Highmark Inc. used internal and external resources in multiple locations to run its short-term disability program, causing inefficiencies and customer dissatisfaction. Management sought to understand the impact of proposed process changes on resources, costs, and service quality. Highmark used information from the Human Capital Group and ProcessView, a business process analysis tool from the Orlando Software Group, to make data-driven decisions.

Business Needs

Highmark Inc., an independent licensee of the Blue Cross and Blue Shield Association, ranks among the nation’s leading health insurers. Highmark operates one of the nation’s largest dental insurers and integrated vision companies and also offers stop-loss and worksite insurance and limited medical plans. For nearly 70 years, its mission has been to ensure access to affordable, high-quality healthcare that improves lives. It fulfills this mission through the products and services that it provides to its 4.6 million healthcare members.

As part of the benefits that it offers its more than 19,000 employees, Highmark maintains a short-term disability program that processes more than 1,100 cases annually. Previously, the program was administered by a combination of internal employees and outsourced support. The company divided its five-member internal team between two physical locations. This team handled interactions with employees seeking to submit disability requests, along with the preparation, mailing, and receipt of the necessary forms for those employees. The outsourced group consisted of administrative staff and physicians who administered medical reviews of all the cases and determined which requests to grant.

“Employees found the program confusing because there were several layers of administration involved, each location had different processes, and it was difficult for them to know whom they needed to contact,” says Maria Hare, Corporate Health Services Manager for Highmark. “We realized that we needed to provide a higher level of service to our employees, so we decided to review our processes and ensure that our program was as efficient and standardized as possible.”

However, before implementing any changes, Highmark wanted to understand the impact of any proposed process changes on customer demand, resources, cost, and service quality.

Solution

For help understanding how best to streamline its program, Highmark called on the Human Capital Group. The group’s consultants used time-tested methods for business process improvement and supported their efforts with an innovative business process analysis tool known as ProcessView. Developed by the Orlando Software Group, ProcessView is an add-in to the Microsoft® Office Visio® Professional 2007 drawing and diagramming software.

Within 30 days, the consultants completed an in-depth operational and financial analysis of the program, using ProcessView to quickly map every process in each location. They used interviews to capture and validate key resource, duration, process-time, yield, and cost data. Within the first 10 days, the analysis output from ProcessView helped Highmark identify multiple opportunities to streamline processes, improve operational performance, and control costs.

The consultants also took advantage of the Office Visio Professional 2007 data graphics features to visually represent the program’s processes and performance statistics. A current-state model provided a benchmark against which eight separate proposed process improvements were quantitatively compared.

“We knew Highmark would derive a lot more value if we delivered a visual component with our findings,” says Erica Wittenmyer, Process Analyst and Industrial Engineer for Orlando Software Group. “Diagramming current-state and future-state processes really encouraged fruitful discussion among the program’s stakeholders—the combination of Office Visio features and the ProcessView data capture capabilities and analytics engine is indispensible.”

In addition, consultants used the data-refreshing and data-linking capabilities in ProcessView to export data into Microsoft Office Excel® 2007 spreadsheet software. In this way, they could verify process-related information with Highmark employees and then automatically import updated data from the spreadsheet into the tool.

Benefits

Because it had a detailed analysis of all the business processes involved in its short-term disability program, Highmark was able to make changes that have had a positive impact not only on service quality, but also on the company’s finances.

• More informed decisions. Highmark took the information provided by the Human Capital Group and the ProcessView solution and made key, data-driven changes to the short-term disability program. The ability to define and compare the impact and cost of future-state solutions gave Highmark confidence that it was making informed decisions based on sound business cases. “Rather than just a basic flow chart, we were given all the data underlying each step of every process, so we could clearly see the impact that any change might have on the rest of the process,” says Hare. “Having a visual representation of our program’s processes helped us validate our data and gave us a higher level of confidence about the decisions that we made.”

• Improved service. Highmark has redistributed the program workload, bringing 86 percent of claims processing in-house, and it now provides a higher level of service to employees making claims. “We’ve reduced our average processing time from eight days to one, and we have better communication with our employees,” says Hare. “Plus, by managing most claims internally, we can more quickly coordinate with employees, the healthcare providers who are treating them, and managers for a faster, safer return to work. It’s a win-win scenario, and we’ve received nothing but positive feedback from employees about the changes that we’ve made.”

• Decreased operational costs through greater efficiency. Highmark has reduced the operational costs of its program by about 10 percent annually. “We re-negotiated the contract with our outsourcing provider and eliminated redundancies, resulting in significant cost savings of $75,000 to date, with the potential for additional savings of more than $250,000 annually,” says Hare. “It’s good to know that we’re having a positive impact on our bottom line even as we enhance our service.”