Perspectives

Case Study

Redesigning the Account Fulfillment Process

industry & client situation

Our client, a multi-state health payer, was experiencing problems fulfilling member-related materials for its ASO group clients.  Materials were not delivered on a timely basis (often months after the plan year began), and once received, quality was frequently sub-standard.  Despite strong brand awareness, high performing customer service and claims, and provider network and pricing advantages, these quality and timeliness issues impacted group and intermediary relationships, threatening the loss of key accounts.

approach

We designed an approach to understand group performance expectations, analyze current processes, and identify root causes of performance issues.  Subsequently, we developed future state processes, organization design, and performance standards needed to meet group and intermediary requirements.  Major activities included:

  • Mapping current state process and analyzing historical performance (quality and timeliness)
  • Interviewing internal stakeholders, including product development, account management, operations, and underwriting to identify potential root causes of process breakdowns
  • Interviewing external stakeholders, both groups and intermediaries, to identify specific examples of performance issues and understand performance expectations
  • Conducting primary and secondary research to capture best practices in member material fulfillment
  • Facilitating visioning sessions with stakeholders from across the organization to design and agree to future state processes and performance standards

Our assessment uncovered several key findings, including:

  • Existing performance guidelines and SLAs, even when satisfied, failed to guarantee groups would receive a quality product on a timely basis
  • Responsibility for meeting customer needs was fragmented across multiple groups with no single source of accountability
  • Lack of communication between operations and account management let to delays and quality issues
  • Operations resource planning did not account for (seasonal and predictable) peaks in demand based on plan year

results

Based on our recommendations, the carrier took a number of actions to improve customer fulfillment.  Among these recommendations, were:

  • Establishing customer-driven performance goals for which operations and account management were jointly accountable
  • Instituting proactive resource planning, allocation and workload management
  • Implementing targeted process improvements

Upon implementation of these recommendations, our client was able to improve both quality and timing of account fulfillment, eliminating most customer issues.