Leading healthcare provider ensures a faster, more effective claims processing operation
公司规模
1,000+
地区
- America
国家
- United States
产品
- Mattersight® Desktop Analytics
技术栈
- Secure Cloud-Based Analytics
- SaaS Delivery
实施规模
- Departmental Deployment
影响指标
- Cost Savings
- Customer Satisfaction
- Productivity Improvements
技术
- 分析与建模 - 预测分析
- 功能应用 - 企业资源规划系统 (ERP)
适用行业
- 医疗保健和医院
适用功能
- 商业运营
- 质量保证
用例
- 预测性维护
- 过程控制与优化
服务
- 软件设计与工程服务
- 系统集成
关于客户
The client is one of the top 5 healthcare providers in the United States, employing over 100,000 individuals and serving more than 50 million members both domestically and internationally. As a leading entity in the healthcare sector, the client is responsible for processing millions of claims annually. This task is critical as it directly affects the financial and emotional well-being of their members, who often find the claims process overwhelming and confusing. The client is dedicated to ensuring that their members have a positive and efficient experience when dealing with medical claims, which is a significant aspect of their service offering.
挑战
As one of the largest healthcare providers in the United States, this client processes millions of claims each year, which means they impact their members’ lives at a particularly sensitive point: the intersection of health and finances. People trying to understand and negotiate a medical claim are frequently overwhelmed, confused and even frightened by the paperwork and dollar amounts they’re dealing with. So this client is committed to providing those members with an experience that is as efficient and positive as possible. The pressure on agents to process claims quickly and accurately was high, and managers could see that somewhere along the line, something was breaking down. Individual processing time was slowing down, and fewer claims were being processed overall. But without any way to identify the specific causes of the problems, they were powerless to fix them. This client needed a clear understanding of their claims processing problems, and a concrete set of tools to quickly solve them. So, they enlisted Mattersight.
解决方案
The client partnered with Mattersight to implement Mattersight® Desktop Analytics across an initial subset of its claims processing agents. This solution provided managers and supervisors with an unprecedented framework for improving the quality and effectiveness of their operations. A detailed analysis of previously uncaptured desktop activity brought a new level of clarity to how agents were spending their time. Self-reported activity was now objectively measured and scientifically analyzed, and unstructured time was broken out and categorized by metric. The output of this analysis was delivered to supervisors in real time, through a dynamic performance dashboard. These new insights revealed the true 'why' behind agents’ performance variability and empowered managers to reduce it. Inefficient business processes that impeded performance were identified and corrected. Risk-elevating actions related to compliance and non-authorized computer use were flagged and addressed. Supervisors were able to provide coaching and feedback focused only on an agent’s best opportunities for improvement, using examples of the agent’s own performance to illustrate target behaviors and strengthen understanding.
运营影响
数量效益
Case Study missing?
Start adding your own!
Register with your work email and create a new case study profile for your business.
相关案例.
Case Study
Hospital Inventory Management
The hospital supply chain team is responsible for ensuring that the right medical supplies are readily available to clinicians when and where needed, and to do so in the most efficient manner possible. However, many of the systems and processes in use at the cancer center for supply chain management were not best suited to support these goals. Barcoding technology, a commonly used method for inventory management of medical supplies, is labor intensive, time consuming, does not provide real-time visibility into inventory levels and can be prone to error. Consequently, the lack of accurate and real-time visibility into inventory levels across multiple supply rooms in multiple hospital facilities creates additional inefficiency in the system causing over-ordering, hoarding, and wasted supplies. Other sources of waste and cost were also identified as candidates for improvement. Existing systems and processes did not provide adequate security for high-cost inventory within the hospital, which was another driver of cost. A lack of visibility into expiration dates for supplies resulted in supplies being wasted due to past expiry dates. Storage of supplies was also a key consideration given the location of the cancer center’s facilities in a dense urban setting, where space is always at a premium. In order to address the challenges outlined above, the hospital sought a solution that would provide real-time inventory information with high levels of accuracy, reduce the level of manual effort required and enable data driven decision making to ensure that the right supplies were readily available to clinicians in the right location at the right time.
Case Study
Gas Pipeline Monitoring System for Hospitals
This system integrator focuses on providing centralized gas pipeline monitoring systems for hospitals. The service they provide makes it possible for hospitals to reduce both maintenance and labor costs. Since hospitals may not have an existing network suitable for this type of system, GPRS communication provides an easy and ready-to-use solution for remote, distributed monitoring systems System Requirements - GPRS communication - Seamless connection with SCADA software - Simple, front-end control capability - Expandable I/O channels - Combine AI, DI, and DO channels
Case Study
Driving Digital Transformations for Vitro Diagnostic Medical Devices
Diagnostic devices play a vital role in helping to improve healthcare delivery. In fact, an estimated 60 percent of the world’s medical decisions are made with support from in vitrodiagnostics (IVD) solutions, such as those provided by Roche Diagnostics, an industry leader. As the demand for medical diagnostic services grows rapidly in hospitals and clinics across China, so does the market for IVD solutions. In addition, the typically high cost of these diagnostic devices means that comprehensive post-sales services are needed. Wanteed to improve three portions of thr IVD:1. Remotely monitor and manage IVD devices as fixed assets.2. Optimizing device availability with predictive maintenance.3. Recommending the best IVD solution for a customer’s needs.
Case Study
HaemoCloud Global Blood Management System
1) Deliver a connected digital product system to protect and increase the differentiated value of Haemonetics blood and plasma solutions. 2) Improve patient outcomes by increasing the efficiency of blood supply flows. 3) Navigate and satisfy a complex web of global regulatory compliance requirements. 4) Reduce costly and labor-intensive maintenance procedures.
Case Study
Harnessing real-time data to give a holistic picture of patient health
Every day, vast quantities of data are collected about patients as they pass through health service organizations—from operational data such as treatment history and medications to physiological data captured by medical devices. The insights hidden within this treasure trove of data can be used to support more personalized treatments, more accurate diagnosis and more advanced preparative care. But since the information is generated faster than most organizations can consume it, unlocking the power of this big data can be a struggle. This type of predictive approach not only improves patient care—it also helps to reduce costs, because in the healthcare industry, prevention is almost always more cost-effective than treatment. However, collecting, analyzing and presenting these data-streams in a way that clinicians can easily understand can pose a significant technical challenge.
