Extreme Makeover

May 1, 2008

An open-architecture document management solution helps a provider reduce expenses and improve member benefits.

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.

An open-architecture document management solution helps a provider reduce expenses and improve member benefits.

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An additional concern, the outdated technology used to produce these customer communications pieces generated a product with a poor look and feel, similar to that of dot matrix.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 [email protected].

May 2008

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