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Healthcare Competency Overview 10 th May 2011

Healthcare Competency Overview 10 th May 2011. Corporate Overview. 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

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Healthcare Competency Overview 10 th May 2011

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  1. Healthcare Competency Overview 10th May 2011

  2. 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) India Philippines U.K. Mauritius USA Jamaica Canada Services Where And When You Need Them

  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 • Agent Partnership Approach • Tenured global management teams • Bridging Emotions & Economics with local leadership People • Business Excellence (BE) – Dedicated organization • Cross-functional process enhancements – AIM, SPARK • Compliance – HIPAA, SAS 70, GLBA, ISO Process • World class and flexible solutions – PMS Systems • Scalable across HGS’ global locations – Inter connected • Secure – Serving data security needs of large payors Technology Committed People, Defined Processes, and Cutting-Edge Technology

  6. Industry Recognition 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 No. 30 in the Top 50 Fastest Growing Companies in India 2009 1 of 200 “Best Under a Billion”Forbes Asia October 2005 Gold Medalist Competency Development (2008, 2009, 2010) Gold MedalistCompetency Development Top 10 Employers Employee Satisfaction /HR Practices Top 20 by Industry Focus – Healthcare Top 10 – Services Offered Top 10 – By Region Served Seal of Product Quality National Product Quality Excellence AwardAugust 2005 Gold Medalist Lean Six Sigma Winner: Most Innovative BPO in 2008 Philippines

  7. 6 100 +100 7 5.96 5.86 6 5.69 5.7 5.7 5.8 5.6 75 +75 5.56 5 75.7% 4.8-5.5 4 +62 50-55% 5.1 50 +50 5 3 +40-45 2 25 +25 1 Industry Average Vs HGS Industry Standard Vs HGS

  8. HGS HealthcareEngagement to Excellence

  9. HGS Healthcare Overview 2011 Process Enhancements Scalability Operational Expertise Payor Expertise Calls Experience Claim Experience All Ideas Matter - AIM 2000 Compliance Annual Growth of 60% for Last 10 Years People& Tenure Member Services 1st in Quality - All Delivery Centers 40 Million Claims Member Calls – 1.5 Million Calls Diet Six Sigma HIPAA Provider Services DR & BCP 200 claim Associates at 100% QA in 2010 99.8% Pay Incidence Accuracy High Dollar & Complex HCFA / UB04 Claims SAS 70 Sharing Best Practices - Spark Provider Calls – 6.5 Million Calls Blended Shoring Plan Sponsor Services Performance Management System GLBA Average Leadership Tenure of 7 Years Experience Engagement Expertise Excellence Over a Decade of Healthcare BPO Experience

  10. Payor Services Data Transaction Onshore Calls Function Sales Support Underwriting Support Plan Loading And Setup Plan Testing Billing Premium Plan Administration and Support 450 FTEs Mailroom and Scanning Claims Data Entry Referral Entry Claim Audit & Medical Triage Claim Payment & Review Claim Services and Support 2100 FTEs Provider Correspondence Provider Customer Service Provider Network Calls Pre- Authorization Calls Claim Rework Unit Provider Services and Support 900 FTEs Benefit and EligibilityCalls Claim Dispute Calls Premium Payment Plan Renewal Wellness Care Support Member Services and Support 300 FTEs OverpaymentRefund Request OverpaymentRefund Posting FraudResearch RefundCalls Research and Recovery OverpaymentValidation 500 FTEs

  11. Perfect Service – Journey and Milestones 1820 FTEs 850 FTEs 34 Processes 21 Processes 450 FTEs New Business Quoting IT infrastructure support 275FTEs 19 Processes Cash Posting Fulfillment center Provider Calls Medical (Level 1 and L2) 65 FTEs 11 Processes Wellness & Point of Care Dental FR Provider Investigations Clinical intake & Provider Loading Provider Calls & Individual Plans 5 Processes Product Build Under and Over payment Case Review Entry Plan Testing Dental Claims Rework Unit Account Receivables Provider Outreach Dental Claims SIU Correspondence Dental Claims Counter Mgmt Underwriting (UAS) Special Projects Delegated Claims Research / CORR Eligibility Check Process Certificates Network Mgmt Batch Suspended Inquiry Medical Claims Claims Administration Product Implementation DRC` Legacy Platform/ Mainframe Platform Legacy Platform/ Mainframe / Windows Platform Mainframe / Windows Platform Mainframe / Windows Platform Legacy Platform 2003- 2004 2005-2006 2007-2008 2009 2010 - 2011 Bangalore /Chennai India / Philippines India / Philippines/ US Bangalore Bangalore

  12. 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 Jan ’09 Jan ’09 to Jul ’09 ~50%Errors due to Documentation 72 Errors Reduced to 0 Improving Performance with Focused Process Improvement

  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 COC CR 28 mins Prerequisites 39 mins COC NP CR PAR 32 mins PLYR CR 20 mins PLYR NP CR PAR 30 mins Cycle Time 149 mins Prerequisites 39 mins Automated Output 30 mins Cycle Time 69 mins Reduction in Rider Mapping Issues from 83.72% to 12.5%!

  15. Business Excellence

  16. Business Excellence Assurance Control Improvement Organization Capability Group Compliance and Audit Group Continuous Improvement Group Quality Group • Excellence Frameworks • Perception Management • Brand Building • International Standards and Regulations • Risk Management • Operations Quality • Transition Quality • Shared Services Quality • Quality Tools and Macros Development • Quality Forum • AIM – ALL IDEAS MATTER • Diet Six Sigma • Six Sigma Projects • QPEP — Quality Professional Excellence Program • 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 • 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 Performance Improvement AIM (Kaizen) • Idea Generation and Processing Tools • Seven Basic Quality Tools • Seven M&P Tools • Decision Making Tools • Project Management Tools • Statistical Tools Voice of Customer/Client PCS Productivity Tools 8-D Diet Six Sigma Process Changes Business Feedback Six Sigma Financial Benefits Lean • Lean Tools DFSS • DFSS Tools Voice of Process Business Growth TRIZ • Innovation Tools Concept Training Let’s Talk Excellence QPEP SPARK

  18. Key Improvement and Business Impact • 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

  19. Questions and Answers Wrap-up and Next Steps

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