Healthcare Highlights

Stephen Connor, Vice President, Healthcare
The Nolan Company, Management Consultants

Healthcare Case Studies

Driving Results through Financial Performance Management in Managed Medicaid

A health plan’s Managed Medicaid business was financially underperforming, thus limiting their ability to invest in new capabilities for members.

Customized Review of Revenue Processing

Our client for this project was a staff model HMO associated with a nationally known teaching hospital. The Plan has a national reputation for consistently high levels of member satisfaction and unusually low administrative expenses. The Plan has enjoyed both consistent profitability and growth. The Plan has nearly 200,000 members and 1,800 employer groups.

Customized Review of HMO Revenue Processing

Our client for this project was a staff model HMO associated with a nationally known teaching hospital. The Plan has a national reputation for consistently high levels of member satisfaction and unusually low administrative expenses. The Plan has enjoyed both consistent profitability and growth. The Plan has nearly 200,000 members and 1,800 employer groups.

Our client for this engagement was the Southeast regional service center for a $16 billion medical and health insurance company. The insurer serves 2.5 million members through five business units and a wide variety of products. Every year, the 1,300 service representatives of the Southeast center handle more than 5 million calls and adjudicate 27 million claims.

Sustaining Compliance in an Increasingly Regulated Environment

For decades, this BlueCross and BlueShield firm has been serving the health care coverage needs of its members through Individual and Group health care coverage, National Accounts, and Medicare/Medicaid program servicing.

Claims and Customer Service Redesign

The Nolan Company was enlisted to aid a large regional group insurer and HMO with the redesign of its claims and customer service areas in the company's growing managed care business segment. Problems included inefficient processes, incorrect use of existing technologies, random assignment of work and rework, and staff training which was not linked to improving customer service.

Sustaining Compliance in an Increasingly Regulated Environment

For decades, this BlueCross and BlueShield firm has been serving the health care coverage needs of its members through Individual and Group health care coverage, National Accounts, and Medicare/Medicaid program servicing.

The Nolan Company was enlisted to aid a large regional group insurer and HMO with the redesign of its claims and customer service areas in the company's growing managed care business segment. Problems included inefficient processes, incorrect use of existing technologies, random assignment of work and rework, and staff training which was not linked to improving customer service.

Rapid Solution for HIPAA Requirements

The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996. The Department of Health and Human Services published a final rule regarding standards for electronic transactions in health care. Currently health care organizations must comply by fall of 2003.