CTG Develops Tool to Digitize Data Capture and Analysis

Key Challenges

Adapting to personalized medicine with patient-focused offerings

Standard portfolios no longer meeting diverse customer needs

Resource-heavy benefits testing during high-volume Open Enrollment

Recruiting, training, and managing 20+ resources twice annually

Business Benefits

150% cost reduction

$1M reinvestment per year

95% average quality index

80% improvement in configuration turnaround

5+years supporting project

CTG’s Blended Managed Services Delivery for Configuration Testing Drives Cost Savings and Efficiencies for Major Health Payer

The Client

Our client is a major health payer in Western New York, insuring close to 700,000 members. The company has offered services in the region for more than 80 years, including a full line of commercial, individual, and Medicare products.

Challenge

With the growth of personalized medicine, the health insurance landscape is changing rapidly, becoming increasingly patient-focused. Standard, one-size-fits-all portfolios no longer meet the diverse needs of each customer. To effectively compete in the marketplace, payers must be in a position to offer customized products to match the ever-evolving healthcare needs of members and their families.

Our client’s goal is to deliver high-quality benefits packages that improve community health, while increasing efficiencies and lowering costs in the process. One obstacle to achieving this goal was the client’s benefits configuration testing process, specifically during high-volume Open Enrollment periods, which required significant resource, time, and financial investments. To execute the testing, the client had to recruit, train, and manage up to 20 new resources during two separate periods annually.

Drawing upon an 18-year history of working together, CTG was charged with identifying gaps that impeded overall quality and finding ways to streamline the process, while continuing to meet the highest levels of customer satisfaction. Simply put, the key challenge was to figure out ways to offer customers more options while maximizing profit margins for the client.

Solution

The first step was to determine what factors in the existing testing model were interfering with overall product integrity and driving up costs. To do this, CTG deployed an onsite Testing Manager to conduct a business process study and gap analysis. In partnership with the client, CTG then devised a new operating model to address those gaps while increasing quality and efficiency. Workshops were conducted between the configuration and testing teams to ensure everyone was on board with the revised process, and existing configuration testing automation tools were revamped.

Gaps Identified	CTG's Solution
Release and rehire of bubble staff for benefits configuration and testing resulted in high training costs each year.	A new hybrid, blended-shore model—comprised of a core team that remained year-round and a flex team that could be brought on during peak utilization periods—enabled the client to eliminate the need to provide expensive training to new staff each year.
The need to adopt new testing resources each year drove down productivity and affected quality.	A core team retained knowledge from cycle to cycle and provided an expert base for the flex team to draw upon. The blended-shore—or sun delivery—model allowed for faster delivery and higher productivity.
A complex and older benefits configuration process added to the overall program cost and timeline.	Configuration and testing experts on the core team can continue to suggest ways to further automate and standardize procedures, simplifying process and reducing overall costs.
A lack of data collection on quality metrics led to inaccurate estimates.	All data related to productivity and quality is now collected and reported.

Results

CTG’s streamlined solution has now been running successfully for more than five years, leading to a 150 percent reduction in the overall cost of benefits configuration and testing. This translates to more than $1 million in cost savings per year for the client, and has allowed for additional investment in automation, further reducing resource needs by more than 70 percent over the five-year period. Turnaround time for configuration has been reduced by 80 percent. Customer satisfaction rating has increased from 3.5 to 4, and the average quality index has improved to 95 percent. CTG’s strong partnership with the client is enabling them to create more value for their members while also driving cost savings and increased efficiencies for the organization.

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