• May 2008 FEATURE ARTICLES •
Document Management: Case History
Extreme Makeover
An open-architecture document management solution helps a provider reduce expenses and improve member benefits.
By Robert Redding
At Health Net Inc., we strive to make our
members and customers a top priority. Based in Woodland Hills,
Calif., Health Net provides health benefits to approximately 6.5
million individuals in 27 states as well as the District of
Columbia through group, individual, Medicare, Medicaid and TRICARE programs. Additionally, Health Net’s subsidiaries offer
managed healthcare products related to behavioral health and
prescription drugs, as well as managed healthcare product
coordination for multi-region employers and administrative
services for medical groups and self-funded benefits programs.
In 2004, a dedicated team at Health Net’s
northeast region decided to focus its efforts on providing
members and providers with more customer-friendly Explanation of
Benefits (EOB) and Remittance Advice. This led to a companywide
analysis of all the ways we communicate with our members and
customers, as well as an assessment of the effectiveness of
those communications.
Recognizing a Need
We realized we had been producing our
customer communications the same way for 20 years and were in
need of a print production makeover. For the most part, Health
Net used preprinted forms that were generated from the mainframe
and printed either internally or externally. Afterward, data was
stored in data warehouse or mainframe systems. All of our
customer communications were mailed as individual pieces, which,
given escalating postage costs, was getting more expensive each
year.
An additional concern, the outdated
technology used to produce these customer communications pieces
generated a product with a poor look and feel, similar to that
of dot matrix. Even minor modifications, such as logos, and new
policy information were very labor-intensive and ultimately, the
lack of flexibility resulted in wasted time and money, and
keeping abreast of regulatory compliance guidelines was a
challenge.
Finding the Solution
Realizing our technology needed upgrading,
Health Net’s employee empowerment climate allowed the ITG Print
Services Application (PSA) team to launch a search for a
document solution that would make it possible to improve our
member communications. The initial goal was to find a
composition software tool that would allow Health Net to create
easy-to-read EOBs, as well as other customer documents for
explaining more clearly the benefits members had used, and the
money they were saving by being members of Health Net.
The team had several objectives in mind for
choosing the software that could accomplish our goal. We wanted
to eliminate the need to produce pre-formed data files by using
the new software to compose documents from data sent by the
mainframe. We also needed the ability to store our documents
ourselves to save on postage, as well as the ability to archive
documents in accessible formats available via the Web. It was
also vital that the new software solution kept our organization
compliant with state regulations, including California’s State
Bill 853, which requires providers to give healthcare service
plan enrollees access to language assistance when obtaining
healthcare services and deliver language-specific documents that
explain benefits.
We initially discovered more than 150
possible document composition options that seemed to fit our
objectives. However, after closer evaluation, we quickly
narrowed our options to five solutions most capable of producing
single-pass output in multiple print languages, including
electronic. We then requested product demonstrations and proofs
of concept from each prospect and narrowed the field further to
three. For these three, we performed extensive reference checks
and the PSA team began assembling preliminary conceptual
designs. We discovered that Exstream Software’s Dialogue product
— an electronic platform for building and deploying all
high-volume, on-demand and interactive document applications
across the enterprise — was the one solution that met our
overall document management needs.
We selected this particular product for many
reasons — but the principle one was its open architecture. Built
from the ground up, it offered a robust platform that
complements a diverse IT environment. This eliminated the need
for us to invest in additional hardware for initial
implementation, as well as for future upgrades. The new document
management solution also allows us to customize documents with
dynamic imported file options — such as logos and customizable
policy information — streamlining the print production process.
Additionally, the technology makes it
possible to archive all documents in PDF and HTML formats, so
they are readily accessible on the Web. It can also produce
fully composed print language files for AFP, Postscript,
Metacode and others. We believed this software solution would
assist us to achieve our objectives to create more effective
documents, as well as save time and operating expenses that were
normally spent on print production and postage.
Implementing Change
After we chose our document automation
solution, the implementation process began. A representative
from the vendor’s headquarters in Lexington, Ky., traveled to
our Woodland Hills offices to introduce and train several of our
associates on the new application. Afterward, one of their
developers visited our facility to provide onsite support and
facilitate the implementation process, helping to move it along
quickly and efficiently. Following just four months of
preparation, the first phase of the solution was successfully
deployed, with our ID cards (generated out of our northeast
region) being the immediate application of the new system.
We also added graphs and shading to create
clearer, more concise EOBs for the members of that region as
well. Since we have been using the solution, we have found other
ways to further improve efficiencies. We use its real-time
capabilities to speed pharmacy authorization applications,
turning them around in a matter of seconds, and we archived more
than 120 million individual documents. Additionally, the
document management product’s double-byte character set allows
us to be compliant with State Bill 853, and soon, we will be
printing health documents in English, Spanish and Chinese.
Member-friendly EOBs
Since initial implementation, we have
literally transformed our customer communications and improved
efficiencies for several processes. We currently have 25
different Dialogue applications in operation. Overall, the
system has allowed our organization to enhance regulatory
support and create easy-to-read customer communications, as well
as to support print, real-time and interactive document delivery
options. In addition, we have reduced back-end costs by
eliminating print vendor dependency, reduced postage costs by
utilizing the system’s high-volume production suite, and
consolidated documents and housed them in an easily accessible
document repository. We have also used the new system to send
fully composed files with print resources in the file,
eliminating individual printer resource maintenance.
The company’s EOBs are particularly more
member friendly. For example, Health Net’s EOBs are currently
distributed to more than 6.5 million members and, in the past,
personalizing the statement per a customer’s individual needs
was a challenge. However, our new software solution supports
this level of customization. Its flexibility makes modifying EOB
documents a relatively simple procedure, drastically reducing
development time from between two and three months previously,
to between two and three weeks currently. Our organization is
also utilizing the software’s real-time module for quick
processing of pharmacy authorization applications because the
data files are now returned immediately in PDF format.
The ability to eliminate pre-printed forms,
house documents and make them available electronically has
brought us a significant return on investment. In the first year
of implementation, our organization reduced its print and
postage expenses by approximately $2 million. Additionally, we
are also realizing benefits from the new solution in our
customer service center. Our customer service representatives
are now able to access archived documents via our Intranet and
view them exactly as the customer sees them to ensure that a
higher level of customer service is delivered.
Over the course of this year, Health Net
plans to make the EOB and other documents accessible to our
members via the Web — eliminating 20 percent of our print in the
first year and a 20 percent adoption rate in each of the
following years. Overall, Health Net expects to see a $2.5
million ROI — providing a huge cost savings for the company, in
addition to the greatest benefit of enhancing member and
customer relationships.
Looking to the Future
As a company, we continue to remain committed
to providing the best services to our members. Moving forward,
our marketing department expects to use the software to enhance
marketing campaigns by adding member-specific advantages
directly into customer communications. For example, if a family
member has asthma, that customer would receive information
specifically for asthma maintenance, policy information, as well
as additional information they may find useful — taking relevant
communications another step further.
By implementing this document management
solution, we firmly believe that we are initiating a successful
customer communications program that will improve the overall
health of our members. Any improvement in health status improves
the bottom line, which means the availability of better services
to all our members.
Robert Redding is applications development
director for Health Net Inc. Contact him at
Robert.Redding@Healthnet.com.