Healthcare and Workware+

Workloads increase, but budgets don't grow to match them. While many elements affecting healthcare payers' work inventories are hard to predict more...

ActiveOps and Healthcare

With Workware+

The Next Generation Workforce Challenge

For a healthcare payer, it's a never-ending struggle.

Workloads increase, but budgets don't grow to match them. While many elements affecting healthcare payers' work inventories are hard to predict more than a few months in advance, some trends are all too painfully clear. The population is rapidly growing and rapidly aging. The regulatory environment is continuously changing, especially in individual states.

Equally, medical advances keep coming at a dizzying pace, accompanied by inevitable leaps in both the quantity and the costs of what you have to cover. All of this makes your back-office workload grow, often dramatically. What is doesn't do is magically add to your budget to pay for handling the additional work.

In 2020 there has been unprecedented demand on the healthcare systems to not only serve those that contract contagious viruses but also support wellness efforts to implement self-care and preventative care.

...So your continual challenge is doing more with less.

Fortunately, we're here to help you manage and predict how to handle this workload.

We are ActiveOps and we've built advanced software solutions with you in mind. We focus on helping companies, especially healthcare payers, handle growing workloads more efficiently and economically, regardless of where that work is done.

Check out this video to learn how ActiveOps can help you!

The Future of Work

Evolving workplace strategies

The workforce has recently gone through an accelerated transition, as we have never experienced. However, prior to the pandemic, companies began looking for a new way to manage their workforce, including home working.

For years Workforce Management and Workforce Optimization have focused on a Call Center. Inbound work queue with fairly predictable workloads. The model was designed to reflect the mentality of work shifts but lacked flexibility.

The new back-office has similar traits but is evolving to include flexibility, well-being, and balance.

Operations have been searching for a better way to manage, measure, and to coach the workforce to be more efficient. The move to supporting remote work is becoming mainstream due to real-estate costs, social, economic conditions (such as pollution and traffic), and a need for a competitive workplace strategy.

Now that the global pandemic has accelerated this effort, it is time to learn from those early pioneers that enabled remote work balanced with the right on-premise and BPO plans. The traditional call center methods are not sufficient to massively improve the back-office and now the remote office.

The new generation of Workforce Management and Optimization isn't a "one size fits all" approach; it must be adaptable to the new way of working. It must offer a range of capabilities for the many roles that your company operates.

What has been your biggest challenge?

Working from home
Work-life balance

The Shift:

The shift in the workplace has operations teams searching for a new workforce methodology. Old methods must adapt and provide a truly “agile” planning and capacity model. Flex working will be the norm, driving the business to suit varied hours of work and location. This requires precision for staffing and inventory management. There is no more “one size fits all” model, and simply adapting the ‘call center’ WFO will not meet the needs of tomorrow’s workforce.

New Operations Characteristics	Next Generation Challenges	Next Generation WFM & WFO
Flexible Workforce	Understanding and Accommodating flexible shifts and locations of workers (home, on-shore, offshore, BPO)	Seamless and flexible data collection methods to accommodate different work locations and specialties (People, Work, & Time)
Workforce Types	Types of work vary with Operations, Shared Services, Case Specialists, & Knowledge capabilities	Ability to plan based on flexible work types. Example: Casework vs. Data Entry
Forecasting & Planning	A high degree of work types changes planning needs to support both centralized & de-centralized forecasting and planning capabilities	Decision support and planning need to be specialized to match the needs of each team and work type
Employee Well-being	Now more than ever, what may have been a small disruption for cold and flu season, could wipe out an entire operation. A new focus on well-being is at the center of corporate responsibility	The information must be real-time, reliable, and transparent, regardless of the type of work or where it is done. Enabled by well-trained and certified managers to keep work-life integration optimized.

Healthcare Challenges and Solutions

Claims Processing, Membership and Enrollment, and Medical Review

The key to reducing these costs is identifying and improving the efficiency of the process and activities to complete adjudication steps for payment of a claim.

