Customer Solution Case Study
/ Claims Processor Boosts Value of Investment Through Technology Center Visit
Overview
Country or Region: United States
Industry: Professional services
Customer Profile
Atlanta, Georgia–based NASCO provides a single-system claims processing solution for national, state, large and small group, individual, and government health insurance programs. The company has 313 employees.
Business Situation
The company required better business intelligence to serve a range of its own and its customers’ business needs, and it also wanted to modernize its technology environment to improve efficiency.
Solution
NASCO attended a Microsoft Technology Center engagement to build consensus about the vision for technology at the company and adopted a business intelligence solution based on Microsoft technologies.
Benefits
· Validation of technology investment
· Better service to customers
· Smarter business decisions
· Greater productivity / “The MTC helped me turn abstract concepts into business understanding.... And, from a technology standpoint, we now have the tools that we need to make our customers and ourselves more successful.”
Charlie Chasen, Manager of Information Services, NASCO
NASCO, a health-insurance claims processor, wanted to expand its business intelligence (BI) capabilities to meet the changing needs of its customers and give its own decision makers better access to information. The company also needed to upgrade its technology infrastructure to support greater efficiency. NASCO attended a Microsoft Technology Center engagement to help company leaders understand the company’s technology direction and the various possibilities for enhanced BI. It then put in place multiple Microsoft products to form the basis for the BI capabilities it needed. NASCO uses those capabilities to increase efficiency for customers and improve visibility into the company’s status with regard to revenue, growth, and operations. As a result, NASCO has improved its service to customers, and it now has tools that foster more-informed decisions and enhanced productivity companywide.
Situation
NASCO helps large health insurance organizations be successful and grow by delivering relevant products and services and a great experience. The company’s foundation is its claims processing system, which provides consistent benefit reimbursement regardless of location. NASCO built the system to handle large volumes; it processes nearly 148 million claims annually.
Improve Business Intelligence
Beyond claims processing, NASCO had identified the growing need to offer business intelligence (BI) information and guidance to its health insurance customers. Changes in the healthcare industry had prompted customers to look to NASCO more and more as a trusted advisor and seek the company’s expert help in becoming more efficient and successful.
However, with no established BI capabilities in place, NASCO did not have the information necessary to provide the advice that customers wanted. The company wanted the ability to combine its industry expertise with the right methodology, metrics, and analyses to help. For instance, one of the ways that customers could improve their efficiency was by increasing the first-pass rate for claims, which is the percentage of claims that can be automatically processed as submitted, without human intervention or any other delays.
“In the past, we knew that about 60 percent of claims were processed correctly the first time, which meant that the other 40 percent required some sort of correction along the way, which is expensive for our customers,” explains John Cicchino, Director of the Business Effectiveness Unit at NASCO. “If we had the ability to focus on the causes of customers’ low first-pass rates, we could help customers improve their initial information collection and submittal process for greater efficiency and reduced operational costs.”
NASCO also faced issues with a lack of BI about its own status. “We needed a better perspective on how we were doing as a company in terms of customers, employees, finances, and operations,” says Julie McKenna, Business Effectiveness Consultant for NASCO. “Once a year, we all scrambled to pull together numbers to prove where NASCO stood—it was very reactive, and we wanted to have a better sense of our own company so that we could make more proactive decisions about our strategic direction.”
Upgrade the Technology Infrastructure
At the same time, the company was in the midst of an overall technology upgrade—a move designed to provide more up-to-date versions of its messaging and database systems. NASCO used Microsoft SQL Server 2000 data management software to support internal business management applications, but it wanted failover and reporting capabilities. The company relied on Microsoft Exchange Server 2000 for basic email messaging but believed that a newer version would be easier to maintain and support.
NASCO also sought to upgrade its content repository, which was built on Microsoft Office SharePoint Portal Server 2003, and increase the sophistication of its workflow processes. “We had a lot of different custom applications that required different processes, and we needed to unify those processes to make it easier for employees to be productive,” says Charlie Chasen, Manager of Information Services for NASCO. For example, the company wanted to streamline the training process for temporary workers so that they could begin contributing to the company more quickly.
“All in all, I knew that the emerging Microsoft products could benefit NASCO in terms of increased efficiency from both user and management standpoints,” says Chasen. “I wrote a plan to upgrade our infrastructure that required a significant investment on the part of the company, so it was important that our senior-level leadership understood exactly why those new versions of products were so important.”
Solution
NASCO began the process of educating executives about the value of upgraded technology by attending a Strategy Briefing at the Microsoft Technology Center (MTC) in Atlanta in June 2008. “We wanted to give senior managers the opportunity to see the technology in action themselves, because that would really make it clear just how much the company could improve our ability to react to changing business needs, reduce costs, and accelerate performance,” says Chasen.
A team of NASCO executives spent a day at the MTC, splitting their time between a demonstration in the Envisioning Center and technology discussions with MTC architects. “The architects went through multiple Microsoft products end-to-end and talked about how all those products work together in real-use scenarios,” recalls Chasen. “We also learned more about the Microsoft road map for upcoming technologies. In addition, the MTC provided a forum where we could get together and see how different departments could build on various solutions.” For instance, the company’s human resources (HR) managers explored the use of Microsoft Office SharePoint Server 2007 for accelerating the time-to-productivity for new employees. That HR group later returned to the MTC for a deeper discussion of how it could optimize the HR department’s use of workflow processes.
