Self-service done right

by Robin Blair

From airport kiosks to online shopping, self-service is today's watchword. In healthcare, no one knows this like health plans. With a multitude of constituencies to serve including members, employers, brokers and providers, health plans are prime candidates to reap the business efficiencies and customer satisfaction opportunities out of self-service--as it should be.

Headquartered in Wellesley, Mass., Harvard Pilgrim Health Care (HPHC) services about 800,000 New England members with HMO, PPO, POS and Medicare plans. The organization's provider network includes more than 22,000 physicians and more than 130 hospitals.

Harvard Pilgrim Health Care began its journey down the self-service path in 2000, after experiencing a multimillion dollar loss the year before. For 11 years, the nonprofit organization grew by acquisition, and by the late 1990s found itself supporting 55 disparate IT systems that impaired its ability to efficiently invoice, collect payments, administer claims and manage accounts receivable (A/R). It was a case of too much IT, not too little, as well is ill-defined business processes. Adoption of self-service capability represented one component in HPHC's resolution strategy to strengthen profits and bolster customer satisfaction.

Not an Event

Harvard Pilgrim's Senior Vice President of Customer Service and Operations Dave Segal characterizes successful self-service as "a journey, not an event. The way to be successful is not to think of components--i.e., a health insurance enrollment process or a payment process--but rather to think in terms of end-to-end, shared business processes with our constituencies. We continually keep customers' business processes, and our own, at the forefront of our work."

In 1999, HPHC outsourced its IT operation and claims administration to Perot Systems Corp., Plano, Texas, which first helped to reduce the number of IT systems involved and integrate those that stayed. Next, they focused on helping HPHC solve its A/R challenges and subsequent customer satisfaction issues.

When it comes to generating premium invoices, the roster rules. In 1999, the health plan's customers submitted changes to membership rosters by phone, fax, e-mail and snail mail. About 80 percent of all enrollment transactions were paper-based, and the remainder were EDI-based. As a result, members might be inappropriately dropped from the roster, retained on the roster after leaving the plan or assigned to the wrong plan.

"Our A/R problems arose not because employers didn't want to pay us," says Segal, "but because the enrollment rosters weren't accurate. If you get the roster right, you get the components that follow right as well," says Segal. One of Perot Systems' first steps was to help HPHC develop internally an online, self-service enrollment tool as the foundation for change. They dubbed it HPHConnect.

From an August 2000 pilot with a handful of employers, the health plan has grown its self-service enrollment component so that today, about 67 percent percent of enrollment transactions run through a combination of their Web-based tool, HPHConnect (24 percent) and EDI (43 percent). Using HPHConnect, employers can logon and update their company's membership information electronically. If they wish, they also can allow employees to directly update their own information via an online enrollment and member services function and retain the ability to review those updates before HPHC processes the information. Even EDI users can take advantage of HPHConnnect. When EDI users submit files containing errors, they are able to logon to HPHConnect and fix the tool online, in real time.

Online Billing

With customers that range from small-market (five or fewer employees) to employers with workforces in the thousands, Harvard Pilgrim Health Care remains ready to adapt to a broad spectrum of customer needs. In the summer of 2002, it partnered with Natick, Mass.-based edocs, a supplier of online account management and e-billing services, to augment its self-service applications for customers.

Online billing allows Harvard Pilgrim's customers to electronically access their monthly premium statements via a secure Internet connection, where they can view all activities and charges associated with their HPHC relationship. Customers are able to make roster adjustments before the final bill is processed, thus eliminating rework due to errors. If they choose, they also can pay their premium invoices online The e-billing functionality from edocs offers HTML presentation, printer-friendly views, invoice archiving, advanced reporting options and accounts receivable reconciliation. In effect, the edocs system "plugs into" HPHConnect, pulling roster data into a compiled invoice which it presents to the health plan.

Employers that participated in the 2002 online billing pilot unanimously agreed it was a valuable experience, one they would recommend to other employers.

Measure of Success

Harvard Pilgrim Health Care's self-service journey isn't yet complete, but already the health plan has results worth crowing about.

Segal says that 90 percent of HPHC customers now pay their premium bills within a 30-day period--and also that 90 percent of customers surveyed (HPHC conducts monthly satisfaction surveys) report being satisfied, very satisfied or extremely satisfied with their business relationship with HPHC. Days of cash on hand--a measure of how many days an organization can operate if they were not to take in any revenue, and an important metric in the health plan arena--have jumped from 47 to 80.

About 20 percent of HPHC's customers currently use online billing. While Segal believes these are positive results, there is plenty of room for the future expansion of these tools, especially within the small and mid-size business markets.

Segal reiterates that the organization's self-service success is not attributable to a single factor. Rather, he says, it's the combination of leveraging IT with re-engineering internal business processes and aligning with customers' business processes that has generated success. "For Harvard Pilgrim Health Care, success also depended on our clarifying internal roles and responsibilities so that functions like accounts receivable, account services and enrollment billing could be redesigned and streamlined for accountability." For HPHC, the effort clearly was, and remains, a productive one.

For more information about online billing from edocs,