Curing Health Plan Ills

By Outsourcing Center, Beth Ellyn Rosenthal, Senior Writer

Curing Health Plan Ills

Health plans can get very, very sick if they continually hear “the check’s in the mail.” Too many experience financial difficulties because they don’t receive timely payments from employers and members. Outsourcing their back office processes is one way they can get paid on time, says Brenda Smoker, vice president of customer support service for Synertech, a health care outsourcing provider in Harrisburg, Pennsylvania.

Claims processing is not the only way health plans can become starved for cash. Sometimes these organizations introduce new products. This can cause a delay in processing their payments because the selling cycle is slower and they must develop new back end processes for the new product. “We can help them create these new processes in a timely manner,” says Smoker.

Sometimes health plans develop headaches trying to keep up with the latest technology. Changes are happening as fast as a viral epidemic. Outsourcing becomes an easy pill to swallow.

Currently Synertech has 27 clients and is supporting over 4.5 million members. Last year the provider processed more than 10 million health care claims and authorizations.

Customers identify their mission critical issues for the Pennsylvania provider. The outsourcer then tailors performance standards to meet these customer needs. Shawn Scott, a director of customer support services, says the provider also will suggest performance standards to customers new to outsourcing.

Incentives Motivate

The company’s performance standards include both incentives and penalties. If the provider exceeds its standards, it receives a financial bonus. If it misses the mark, it must pay a penalty. In 1999 Synertech met or exceeded these performance standards 97 percent of the time. For five months out of 12 it matched its performance standards 100 percent. “Incentives motivate us more than penalties,” points out Smoker.

Synertech employees find their compensation is tied to their customers’ satisfaction. Whenever Synertech meets certain performance standards, the employees receive a bonus in their paychecks. “When we miss a standard, we are all over the problem,” says Tom Hayes, director of customer support services. “We might miss it once, but we won’t miss it twice.”

The company assigns each new customer an account manager who is responsible for its needs during the course of the contract. Synertech encourages its account managers to learn their customers’ businesses as well as become familiar with the personalities involved. “We rely on these account managers,” says Hayes.

These staffers have direct access to Synertech’s senior staff to come up with an Rx if a problem arises. There are no chains of command when it comes to fixing a problem. “They have access to everyone. They can knock on the president’s door if they need to,” Hayes continues.

If a problem arises, the supplier tries to assess if the difficulty is caused by the supplier’s policies or if it is a direct response to an action on the client’s end. “We do right by our customers. If something is wrong, we make it right,” continues Smoker.

The provider has various departments monitoring its performance standards. These departments then report to a central area so that no problems will go undetected.

An Emphasis on Customer Service

Smoker says the company “realizes that technology is wonderful and is dramatically changing how we do business.” However, the executives at Synertech believe technology is only one piece of the outsourcing puzzle. Customer service remains the bedrock of its outsourcing philosophy.

Experience has taught Synertech that satisfied customers are a potent marketing tool. Smoker says they lead to increased contract renewals, great referrals and glowing testimonials.

Hayes insists the service philosophy is deeply engrained in the company’s culture. While its corporate goal has always been to provide realistic solutions to its customers, its employees have always tried to remain sensitive to customer needs.

The company was formed in 1987 to perform backroom services for Pennsylvania’s Blue Cross Blue Shield. In 1997 Synertech acquired a software product and became a software developer overnight. That year Computer World nominated the provider for its Smithsonian Award, given to companies who demonstrate a visionary use of information technology. The company is now an Application Service Provider (ASP) as well as a traditional outsourcing supplier. As a service provider in the health care arena, it supports multiple platforms and claims processing systems.

Smoker says many of Synertech’s customers tried processing their own claims only to discover they didn’t do it well. Then they got in a bind. If they don’t get their capitation payments mailed to their health care providers, their business can deteriorate because their physicians will go elsewhere. That’s when they look into outsourcing as the needed medicine to solve their back office problems.

Benefits and Claims Moving to the Web

Today these companies face a new challenge to their economic health: the Web. They realize their members and employer groups are clamoring for Web-based technology. They want their benefits and claims history on-line. “The Web is pushing more health plans into the arms of the ASPs,” says Smoker.

Lessons from the Outsourcing Primer:

  • Changing technology, back office back ups and the Web are pushing health plan providers into outsourcing.
  • Satisfied customers provide increased contract renewals, wonderful referrals and glowing testimonials.
  • Eliminating the chain of command to solve problems keeps the customer happy.
  • Incentives motivate.

About the Author: Ben Trowbridge is an accomplished Outsourcing Consultant with extensive experience in outsourcing and managed services. As a former EY Partner and CEO of Alsbridge, he built successful practices in Transformational Outsourcing, Managed services provider, strategic sourcing, BPO, Cybersecurity Managed Services, and IT Outsourcing. Throughout his career, Ben has advised a broad range of clients on outsourcing and global business services strategy and transactions. As the current CEO of the Outsourcing Center, he provides invaluable insights and guidance to buyers and managed services executives. Contact him at [email protected].

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