SBPASC transforms claims processing nationwide

In today’s healthcare industry, accessibility and ease-of-use are paramount, as customers have come to expect easy-to-navigate services designed to make once complex processes simple.

Service Benefit Plan Administrative Service Corp. (SBPASC), which provides IT operations and services for the Blue Cross and Blue Shield Service Benefit Plan, is well aware of those new consumer expectations. This shift pushed the company to launch NextGen, a program to make its healthcare offerings more accessible to customers nationwide, starting with systems for health-plan enrollment, claims processing and customer service.

“We wanted to create products that have greater speed to market for new benefits and products, support new and emerging value-based payment models, streamline processes to achieve operational excellence, and improve the overall member experience,” says William Byrd, vice president of business solutions delivery.

After evaluating the “topline business needs,” says Byrd, SBPASC decided on three main drivers for establishing technologies to adopt and build to create a nationwide customer-service platform. NextGen, which involves 10 systems and products, simplifies claims-processing, automates manual tasks and delivers deeper business insights through data.

Improving the customer experience

SBPASC’s first main driver was to “enhance the customer experience by establishing a national customer-service platform to deliver superior service,” says Yuping Zhu, senior director of federal employee plan (FEP) products and delivery. This platform needed tools capable of serving branches across the country, rather than solutions aimed at each branch location.

To accomplish this, the organization developed Member360, which it launched in 2016. The platform helps consolidate FEP enrollment, claims, benefits and other data into one easy-to-navigate interface so customer service representatives can better support customers.

SBPASC also developed Inquiry Management, launched in 2017, to enable customer service representatives to open, route, track, manage and report customer inquiries across the nation.

The organization’s second main driver for NextGen was to “increase efficiencies by enabling configurable benefits and claims adjudication; changing code, benefits and products through configuration; applying business-rules driven claims adjudication; and proving seamless and efficient claims adjudication with real-time operational dashboards,” says Byrd.

These configurable platforms would allow individual branches to have the settings, real-time data and features they need, without requiring extra resources to create custom services for each specific branch.

To accomplish this, SBPASC implemented Claims Workflow Management (WFM) to create a more seamless experience for inventory management, assigning tasks and managing productivity. Seamless Adjudication followed, allowing for real-time claims processing notification and for employees to make quick and necessary edits in the reports as needed.

SBPASC also developed its Configurable Claims Adjudication Engine (CCAE) to facilitate flexibility with claims processing by introducing configurable business-rules and business-process management, Byrd says. Configurable Benefits and Products (CBP) was also implemented to replace SBPASC’s existing benefits administration system with a more configurable and flexible platform for claims processing.

As part of its third main driver for NextGen, to improve productivity by standardizing and optimizing the post-adjudication process and introducing on-demand reporting, SBPASC leaned on robotic process automation (RPA). This has helped reduce the need for temporary staff during open enrollment season by automating much of the enrollment application process. 

Embracing change

Encouraging employees to make the cultural shift to embrace new systems and processes can be the biggest hurdle — especially for nationwide organizations. SBPASC used actionable results to make the process easier, as employees were more eager to get on board when they saw the benefits in their day-to-day work.

The organization’s biggest shift came in 2018, when it implemented DevOps as a way to quickly respond to the growing and changing needs of the business and to support all the initiatives that were being pushed at once under NextGen. 

“With these improvements, infrastructure teams could provide 11 additional development and test environments in 2018 — more than twice the number of environments delivered in the previous year — without significantly growing the team delivering and managing these environments,” says Greg Bishop, director of technical infrastructure for SBPASC’s Service Benefit Plan Operations Center.

Additionally, the need to manually fix errors dropped three times from what it had been before the DevOps implementation. Deployment and test automation also saved employees thousands of hours per month, which helped encourage the internal culture shift, as teams could see the direct benefits of embracing these new systems.

“These capabilities enabled teams to assess customer feedback and turn around changes quickly, driving a customer-centric culture,” says Byrd.

Embracing cross-company collaboration for growth

The NextGen program has pushed changes that Byrd and others expect will facilitate well-rounded growth across the organization. Teams now collaborate using Scrum and Kanban practices, and the organization formed a “leadership coalition,” called the NextGen Plan Champions and Transition Lead, to encourage consistent engagement with all initiatives.

One major goal of NextGen is to streamline efficiencies across all 36 plans offered. Since implementing these initiatives, 24 plans of 36 plans have adopted Member360, 16 have adopted Claims Workflow Management, and 33 have implemented FEPInsights, a platform aimed at providing deeper analytic insights and allowing users to access information faster.

By centralizing the solutions, instead of addressing them individually, adoption is up across the board, with an 88 percent increase in unique monthly users in 2018 logging into the Member360 platform.

Ultimately, the NextGen program has helped reduce costs, eliminate some manual tasks and minimize the need for hiring temporary workers. And by enacting change at the national level, the NextGen program benefits “36 individual BCBS plans by not having to develop them for their individual organizations,” says Byrd.