What continuous improvement looks like when staff buys in

How one health plan manages substantial growth and volume with a Lean approach

By and Craig Weathers | 1 minute read | August 26, 2019

Just a few years ago, Inland Empire Health Plan (IEHP) faced an unexpected surge in membership. The communities in Southern California it served were hit hard by the recession and had one of the highest unemployment rates in the nation. As people lost insurance coverage along with their jobs, IEHP experienced substantial growth in its two lines of business: Medi-Cal and Cal-Medi Connect.

“We had gone from being a pretty good-sized plan, but manageable with kind of our current structure and processes,” CEO Bradley P. Gilbert, MD, MPP said. “Then all of the sudden we’re over a million-member plan…So that sudden growth exposed weaknesses in our processes.”

After trying a few small-scale process improvement projects, IEHP selected a Continuous Process Improvement Transformation direction with the Simpler Consulting Business System for a more comprehensive approach to improve provider and member experiences. With over 2000 employees, it was important for IEHP to achieve standard processes enterprise wide. Just a few examples of projects and Value Stream focus include:

1) Access to interpreters – How can members more quickly access interpreters?
2) Durable medical equipment (DME) – What’s the most effective way for submitting, managing and approving requests?
3) Member call center – How do we reduce handoffs and achieve as many “first-call” resolutions as possible?
4) Provider call center – How can we better respond to Provider needs?
5) Claims – How can we improve turnaround time for claims?
6) Authorizations – Can providers get members’ authorizations easily?
7) Claims – Are providers getting paid correctly?
8) Onboarding – What’s the best way to add new providers and get them seeing members quickly? How can we make the process transparent from contracting to credentialing to training?

Learn more about how IEHP succeeded with Continuous Process Improvement Transformation with the Simpler Business System

Dr. Gilbert shares that IEHP enjoys strong participation from staff in continuous improvement activity, and it has grown over the years. “It’s been a beautiful evolution that Simpler has helped us achieve by doing two things,” he said. “First, it provides a positive structure to engage our team in improving processes, and second the coaches and mentors have been very effective at helping us build the internal capabilities and resources to keep improving.”

Thanks to IEHP for sharing its story. To learn more about what Watson Health Simpler can offer your organization, please contact your IBM representative or IBM Business Partner, or visit IBM® Watson Health™ Simpler.