation

Once edit codes have been ranked, the teams focus on requirements and execution on the edit codes that will increase First Pass Rates (auto-adjudication). Using this value-lens, CareFirst operations can utilize robots to guide organizational improvement across the enterprise, and ultimately deliver both financial and service-level results back to their members and providers.

Not a single platform

Many payers only consider automation within their core system. However, the CareFirst team utilizes multi-platform robotic process automation to solve enterprise-wide challenges. This approach has led them into automation that includes mainframe, web services, and other types of platforms. They are currently working to automate new opportunities such as cash receipts, member/physician look up from third party applications, and other Blue Association applications.

We appreciate CareFirst as a customer utilizing OpenConnect solutions for analytics and automation. I for one am very impressed with their organizational approach for business improvement. Well done!