Case studies

Mid-sized BCBS Plan

 

We were engaged to improve claims processing throughput.  The BCBS Executive Team was looking ahead to 2014, and understood the need to be more efficient to stay competitive.  Following the three week assessment, it became apparent they did not need to invest heavily in IT automation, as some had speculated, but rather broaden the use of existing applications and train their supervisors in how to better measure and control variance, potentially yielding a 20%+ increase in claims processed without adding staff. 

 

Large Provider of Dental Plans

 

We were engaged to find and fix problems with the way providers were brought on-board, focusing on the processes to recruit, contract and manage background checks.  We developed a new process that retained a lot of the current workflow and used an BPM tool  the customer had already licensed to automate the prospecting, and the state and national regulatory data integration.  The new process resulted in faster on-boarding and greater physician satisfaction while reducing errors from manually managing regulatory processes.

 

Mid-sized Healthcare Plan

 

We performed a review of the claims appeal and grievance process across all the states in which this company was doing business, and designed a new workflow that routed work faster based on new rules, which in turn cut down on the time it took to manage initial responses.  This solution allowed the organization to better manage state-mandated response times and avoid any issues with state insurance commissioners.

 

Large BCBS Plan

 

Looking to better manage cost of care, this organization was looking for a solution to track the effectiveness of the wellness investments they were making for their members with chronic conditions.  We developed a set of algorithms to allow the plan to track the changes in non-preventive care by condition across multiple wellness offerings. 

 

IT Solutions Vendor to MA Plans

 

A provider of products and services to the Medicare Advantage organizations was trying to increase market share, and we developed a sales and marketing strategy that allowed them to get in front of more prospects and close more deals.  Included was a analysis of the competition, product placement, a SWOT analysis, sales and marketing tactical roles and responsibilities how to leverage their thought leadership, and how to track their success.

WKP Consulting, Inc.

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WKP Consulting, Inc.

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