ControliQ provides detailed event-based intelligence and workforce management to improve productivity and a single performance view of all operations resources from individual, robot, team, and department aggregating and presenting actionable operations data from existing back-office systems.

ControliQ also provides:

Real-time data on the activities and productivity of your claims staff allowing team leaders and managers to monitor and manage in real-time to adapt to changes in work volumes.
Establish a comprehensive business-as-usual view of all operations to plan work and capacity consistently across all operations.
Data-driven planning and forecasting enabling operations staff across the businesses to work consistently to their full capacity

According to a recent AHIP study, the average cost of processing a claim was reported at $1.36 per claim. The average cost of processing an automatically adjudicated claim was $0.99 per claim; the average cost of processing a "pended" or delayed claim, which often requires additional information or more complex manual processing, was $3.99 per claim. Health care payers are feeling costs pressure from excessive overtime, contractors, and general labor costs to manage the claims process. Now add in the fact that most workers will not be in an office.

Challenge:

The costs are broken down into several factors:

Costs of FTEs manning claims processing centers
The complexity of pended claims and challenges to automate
Ability to accurately and automatically track claims inventory and processing time

Claims Processing:

Solution:

Membership, Enrollment, and Other Service Operations:

Challenge:

Solution:

In addition to work being distributed to remote offices, BPO/TPAs, and other new challenges with the digital workplace, it is highlighting the need for more visibility. Administrative costs for all Health Insurance providers are changing dramatically. A new competitive landscape from ACA individual markets, traditional group markets, and new entrants competing for the same members. Administrative expenses average 19% of the premium in the individual market, 13% of the premium in the small group market, and 9% of the premium of the large group market.

The costs are broken down into several factors:

Labor costs required to assist individuals to continue to rise as 60% of Plans report eligibility and enrollment assistance is still required.
Costs of FTEs manning processing centers continue to rise.
High enrollment times and costly Assister programs (peaks and valley of capacity).

The key to reducing these costs is by identifying and improving the efficiency of the activities to complete enrollments and inquiries.

WorkiQ provides detailed event-based intelligence and workforce analytics to gain visibility of time and activity.

WorkiQ provides:

Real-time data on the activities and productivity of your back-office staff allowing team leaders and managers to monitor and manage in real-time.
Identify non-work-related behavior or application choke points to provide in the moment coaching opportunities.
Manage remote workers according to the same standards as their in-office team members.

Medical Review:

Challenge:

A priority of every case management intervention is to support the patient, making sure they are getting the best care and support over a continuum of time to achieve positive clinical outcomes. Medical Review (MR), interventions help ensure patients receive the "right care at the right time" to improve clinical outcomes and lower costs. However, this effort comes at a high cost to Payers forced to balance the cost of MR and the best approach to staffing and/or outsourcing.

The costs are broken down into several factors:

Costs of MR staff including Reviewers, Physician Advisors, and MR Program Managers.
Costs associated with prioritization of discharge planning, pre-certification, and clinical case appeals.
Managing processes such as Demand Management, Medical Review, Case Management, and Disease Management.

Solution:

The key to reducing these costs is identifying and understanding the efficiency of the process and activities to complete adjudication steps for payment of a claim.

FocusiQ provides structure, data, and a Way of Working to make optimal use of the time helping align individual work with organizational goals.

FocusiQ provides:

Understand the capacity available for productive work and progress the Urgent and Important.
Visibility where time is spent with a transparent progress plan and actual by activity.
Recognize changing priorities and make informed choices in time by knowing outcomes and seek new learning.

Introducing Workware+

The Managed Ops Platform for Healthcare

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Workware+ is ActiveOps management platform providing a complete set of tools, processes, and software to manage work performed anywhere in the modern enterprise.

Flexible data collection providing real-time visibility of productivity, utilization, and capacity. Providing data insights ensuring certainty and control.

Workware+ helps you simplify the running of operations!