The POWER System: Increasing Productivity with Fewer Personnel
Issue:
PBSI sought a solution to improve claims processing while also reducing costs. The previous processing system was cumbersome and required extensive labor hours. Management wanted a proactive systematic tool to identify potential performance and consistency issues before they could negatively impact customer requirements or satisfaction. Management also sought to contain or decrease operational costs without sacrificing quality and reliability.
Methodology:
POWER was developed and implemented in all facets of our Medicare operation.
PBSI’s POWER (Paperless Operational Workflow and Electronic Routing) System is a rules-based electronic workflow manager, e-document repository and database that blends multi-operation processing into a seamless, real-time environment.
POWER provides a virtual work environment that transfers documents in seconds instead of days and allows simultaneous viewing of the documents by resources in multiple locations. Handling of paper files is virtually eliminated. Electronic workflow management ensures that all tasks are worked according to schedule and that management reports contain accurate, real-time data, resulting in improved service to customers while reducing overall costs.
Outcome:
Over 25 percent in staff reductions were quickly realized, in addition to reductions in supply, facilities, and postage costs. While our productivity increased, the number of full-time employees (FTEs) required to accomplish tasks was reduced. The implementation of POWER resulted in meaningful savings and reduced labor costs:
|
PBSI Division |
Actual # of FTEs Reduced |
|
Claims/Mailroom |
17 |
|
MR/Audit and Reimbursement |
25 |
|
Benefit integrity |
2 |
|
Provider Customer Service |
8 |
|
Claim eligibility redeterminations/appeals |
28 |
|
Total |
80
|
The impact of these reductions has been significant; PBSI saved $3.9 million in employment costs over the first year of implementing POWER through the reduced need for staffing. POWER continues to provide return on investment; we are able to do more work, more efficiently, with fewer personnel. Our streamlined staff can now accomplish more work at a higher quality than a larger staff could previously manage. POWER has truly enabled PBSI to do more with less.
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Measuring the Benefits of POWER: Increasing Quality at all Organizational Levels
Issue:
- The issue of claims processing, especially turnaround times for claim payment, attracted increasing attention among health plans and providers. The reliance on paper documentation for Medicare claims operations increased the potential for mishandling, delays in processing, lack of real-time information, and inaccurate workload reporting. Providers and beneficiaries became unhappy customers, which increased the workload for Customer Services and other areas that engage in public outreach support.
- In addition to being cumbersome, paper-heavy processes delivered less accuracy than electronic systems. Studies indicate that on average, about 94 percent of claims received electronically from hospitals are "clean," versus 87 percent of paper claims, according to a survey completed by the HIAA.
PBSI wanted a data management tool that would improve efficiency, reliability, quality, and managerial oversight throughout the company—all while decreasing overall costs.
Methodology:
To address these concerns, PBSI developed POWER (Paperless Operational Workflow Electronic Routing), a virtual work environment that transfers documents in seconds instead of days and allows simultaneous viewing of the documents by resources in multiple locations. With POWER, repetitive tasks are automated into a tool that adds speed, consistency, and accuracy to daily task processing. POWER streamlines data access, entry, extraction, and storage, and automates routine tasks. POWER-driven processes have proven to be significantly more accurate, efficient, and cost-effective than the manual, paper-intensive processes. PBSI realized significant improvement in our capabilities throughout the organization while capturing real reductions in expenses.
Today, POWER has applications in every functional area at PBSI. Tasks that traditionally require paper or multiple sources of information have been enhanced with POWER. Management activity, quality assurance, and process improvement are facilitated by real-time updates, workflow status documents, and reports. Productivity statistics, provider specific data, error history, time to resolve tasks, and other information that was previously difficult to obtain is now readily accessible. Tasks that formerly required several reviews by multiple staff can now be processed with greater efficiency by one individual with one review.
Outcome:
Across our operations, PBSI has implemented POWER to successfully improve operations and reduce costs. Examples include:
Processing Redeterminations: Due to the vast number of process improvements made possible by POWER, PBSI has dramatically improved our Redeterminations processing. Our performance has greatly exceeded the national average, and this has been possible with a reduced staff.
| Program |
PBSI |
National Average |
| Part B Redeterminations |
99.14% |
93.24% |
| Part A Redeterminations |
99.14% |
67.78% |
POWER has measurably improved our processes: Employee production has increased overall by 32%. Since implementing POWER, the ability of an employee to process redeterminations has risen from 19 to 25 per day. POWER has made the process faster and more accurate, more collaborative, more proactive to timelines, and improved managerial oversight.
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Processing Claims / Mailroom
Before POWER, PBSI’s Claims Development Letters (CDL) process would take an average of eight to ten days. Processing was often slowed due to misrouted mail or slow handling of mail.
Since implementing POWER, the time it takes for the overall CDL/response process has been reduced from an average of eight to ten days to one or two days. The POWER-based process not only saves time in the mail room, it also saves significant time in the claims processing, adjustment, and customer service areas. Adjustments caused by late responses to CDLs have been virtually eliminated.
PBSI has enjoyed positive impact on quality and efficiency in all PBSI Claims activity. POWER has eliminated the need for paper files to be maintained onsite, routed internally, and stored for record retention. The process has reduced the number of misrouted and lost work items. Since the implementation of POWER, PBSI has reduced its pending receipts by 34%, even while implementing staff reductions.
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Medical Review Services
The introduction of POWER into the PBSI Medical Review (MR) area has resulted in significant staff savings and efficiencies. Prior to POWER, PBSI Medical Review was slowed by the realities of mailroom processing, transit and delivery times, and the need for physical distribution of paper documents to the correct place.
With the implementation of POWER, the entire Medical Review workflow was transformed to a process that benefits providers, the Medicare program, and the internal PBSI Medicare operation. POWER-based automation of medical record requests has produced significant savings and efficiencies, and has led to increases in the satisfaction levels of our clients.
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Provider Audit and Reimbursement (PAR) Services
POWER has contributed to significant workflow improvements and efficiencies in the PAR area. POWER has allowed PAR to save clerical expenses for copying, filing, and the postage expense formerly attributable to the need to route work to satellite offices. PAR’s physical space needs have been reduced as the number of the hardcopy documents required is much lower.
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Provider Enrollment Services
POWER has been implemented in the PBSI Provider Enrollment (PE) Application process. All new PE applications are scanned into POWER and PBSI is realizing significant productivity increases as a result. Even with reduced PE staffing levels, PBSI has seen an increase in the accuracy of PE application processing.
The efficiencies of the POWER system are evident. Prior to implementing the POWER system, our PE operations were maintaining over 5600 linear feet of filing cabinets to accommodate all of the generated paperwork. Since transitioning to POWER, it has not been necessary to add a single additional filing cabinet. POWER has enabled operations to be maintained digitally, reducing the need for continued facilities investment. Additionally, the ability to respond to any request for information can be handled immediately, thanks to the accessibility of all data.
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Quality Assurance
Our Quality Assurance group noted that once departments implemented POWER, quality reviews improved. POWER increased oversight and documentation in a standardized manner, allowing quality reviews to be performed more quickly.
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