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By
March 11, 2019

2019 AWARD FINALIST SPOTLIGHT: Blue Cross Blue Shield of Michigan - Finalist in the Operational Excellence Project under 90 Days Category

 

Read this article about Blue Cross Blue Shield of Michigan, one of our finalists, in the category Best Achievement of Operational Excellence Project under 90 Days, selected by the independent judging panel, for the 2019 Business Transformation & Operational Excellence Industry Awards program. Click here to read articles on other finalists.

 

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Medicare Advantage Attribution

Under contract to the Centers for Medicare and Medicaid Services (CMS), Blue Cross Blue Shield Michigan (BCBSM) markets and manages Medicare Advantage (MA) products to individuals age 65 and older and is the 6th largest Medicare Advantage plan in the country. Like all health insurance products, MA plans are based on trusted relationships – between patients, physicians and health plans. These relationships establish a fundamental association for the maintenance of health and the delivery of care. The data supporting and defining these relationships is a critical underpinning to MA health plans, as the relationship between a member and their primary care physician (PCP) is the basis for defining accountability to: (1) a member’s health and (2) performance-based measurement and reimbursement to physicians. This alignment of a member to a PCP in an MA Plan is known as MA Attribution.

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In response to critical feedback from some physicians, in early 2018, BCBSM recognized the organization’s MA Attribution process needed to improve. Incorrect MA Attribution was hindering BCBSM’s ability to determine physician performance, timeliness and cost of care metrics. Payments to physicians were delayed and in some cases inaccurate, resulting in physician frustration. Additionally, members received erroneous communications. For BCBSM, gaps in care remained unresolved, lowering plan quality scores and resulting incentive payments.

 

MA Attribution Team 1

 

Evaluation revealed lack of understanding of the required steps and proper sequencing of the process. A cross-functional team was assembled to examine the process and make recommendations for repeatable improvement. To achieve quick results, leadership determined a Kaizen event would efficiently optimize the process, providing a structured problem-solving methodology engaging all stakeholders across the end-to-end process. The event enabled the team to identify a portfolio of improvement opportunities within two days, rather than traditional improvement projects which could extend four to six weeks.

 

The team transitioned quickly to implement the identified actions. An action plan tracker was used in meeting with the initiative teams to monitor progress and enforce accountability. A cadence of touchpoints with executives ensured momentum was sustained and obstacles were cleared promptly. All action items were completed within 8 weeks, and the future state was fully operational upon completion.

 

The improved process resulted in more precise MA Attribution for the 14% of BCBSM's total MA membership where inaccuracies were discovered. This improvement has increased the quality and accuracy of every program and/or payment that is consuming MA Attribution data. To illustrate the improvement scope: The team identified six payment programs, totaling more than $60 million in payments. Increased MA Attribution accuracy has improved the overall correctness of payments across these respective programs.

 

Positive business results must equate to positive member results. This project also delivered on that. Improving MA Attribution accuracy enhances the relationship between members, physicians and BCBSM. With accurate MA Attribution, members get timely, efficient health care, delivered cost-effectively that improves their overall quality of care, and their quality of life.

 

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About the Awards

The Business Transformation & Operational Excellence Awards have been established to showcase globally the most outstanding organizational achievements through the application of Operational Excellence programs. Click here to view the Press Release.

The winners for all categories and for The Platinum Awards will be announced at The Business Transformation & Operational Excellence Summit & Industry Awards on Wednesday March 20th, 2019, from 6.30pm, in the Venetian Ballroom at the Loews Portofino Bay Hotel at Universal Orlando Resort®. 

The Business Transformation & Operational Excellence Awards are open to all organizations, both private and public sector, across the globe, which have implemented Operational Excellence programs to deliver outstanding business results.

The 2019 Awards will be held in conjunction with the Business Transformation & Operational Excellence World Summit on March 20, 2019 in the Venetian Ballroom at the Loews Portofino Bay Hotel at Universal Orlando™

 

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BTOES.com

The issues in this article are just one of topic areas that are going to be discussed at the Business Transformation & Operational Excellence World Summit & Industry (BTOES19). March 18-22, 2019, Loews Portofino Bay Hotel at Universal Orlando Resort®

BTOES is the industry’s biggest and best, senior-level, cross-industry gathering of Business Transformation & Operational Excellence industry leaders and senior executives.

It also hosts the Business Transformation & Operational Excellence Awardswhich showcase globally the most outstanding organizational achievements through the application of Operational Excellence programs.

The summits hosts a number of private forums for C-Level & Global corporate-level leaders as well as business unit heads.

With over 150 speakers, over 100 sessions, 12 Keynotes, 9 Track Themes, 5 parallel tracks, 60+ track sessions, 50 roundtable discussions, 20 Interactive Workshops, 6 Thought Leader Panels, 5 Leaders Boardrooms, 5 co-located events, the Industry Awards Program, Site Visits, 20+ hours of social networking including 2 gala cocktail parties, dinners, numerous group activities, this is the ultimate event to benchmark, network and drive Operational Excellence to the next level.

 

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BTOES19 Awards

 

There is a strong focus on Cultural Transformation, Customer Delight, Sustaining an Operational Excellence program, Need for end-to-end Business Transformation, Keeping up with new technologies/impact of digitalization and Leadership Buy-in & Understanding. We dedicated two tracks to advanced technologies, such as AI, Machine Learning, RPA, Predictive Analytics, Blockchain, Cloud infrastructure etc.

The agenda is designed to encourage active meaningful conversations though all day enhanced networking and interaction opportunities, including

  • All-day Refreshment & Themed Breaks

  • 1¼ Hour Hot Breakfast Networking Sessions

  • 1½ Hour Hot Plated Networking Lunches with Topic & Industry Sector focussed tables

  • 1½ Hour Roundtable Sessions by Topic & Industry Sector.

  • Keynote & Themes Panel Sessions

  • Hosted Welcome Receptions from 5.30pm

  • Expanded more lavish Awards Program

  • Newly launched Night Summit for attendees to meet after dinner

For more information or to discuss the summit in more detail please schedule a call below,

Click here to schedule a call. 


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