Healthcare Highlights

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

Nolan Perspectives

The Steady-State Imperative

Achieving steady-state operations may not be the most glitzy goal for a business leader, but it is a very necessary step towards competitiveness – and often a very challenging one.

EOC Validation Helps Avoid Costly Errors

Many payers have been expanding their business through additions of new lines of business (e.g. Marketplace, Medicaid, Medicare) and/or new geographies. They often find themselves driving towards very aggressive dates and, in some cases, with unfamiliar products. 

Ancillary Benefits and Persistency

Product Portfolio Management is enhanced by understanding how different benefit packages interact with Persistency of the main offering. Health Plans who are or are considering offering ancillary benefits gain from knowing the lift provided or not provided by ancillary benefits.

The Power of Persistency

Health Plans are Gaining Competitive Advantage with Portfolio Management and Persistency Modeling

The Great Exchange: Health Insurance Approaches a Tipping Point

The health insurance industry is on the verge of a major shift — one that promises to change how insurance coverage is marketed, sold, and consumed. Here’s our perspective on how the Exchanges will transform the industry — and what health insurers can do to compete.

A Healthy Plan for Member Engagement

In the age of Affordable Care, individuals are playing a more active role in their own health.

New Healthcare Models Are Driving Increased Administrative Expense

Over the past 20 years, health plans have made significant progress in reducing admin expenses, but new healthcare models are requiring health plans to implement new capabilities, which is driving costs back up.

Staying Effective in an Efficient World

The pace of business today and the realities of the current economy have resulted in changes and adjustments throughout the business world. With cost pressures, businesses have stressed the impact on service.

Who’s in the Driver’s Seat for Business Analytics Value?

I recently wrote an article concerning the need to extract business value from Business Analytics.  A reader then sent me the following question and comment: “Who should be charged with making sure this happens – is it the responsibility of the CIO, line-of-business heads, data scientist (where t

Benefits of Maturity in Business Analytics

A recent ComputerWeekly article presents some startling figures concerning the amount of money businesses are investing in business analytics. The article1 reports that business intelligence software and services will reach $143 billion in 2016, with two-thirds of that being on services.

Solving Complex Business Problems: Harnessing vs. Adding Horsepower

Business leaders have categorized the problems confronting them as “complex” since the phrase “business problem” was coined. And those problems are getting more complex. The pace of technology, new competitive landscapes (e.g.

Efficiency Versus Effectiveness

“Effective use of technology and data can improve the quality of care and make our health-care system more efficient,” said Health and Human Services Secretary Kathleen Sebelius.

Health Insurance: Change in an Uncertain Market

 Earlier this year, the Nolan Company conducted a market scan of the health insurance industry through targeted interviews and reviews of public information. The purpose of the scan was to develop a qualitative understanding of what health insurers will focus on over the next few years.

Healthcare Exchanges: Change and Evolution

With its beautiful foliage and cooler temperatures, fall is a time of reflection on the achievements of the current year and preparation for the upcoming year. Reflecting on 2012, it has been a year of significant change and uncertainty in the healthcare industry.

Healthcare Change is at Historic Highs - How will Your Organization Adapt?

Adapt or die. So Charles Darwin wrote, and any shrewd businessperson knows it applies to companies as surely as it does to plants and animals.

Study: Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS

Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS Challenges, Estimated Costs and Potential Benefits
Nolan conducted a study for the Blue Cross Blue Shield Association that assesses the costs, operational challenges, and potential benefits of migrating to ICD-10-CM and ICD-10-PCS. 

What Cooking has Taught Me About Operational Changes

I am an amateur cook. I’ve learned to cook as amateurs do: by watching my father, Boy Scouts, talking with friends who cook, and reading about food and recipes. But, most important, by breaking eggs and giving it a try!

Analytics in Action: Medical Loss Ratio

Many health plans are making investments in analytics that are becoming solutions in search of a problem.  If executives don’t engage their analytic staffs on critical issues, the result can be “analytic drift.” The analytic staff is adrift when they are spending their talents—and the plan’s mone

Developing an Analytics Culture: Moving from More Reporting to More Action

It is generally accepted in many industries that the next frontier in competition will revolve around analytics. Companies that figure out how to leverage analytics will improve business performance by reducing costs, improving customer satisfaction, and understanding more clearly who their customers are and what they want to buy.

Is Your Organization Ready for Healthcare Insurance Exchanges?

Whether you're ready for it or not, the implementation date for Health Insurance Exchange is coming.

Defining Process Architecture: Why It Matters to Health Plan Operations

Productivity in many administrative functions in health plans has increased four- to five-fold over the last 20 years.

Will "Process" Trump "Project" in PMO?

We don’t actually expect “Process” to replace “Project” in “PMO,” but given the pervasive changes in health care, we do believe that the process management office is becoming essential. The health care industry is undergoing change of a scope and pace unlike anything we’ve seen.

Managed Medicaid Rated a "Strong Buy"

If we were rating managed Medicaid as a stock, it would be a “strong buy.” Why? Read on.

There will be sustained enrollment growth in managed Medicaid. It is estimated that the number of people eligible for Medicaid will grow by 16 million over the next 10 years.

The Basis of Competition is Changing-Are You Ready?

Understanding the impact of reform is a bit like watching mountains emerge from the rain and fog: you don’t see the mountain all at once.

Will Health Care Be Reformed

Will there be health care legislation? At the time of this writing, there is a House bill and a Senate bill. The bills are lengthy; running approximately 2000 pages. Reading the entirety of the proposed bills is a chore, to say the least.

Can You Compete on the New Basis?

As I’m writing, C-SPAN is in the background with a discussion about the bewildering set of potential laws that we are arguing over as part of health care reform.

We Have a Wicked Problem on Our Hands

We are in a historic debate about how and whether to reform the national health system. Of course, ‘reform’ is in the eye of the beholder.

Not Just "All or None"

With most of the increases in health care costs of the last 10 years shifted to the employee, there has been little incentive for health insurers to pursue the focused, effective management of health care resources.

Negotiation: Not "What Can You Do for Me?"

Recently, while developing a negotiation unit for a health insurance client, we were prompted to think about what makes an effective negotiation program. We were also reminded of the elements critical to the success of such a program.

The $2000 Trebuchet: Flying Pumpkins and Process Design

There is a book that is truly dangerous, and I will not name it in the interest of protecting you from yourself and me from the author’s lawyers. But it has a title something like Backyard Trebuchets. If you see it, do not touch it. Run away.

Health Insurance: Opportunity Knocks; Who Will Answer?

As health care expenditures continue to rise from the current level of more than 16 percent of the GDP, the increasing cost of health care benefits will result in many employers declining to offer health insurance to their workers.

The Most Common IVR Design Error for Health Plans

Nearly every claim, member service, or health service project we do involves an interactive voice response problem. So we have a lot of practical experience with IVRs—the good, the bad, and the ugly.

Quality Healthcare: What Is It and How Do We Know?

As insurers, employers, and employees, we tend to focus on the cost of healthcare. But given the data on the quality of care delivered in the United States, should we also be giving at least equal time to the quality side of the equation?

What Were You Thinking?

It was second down, late in the fourth quarter, and the score was tied in a high school football game between cross-town rivals. The home team was deep in its own territory when the second-string quarterback, who had replaced the injured starter, was also injured.