Driving Efficiencies and Quality Through System Improvements

THE CHALLENGE

A state Healthcare third party benefits administrator (TPA) concluded that its existing core healthcare insurance administration system was no longer a viable platform to support the current and future business needs of the organization. The volume and complexity of enrollment and premium billing transactions outgrew the capabilities of its current systems. Reliance on manual processes, inadequate workflow management, deficient system controls, and sub-optimal reporting capabilities served as the catalyst for change.

OUR APPROACH

The Vynamic team launched a comprehensive initiative to assess and redesign the TPA’s Eligibility and Finance operating environment. Vynamic thoroughly evaluated the business processes and technology enablers supporting the current operating environment for the purpose of identifying key issues, evidence, and impact. Informed by the findings of the assessment along with leading practices research, Vynamic redesigned the TPA’s business processes to increase transaction throughput, reduce variability, and improve overall quality.

THE RESULTS

Vynamic partnered with the TPA to identify a capability rich, cost-effective solution to support the newly redesigned business processes.

Some specific results achieved include:

• Identified 50+ “quick wins” that delivered significant benefits to the organization
• Evaluated solution options, including detailed financial and risk assessments
• Projected cost avoidance savings as a result of improved claims reimbursement accuracy, increased organizational capacity, and better overall quality