Om as a Competitive Advantage in Your Organization

Assignment 3: OM as a Competitive Advantage in Your Organization

Anthony McCants Porter

Jack Welch Management Institute

Dr. Richard Chua

JWI 550: Operations Management

Sunday, March 5th 2016

Executive Summary

BlueCross BlueShield of South Carolina and Health Net work hand in hand in order to provide exemplary service to our veterans, providers, and VAMC staff. This paper will discuss the overall operations of that relationship in reference to the veteran’s choice program. This is followed by a closer look at the appointing and authorizations as well as the claims process.  After, the in depth discussion, actionable recommendations will be made to better the process outlined earlier in the paper.

        BlueCross BlueShield of South Carolina (BCBSSC) is a sub-contractor for HealthNet (Centene). As a sub-contractor, we assist with the Veteran’s Choice Program. The program allows veterans to receive health care within their own community. Using the program does not impact their existing VA health care or any other VA benefit. In order for a veteran to be eligible they must already be enrolled in VA health care. They must also meet one of these two requirements:

• The veteran has been or will be waiting more than 30 days for VA medical care.
• The veteran lives more than 40 miles away from a VA medical care facility or face on of several excessive travel burdens (travel by air, boar, or ferry, etc.)

The overall goal is to fine the necessary health care for the veteran in a timely manner so as to assist them with their ailment. With that being said, there are multiple competitive priorities that we strive to place first within our organization. We focus mainly on Quality, Time and Flexibility.

• Quality

• We understand that when a veteran is reaching out for our assistance, their home VA is unable to provide the services they need. This already feeds a sense of frustration. We strive to deliver a process that is memorable, enjoyable, and stress free. We pride our self on delivering world class customer service since we are a 100% service based company.

• Time

• In every aspect of our contract, there are time restraints. To name a few, when we receive a consult from the veterans VA, we have 5 business days to contact the veteran in order to gain their preferences. From the point of gaining their preferences, we have 5 business days to reach out to a provider (within our extended civilian network) to start the appointing process. The provider then has the responsibility of providing an appointment within 30 days from the day we call. These guidelines follow the requests that are labeled as routine. If the consult is labeled as urgent, we have a total of 2 business days to get the preferences and call a provider. The provider would then need to be able to see veteran within 5 business days from our call.
• There are instances where our timeframe is longer than they would have waited to be seen at their local VA. In these cases, the provider or specialty they need isn’t an option within their VA. We still stand to the timeframes that we have in place in order to better serve the veteran.

• Flexibility

• Medicare eligibility plays a big role in the way we are able to treat our veterans. In order for a provider to participate in our program, they must already accept Medicare. The main reason for this is due to the way we pay our claims and also allowing us access to the huge network of doctors participating within the Medicare network. With this network, we have the flexibility to meet the preferences of the veteran in regards to who they want to see, when they want to be seen, and what they want to be seen for. It is very rare that we are unable to find a provider able to perform the necessary medical treatment.

Bottom-line, all of the above can boil down to competing on differentiation and response. Senior management should take the three areas above and focus on them in the order they are given. It is proven that an exceptional customer service team raises the bar when comparing with other competing companies. If you have a solid customer service team who understand the need for the job and how to deliver service, you have completed a piece of the puzzle in reference to a functioning OM based business based on service. By focusing on time and not allowing those restraints to be altered, we are remaining constant in our deliverance of service to our veterans. If this does change, or must change, you run the risk of veterans not looking to our program due to our untimely guidelines that need to meet their needs. Senior management is constantly fighting this fight due to the inability of Health Net to keep up with the work we are producing. So far, we are winning the fight, but tomorrow is a different day. This also plays into the mention of flexibility. Senior management needs to understand that providers are sometimes getting false information from third parties in reference to our program and how it works. Because of this, there are instances were a provider may remove themselves from the program. It has been and more than likely needs to be a bigger focus on retention and reeducation so as to keep our providers just as happy as our veterans.

Question 2: Refer to the Ten Strategic OM Decisions (page 8, Heizer & Render):

Design of goods and services

We are a service based company. We are designed in a way that caters to the need of our veterans medical care for which we are able to deliver better than their local VA. We are constantly tweaking the process from start to finish thus making sure our processes truly meet the ever changing needs of our veterans. Seeing that we focus on differentiation and response, this process is more than likely the most important of the ten decisions discussed as it allows us to stay ahead of our competition and continue to satisfactorily serve our intended market.

Managing quality

BCBSSC is quite clear on the demands placed upon us from our providers and veterans. We have processes in place in order to meet those demands in way that constantly provides exceptional customer service. We also do constant service research to determine what needs to change within our internal processes as well as our parent processes in the instance we find something that can be changed. The quality of any product or service is key to any company. We take great pride in knowing what is best for the type of service that we deliver. We make sure to listen to our veterans and providers  thus learning what is best in regards to what we are doing and what we need to improve upon.

Process and capacity design

As a sub-contractor, our control of the program is limited in regards to the changes that we can make on the fly in order to better service our veterans. Some of the most important processes that we have in place must be tested and backed with data to prove if that process truly helped or hindered our veteran. During these times, the capacity of calls we are able to take lessens and, though rarely, possibly grows. This of course aligns with the competitive priorities we have in place. The goal is to always provide a pleasant process to our veterans and providers. By working through a test environment, at times, the level of service we deliver can be hindered.

Location strategy

Currently, we have multiple locations throughout the United States. Some locations are strictly meant for outbound calling, some are meant for claims and billing for our providers, and others are meant for veterans only. The location of these call centers aren’t necessarily important as all of our agents on the phone are able to assist whoever may be calling in. Currently they are focused on the hours of need for our points of business. However, this is not a focus of senior management. Before my introduction to the company, our call centers were working on a 24 hour rotating schedule thus allowing certain call centers to hold most of the business during certain hours of the day. During this time, service level and customer service response did not change from where we are now.

Layout strategy

Please refer to Appendix 1 for a visual reference. Currently, we have room for 132 agents on the call floor. Of the space provided, we have 52 filled and answering calls. The current layout isn’t best for communication but best for team involvement and noise reduction. In a call center environment, this is considered what is best given our current layout options. Currently, senior management isn’t concerned about the layout of our call center. They do not feel that a layout change or different desk situations would benefit the call center environment at this time.

Human resources and job design

Our work force is divided into two categories – Permanent and Temporary.  Our permanent employees are “managed” by BCBSSC Human resources where as our temporary employees are “managed” by Kelly Services – a temp agency. Both agencies work together to formulate the job standards need to bring in individuals to fill our vacancies. Health Net also has a hand in this as they provide a guideline as to what type of experience is needed in order to perform well in the position of Claims Customer Service Advocate. All employees are reviewed monthly on internal standards so as to know where they stand. Annually, permanent employees are reviewed at which time, we advise them on areas of improvement and excellence in accordance to BCBSSC standards outside of Health Net standards.