Case Study

RPA Incubation and Re-engineering for Major Payer Drives $3 Million in Annual Savings

Industries
Healthcare
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 Truly transformative partnerships are built with the confidence and transparency to enable a custom, cocreative model. Since 2003, one of the top five healthcare payers in the U.S. has trusted HGS for a services partnership that over the years has grown in scale and scope to cover 95+ processes and several lines of business, including Medical, Dental, Life, Vision, Long-Term Disability, Short-Term Disability, Pharmacy, Workers’ Compensation, and Medicare/Medicaid Group, and Commercial plans. In late 2015, the client’s senior vice president saw opportunity in HGS’s expanding role with our clients as an innovation hub. He turned to HGS as a valued client partner with a simple question, “How can we completely re-design and re-engineer the way we are delivering services to our customers?” HGS answered with a solutions portfolio including innovation like intelligent automation solutions we have deployed to significant results.

 

 The HGS team in Bangalore created a detailed Re-engineering and Transformation Project Plan to innovate and radically change the operations delivery and bring in customer experience optimization. This meant changing business strategies of engagement, bringing innovative solutions into delivery, and partnering with clients to co-create new value propositions for their customers. The objective was to identify opportunities to transform the way our engagement with the client was operating, including finding ways to re-engineer existing processes through Elimination, Simplification and Automation, and helping capture the right data sets to drive analytics to improve overall effectiveness of delivery.

HGS worked with the client to completely map the process value stream. We created an onshore and offshore solution with a 360-degree view of our delivery and potential failure points. Our holistic approach employed an HGS-fronted governance team comprising both HGS and client representatives, with monthly review meetings attended by executive leadership from both parties.

After a detailed review, key areas of optimization were identified for Year 1:

  • Sales Operations – Customer Onboarding and Plan Loading for End Customers
  • Claims Operations – Claims Payment Analytics – Reduction of Potential Fraud, Waste, and Abuse

 

 Per this cocreation model, gainsharing is employed for mutual incentives that drive optimized ROI for the client. The ROI momentum has been building each year, and, as of late 2016, the synergies of this partnership cumulatively drive more than $3.3 million in annual savings for this client (a 230% improvement on the client’s $1 million annual goal), with zero upfront costs. The client now counts HGS as their preferred provider and plans to move our transformative RPA innovation into other areas of the client’s business. The client continues to share processes with HGS—for replication of success. Today HGS is automating more than 20 processes for this client. Here, we highlight the three key areas of smart automation success we have delivered for this client: enrollment, provider database management, and commercial billing/cash posting.

 

Our Solution

 

  1. Medical and Specialty Enrollment

How We Do It

 

In 2015, HGS looked at a process of manual data entry for member details in the enrollment system, starting from PDF applications over different formats. For Specialty enrollment, as per this process, the client was converting XML into PDF applications, which were manually indexed and given to resources for entry. Before HGS’s intervention, there were 12 screens to be filled manually, with requirements of more than 99% accuracy for data entry. For Medical enrollment, applications were coming from brokers with multiple instances of missed info and multiple data entry provisions.

For Specialty Products (insurance other than medical, like dental), HGS custom built a blended RPA solution that automated the process from the source. For Specialty enrollment, this meant using XML for system data entry. We added key steps before data entry, including conversion and saving of XML to PDF apps, with manual checkpoints on every screen for accuracy. Finally, dynamic coding accounted for system latency. For Medical Products, we automated a process to extract and load information from incoming Excel documents. We created a workflow tool to identify and highlight missing information and automate scripts to upload data into the system as well as manual checks to minimize errors.

Business Result

 

HGS took the Specialty queue live in 2016, with Medical going live in 2017. We have achieved significant savings for the client. For Specialty, we helped drive an increase from 25 to 40 apps daily, reducing cost by 40%. For Medical, we reduced cost by 30%, decreasing the time taken to complete one application by five hours. With these processes, the HGS team has thus far achieved $400,000 in annual savings for the client.

 

  1. Provider Database Management

 

How We Do It

 

Our second highlighted RPA solution addresses a crucial provider engagement weakness for many of today’s payers: access to care that affects Star ratings. For our Provider Database Management (PDM) RPA solution, we addressed a key problem for payers today---PDM and the repetitive and potentially negative impact of inaccurate databases as a result of the frequent provider updates required from multiple applications. Agents were experiencing a high propensity of errors with data keying, leading to an unclean master database. There was an extensive auditing and quality assurance (QA) requirement, since all errors result in inaccurate or delayed claims payments.

In designing the solution, HGS mapped multiple scenarios and query types to be automated for the client. We designed a solution and implemented non-invasive automation technology and built multiple validation rules to ensure clean entry into the master database.

Business Result

 

Before automation, there were 17 manual steps in the process queue. HGS reduced manual steps by 70%. Additionally, we reduced total handle time from 56 minutes to less than 14 minutes, for a greater than 75% savings. For this solution, we employed our intelligent RPA solution to drive $300,000 in annual savings for this client.

3. Commercial Billing/Cash Posting

How We Do It

 

With this solution we addressed another key challenge for today’s payers: late payment and interest case flow issues. HGS’s solution for this area of client business is built with an approach that comprises three phases. Phase 1 downloads checks with a robot accessing the electronic financial record (EFR) from the client application. This check location, navigation, and copy function is addressed before converting to the financial institution site for PDF downloading and Excel reporting. Phase 2 employs the robot to read files and input data onto the legacy platform, with navigation through the system, member search and data entry, and set up for unsolicited refunds. Finally, Phase 3 includes robot navigation of client applications and system, followed by check posting, and completion at the financial institution site. This solution went live in 2017.

Business Result

 

For each phase of this process innovation, HGS achieved an FTE count reduction, for 40-60% efficiencies and total annualized ROI across phases. The forecasted savings for this solution is more than $1 million.

 

 

Looking Ahead

HGS is dedicated to sustaining these impressive client savings. And this client continues to broaden the solutions scope for HGS’s proven cocreation and RPA innovation. For example, HGS has now expanded the initial scope of our intelligent automation and moved into areas like analytics and dashboarding, identifying more and more opportunities for automation and optimization—in terms of both in-house and outsourced delivery.