As of May 2010, NASCO has the pieces in place to make great strides for itself and for its customers. The company upgraded to Microsoft Office SharePoint Server 2007, Exchange Server 2007, SQL Server 2005, and Office PerformancePoint Server 2007 business intelligence software, and it already has built several tools based on those products that will help provide the BI capabilities that it needs.
Now that NASCO has established a powerful combination of processes, measurements, and analyses, it can give its group of consultants what they need to help customers improve their efficiency. Following a proven methodology, the consultants use the tools that NASCO built on top of Office SharePoint Server 2007 to identify customers’ current processes, ideal processes, and the gaps between the two. The consultants make heavy use of Microsoft SQL Server 2005 Reporting Services as they analyze areas for improvement. In the future, NASCO plans to implement self-service capabilities for customers using Office SharePoint Server 2007 extranet functionality.
NASCO also developed balanced scorecards using Office SharePoint Server 2007 to track key performance indicators and measure the business health of the company. It included historical data so that it can note and examine trends based on time of year and other factors. Decision makers can view the data in overall terms or look at a particular area in detail to determine whether to reallocate resources, change tactics, or make other strategic decisions.
Benefits
For NASCO, visiting the MTC and upgrading its technology infrastructure provided the direction and tools necessary for the company to improve customer service, provide better decision-making capabilities, and increase productivity. “The MTC helped me turn abstract concepts into business understanding. By seeing real examples, our executives gained a greater understanding of what technology can do for NASCO, which makes my job a lot easier,” says Chasen. “And, from a technology standpoint, we now have the tools that we need to make our customers and ourselves more successful.”
Validation of Technology Investment
The company came away from the Strategy Briefing at the MTC with a greater level of consensus about its need for technology improvements. “For us, the MTC engagement was an affirming experience that made executives more comfortable with the company’s collective technology investments and decisions,” says Chasen.
The company found it helpful to hear about future technology plans from MTC architects because that information helped NASCO with its own planning. “As the person who’s responsible for making IT recommendations, the MTC engagement was invaluable,” says Chasen. “And it’s much easier for executives to understand the business benefits of new IT projects because of what they experienced at the MTC. In fact, I’ve been asked to escalate certain projects because they deliver capabilities that executives saw at the MTC and want immediately. They’re confident that Microsoft technologies can solve their business problems.”
Better Service to Customers
NASCO now can offer enhanced services to its health insurance customers because it has comprehensive analytical tools at its disposal. “We’re able to be more proactive in meeting our customers’ needs,” says McKenna. “We don’t have to wait for them to experience problems with their processes. Instead, we can identify lags in their claims performance and address them before they become an issue.” For example, NASCO can alert a customer to an unusually large inventory of suspended claims, and then it can help the customer find the source of the problem.
“With the healthcare industry becoming increasingly complex, our health insurance customers need information as to how they’re performing to ensure cost-effectiveness. We as their trusted advisors need to be able to dive down into the details to perform root-cause analysis and help them make the right changes to maintain and improve their operational efficiency,” says Cicchino. “Because we can rely on the tools in our Microsoft infrastructure, we now have the insight and data to take customers from Point A to Point B.”
The company already has seen its customers’ first-pass rates for claims climb from around 60 percent to above 82 percent as the result of helping customers fix common process errors. “Because we have the data to support our analysis, we’ve been able to foster a huge increase in the number of claims that are automatically processed the first time around,” says Cicchino. “As the number of claims grows, our customers won’t have to add staff to handle that increase.”
Smarter Business Decisions
NASCO also has better visibility into its own business because it can continuously track growth, efficiency, costs, and other critical business elements. The company used to rush to find numbers once a year; now it can see what it needs immediately. “We use Office SharePoint Server 2007 as the source for key metrics,” says Cicchino. “In any given month, we have reliable data available to show us how we’re doing, which means that we can make adjustments along the way.”
For instance, NASCO can look at calendar-related trends to see how far behind or ahead of revenue it is in certain areas. “If we get too far behind and see that there’s no chance of hitting our target for that area, we can reallocate resources to another area where we can be more successful,” says Cicchino. “We have predictive measurements and better resource utilization, now that the data is there to help us make sound decisions.”
Greater Productivity
By implementing up-to-date technology solutions, NASCO has increased productivity in various facets of its business. “Efficiency has gone up since we’ve given employees the tools that they need to get their work done more quickly and effectively,” says Chasen. “And, on the IT side, we’ve reduced operating costs through easier management and faster development.”
The Business Effectiveness Unit, for example, uses the list capability in Office SharePoint Server 2007 to develop and maintain the intake process for new consulting work, replacing the yellow legal pad that Cicchino used to use to track new jobs. “Now anybody in the company can see what’s in our work queue, which means fewer questions about our upcoming work,” says Cicchino. “And we have a better picture of our work requests because employees fill out forms to log all their relevant project information into the repository, so we know what the work involves before we start. We’ve gone from chasing information to being able to use and supply information, and that has made us much more productive.”
“Employees now use Office SharePoint Server 2007 instead of email to share documents and information,” adds Chasen. Overall, NASCO employees find it easy and intuitive to use Microsoft products, which means that the company derives additional value from its technology investment.
Microsoft Technology Centers
Microsoft Technology Centers (MTCs) provide everything you need—technology experts, industry leaders, and an outstanding environment—to envision, plan, and architect a complete, customized solution.
For more information about Microsoft Technology Centers, go to:
www.microsoft.com/mtc