Merging operations can be costly and time consuming when it comes to getting employees on board. Rather than relying on expensive change management consultants, a large health plan provider empowered its employees with an innovative team engagement process to speed benefits from a recent merger.

In the tumultuous healthcare insurance industry, mergers and acquisitions are a fact of life. For a regional health insurance provider on the East Coast, the challenge of merging operations with another insurance provider took on new urgency in light of the Affordable Care Act. The key question facing the newly formed leadership team: How to capture efficiencies from merged operations while maintaining and potentially improving services to a larger network of patients?

Change Acceleration vs. Change Management

For the Integration Director charged with leading the merger, top priorities were to devise a plan for seamlessly handling the surge in calls coming from new hospitals and clinics added to the provider network, and to keep a lid on claims costs from expensive medical procedures. The Director knew from experience that these issues – such as member eligibility for services, obtaining proper authorizations for procedures, and accurately billing of claims – could quickly derail the expected benefits from the new alliance.

Based on prior experience, the Director turned to Leap Technologies and its Rapid Action change acceleration method for help. Rapid Action is the flagship in Leap Technologies’ suite of team engagement tools and processes designed to speed results from change eff orts. Rapid Action fills the gap between large-scale process reengineering and conventional change management programs. It provides a practical way to engage employees on small, highly productive teams to anticipate problems and map solutions related to mergers and acquisitions “before the train leaves the station.”

According to the Director, “I knew we couldn’t just communicate and train our way through the issues ahead of us. Our merger partner had a well developed Lean Six Sigma Deployment that we intended to learn from. But, for the integration issues we were facing, we needed a faster, more nimble methodology for solving problems. Rapid Action’s learn-as-you-improve design, using short weekly meetings over 60 days, was the answer I was looking for to engage employees from both organizations to merge operations.”

Speeding Process and System Integration

Ensuring continued smooth service from new hospitals made available to policy holders from the merged plans topped the list of merger concerns. Members of the newly formed senior leadership team anticipated a big increase in calls regarding eligibility, authorizations, claims, benefits, and more.

To get ahead of the potential problem, the Director immediately launched two Rapid Action teams to develop and execute the plan for ensuring a smooth transition. The “HAT” team” (for hospital automation), comprised of call center reps and health plan specialists from the merged organization, took on the challenge of helping new hospitals use the acquiring plan’s advanced, automated call center tools to speed response to standard customer questions.

The HAT team followed the Rapid Action approach and launched through a “fast-start meeting”. Within 30 minutes, team members were engaged in activities to brainstorm, sort, and prioritize ideas to solve the problem. Based on their work in the initial meeting and weekly one-hour action meetings over the next 45 days, the team developed and implemented several solutions,  including:

• A new hospital orientation package: Brochures, quick guides and giveaways to educate policy holders
• A pre-introduction call to key hospital personnel to introduce them to the merged organization and the automated help system
• An “in-hospital” training program for the company’s customer service reps to develop relationships and firsthand knowledge of hospitals and other healthcare facilities expected to have high utilization

According to the supervisor assigned to lead the Rapid Action team, “Rapid Action produced a very different kind of roll-out plan than we had constructed in the past. Using the Rapid Action tools and activities, we came up with a plan that went above and beyond in terms of speed of implementation and thoroughness.”

Anticipating and Reducing Errors

The second Rapid Action team, comprised of claims analysts and supervisors, launched with the charter to prevent delays on authorizations, misdiagnoses, coding errors on bills, and other factors known to drive-up costs. The “E² Team” (standing for efficient and effective), brainstormed a number of solutions for managing costs while still ensuring responsiveness to members, including:

• Identification of frequently miss-coded procedures by hospitals
• Development of a quick reference guide on the merged plan policy and billing codes
• Standardization of claims processing workflow for claims analysts and training to ensure consistent application of policies for payment
• Auditing of billing histories to flag items without contracted reimbursement rates (such as miscellaneous medical equipment) and negotiate discounted contract rates for members

These solutions and others implemented by the team reduced claims costs without impacting coverage for procedures. For example, new contracted rates for one procedure alone was forecasted to produce savings of more than $250,000 per year based on historical claims levels.

Making Employee Engagement the Vehicle for Ongoing Integration of Operations

The speed and results of the initial Rapid Action teams (all solutions developed and implemented within 65 days) created momentum and confidence to deploy additional teams on integration issues. Examples of “next wave” Rapid Action team assignments included:

• Migrating member data to a new customer service IT system designed to provide easier access to member profiles and claims histories
• Upgrading new employee orientation training and providing refresher training for current employees on changes resulting from the merger
• Developing targeted pre-admission and discharge protocols to reduce inpatient average length of stay for procedures with highly variable billing rates

The Director confided, “There was some initial skepticism that our people could take on these challenges while managing the additional workloads associated with the merger. However, Rapid Action proved to be ideally suited to our need for maximizing results with minimal wasted time and effort.”

Organizations confronted with improving operations from mergers and acquisitions and sustaining service levels can accelerate integration when equipped with an easy-to-deploy method for productively engaging leaders and employees. With its just-in-time, minimally disruptive approach, Rapid Action fit this healthcare insurance provider’s need to accelerate the merging of operations, while building teamwork at the same time.