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Actuarial Soundness: Striving for Operational Excellence Fritz Rankin, CFO/COO, CareOregon ACAP CFO Meeting March 15, 2011
Actuarial Soundness:Striving for Operational Excellence
Fritz Rankin, CFO/COO, CareOregon
ACAP CFO MeetingMarch 15, 2011
Today’s Objectives
Provide a brief overview of what is API and Operational Excellence
How and why we have incorporated Lean methodologies and tools to improve quality and decrease costs
Provide an example of a Lean API Team’s results and management’s role
Lessons learned
The Need for Improvement: 2006
• Implemented a new integrated Claims Adjudication System in 6 months
• Brought claims processing “in house”
• Became an insurance company
• Added Medicare Advantage plan 6 months after implementation
• Doubled in size (from 100 – 260 employees)
• Renovated and moved to new building
Data Sanity, Davis Balestracci Jr., MS
The Case for Continuous Improvement
Invested in our People
• Operational Excellence Department provides ongoing support and training in improvement methods and tools
• Cross-functional API (Accelerated Process Improvement) Teams work together to test ideas
• Executive Sponsorship is provided to each team• Facilitator/Coach Roles Developed• Team Members attend training (come with a
process they want to improve) • Ideas can come from anyone, but must be
strategically and conditionally prioritized
Tools Teams Learn in Training
Voice of the Customer Scoping, developing charters Personal style profiles Ongoing regard Value Stream Mapping Continuous Flow PDSA (Plan, Do, Study, Act) A3 Problem Solving Ease and Impact: Prioritizing 30-60-90 Implementation/Sustaining
Value Stream Map (VSM)
• A graphic map of steps that occur from the specific request for a product or service to the delivery of that product or service.
If you can't describe what you are doing as a process, you don't know what you're doing. W. Edwards Deming
The Issue WAS
• The current member denial letter production and mailing processes are cumbersome, labor-intensive, and error-prone, raising regulatory risk, creating delays in mailing and undermining member and provider satisfaction.
Current State Map (old process)………
Future State Value Stream Map (now our new current state)…
Member
CareOregon MD makes denial
decision
PT = 7.5 minutes
LT = 1 day
Q = 99%
Demand ≈ 6,000 letters a year (x3 = member, PCP & specialist)
14-day turnaround time
CareOregon
Request
PCP
Specialist
Vendor
RN uses clause library to create
denial letter in DMS; reassigns to MBAA
PT = 10 minutes
LT = 5 minutes
Q = 100%
Mail Room picks up letters from printer, stuffs & holds for
MCHD
PT = I minute
LT = 1 hour
Q = 100%
MBAA faxes letter to PCP & requestor; prints to mail room
PT = 0.5 – 3 minutes
LT = 4 hours
Q = 100%
MCHD picks up and mails letters
PT = 4 hours
LT = 1 day
Q = n/a
Cost = 87¢ per unit
5 minutes
7.5 minutes
240 minutes
10 minutes
60 minutes
0.5 minutes
1440 minutes
1 minute
3190 minutes
255 minutes240 minutes
1440 minutes
What is the default printer
for users?Clause library in
progress!
Will include 1-page translation notice with all
letters
3rd floor duplex printer
Clause LibraryAssumption: providers
prefer receiving notifications by fax
Eliminates batching!
Estimate 60% of fax numbers are in QNXT
Kim has to fix margins and then fax to PCP and requestor as temporary “fix”
API Team:Denial Letter Future State VSM
Eliminated 6 steps in process
Savings of 1.5 hours per denial letter or 10,675 hours per year
Savings of $31,242 per year
Total Cost SavingsFU
TURE STATE
Annual Savings: $31,242
$39,812
$8,571
$-
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
Current Cost per Year Future Cost per Year
Impact
• Medical Management staff impact– Increased efficiency
– Standardization of letter content while allowing for member specific reasons
– Increased staff satisfaction with the process
• Provider impact– Same day notification
– Specific detail about reason for denial
And most importantly….
• Member impact– More specific detail about reason for denial
– Information about other resources
– Directed back to PCP to discuss options
– Same day mailing
Did I give you the information you needed ….
Did you get your question answered….
Do you have all the information you need….
• Takes management and associates away from their cube or office to:
– see what is actually happening
– communicate with those people that do the work
– experience and validate understanding
Leadership Gemba Walks
Gemba walk
Opportunities for standardized work…
• What do you do that’s ‘repeatable’?
• What processes have a lot of variation?
• What processes are not clearly defined?
• What processes promote confusion? Errors? Waste? (CAUTION HERE)
• What processes are ‘ripe’ to be standardized?
Lean Thinking
The challenge to look at all aspects of the business with an eye towards CONTINUOUS IMPROVEMENT
Have you noticed something that could be improved?
Did you make a recommendation? Did positive changes occur?
People need the tools, skills and authority to make improvements…
Indicators of non-standard work
• Sometimes…
• Maybe…
• If…
• It depends…
• Possibly…
• Perhaps…
Lean Roles of Managers and Supervisors
1. Help each person to take initiative to solve problems and improve his or her daily work
2. Ensure each person’s job is aligned to provide value to CareOregon members and the community
“Empowerment without alignment is chaos”Peter Senge, Fifth Discipline
Lessons Learned So Far…
• Constancy of purpose is important!– Avoid “flavor of the month”
– Training and support for staff, management and Senior Management is continuous
– Support and involvement of Leadership is vital
– Reward and recognition (OPEX Quarterly)
Lessons, continued
• Bottom up, top enabled (organic)
• Consultants must “teach us to fish”
• Improvement can be fun and rewarding!
• Customer focus reframes the way we think about everything we do
• Staff have to hear consistently the message that it’s the process, not the people
Lessons, continued
Lots of data to analyze …..
IT Support is critical !
And ours is fabulous
Questions?
