Client Successes

Workforce Optimization for a Medicare Administrative Carrier (MAC)

Northeast MAC

Challenge

A Medicare Administrative Carrier (MAC) located in the Northeast region of the U.S. began to experience a month-over-month decline in Medicare claims volume.  This volume decrease drove efficiency concerns for the MAC’s leadership team; however, due to limited productivity and efficiency reporting, there was little visibility into the actual performance levels and improvement opportunity.  The Claims Processing Center’s reporting did not include operational key performance indicators (KPIs), as it was initially designed to focus specifically on claims processing productivity as compared to subjective goals established by the Supervisory Team.  Furthermore, all data was self reported by the claims processors. 

An additional barrier to quantifying the actual efficiency of the team was relatively new front line leadership.  They had not yet had an opportunity to submerge themselves into the interworking of the day-to-day operation, and tenured members had become entrenched in managing the status quo, creating a reactive environment. 

While many organizations experience similar growing pains as they establish longevity in their particular service industry, these issues were exceptionally dire to this MAC due to a looming contract rebid.  Demonstrating operational efficiency during this process would show favorably to their client and sustain cost competitiveness. 

Approach and Results

Our approach to this client’s challenges was two-fold.  First, CVP established a baseline of current productivity statistics and set target performance levels.  To do this, we conducted a series of time studies, which scientifically measured the actual productivity for each type of claim across the entire enterprise.  With this data, we were able to analyze the actual operational efficiency and forecast potential gains and cost savings.

Simultaneously, we executed our operational optimization methodology: conducting skills assessments of all personnel, examining systems and tools, and conducting operational and workforce management training for the front line leadership. 

Through these exercises, we were able to: define and establish performance KPIs, which drove and tracked back to the MAC’s overriding goals (both operational and financial), design performance reporting that was sourced from automated systems, and make staffing optimization recommendations which would increase the overall profitability of the project.

CVP concluded this engagement by leaving the MAC with a customized roadmap and action plan to continue the changes that had commenced.  Both the roadmap and action plan were segmented into bite-sized, comprehensive projects that were jointly prioritized with the MAC Team’s leadership to ensure practicality and attainability.  Our project also provided the client with a version of CVP’s proprietary workforce management scheduling/forecasting tool to help drive continuous and sustained optimization. The client is now positioned to define optimized staffing levels using this CVP tool.