Medical Administration Professionals Can Accomplish More

Looking Through a Lean Lens: “The real voyage of discovery consists not of seeing new lands but in seeing with new eyes “ - Marcel Proust

Why Apply Lean in a healthcare organization? For many reasons but most importantly the adaptation and application of Lean is focused on providing better and faster care to the patient, and of course doing it at the right cost (no waste).

Lean is a patient-focused approach that puts the needs of the patient at the forefront. Therefore, it is a philosophy that aligns well with the current primary strategic objective of all healthcare organizations.
Lean is also staff-focused – by improving internal operations with a mandate to deliver more value to our patients, we want to improve the work life and enhance the pride of the staff in their valued contribution to patients. Staff are the most valuable resource and Lean is about tapping into the knowledge and experience of every employee and giving them the effective methodology to transform their processes that cause frustrations every day. Ultimately “restoring joy to work”.
Today more than ever, healthcare is faced with both quality and financial concerns. Healthcare demands and costs are rising, creating more pressure on the system and with more pressure quality issues may increase.

Lean provides a proven and effective approach to optimizing quality and value, from the perspective of the “patient” while improving efficiency.

Samples - Actual Administrative Transformations

These following objectives were established at the beginning of each transformation -

Support the primary objective of creating and maintaining an unwavering focus on the patient;
Improve quality of care and safety of patients and staff;
Increase the effectiveness of processes;
Increase patient satisfaction with processes and the experiences of care;
Raise employee morale;
Increase productivity;
Lower costs; and,
Allow medical and administrative professionals to provide the best care patients required.

1. Medical Services Branch – Out of Country Medical / Hospital Claims Billing

The project consisted of planning, leading and supporting implementation of a Lean Transformation to improve Claims Management.

Process 1: Out-of-country Medical Claims Billing

Background: When the organization started its lean journey in processing out of country claims, it had a backlog of approximately 950 claims which grew to a high of 2,200 while this Lean initiative was in progress.

The Challenge (goal): The expected outcome was elimination of the backlog of claims and an improved turnaround time from 67 to between 9 & 19 days from when the claim was received to when it was paid.

Actual Result - 73% Turnaround time improvement (to 18 days)

Current State: Using Lean’s value stream mapping, it showed it took approximately 67 days from receipt of an out of country claim until they were paid, refused, or returned the claim for additional information. The volume of claims that needed to be handled were 373 services in each bi-weekly payment cycle to keep pace with patient demands.

Future State: Staff eliminated the out of country medical and hospital claims backlog (2200 at its highest) and shortened their processing time to 18 days, removing 49 full days from their processing cycle – the time from when a claim arrived to when it was either paid, refused or returned to the submitter for additional information. This was a reduction of 73%. By eliminating a backlog and shortening the time needed to process claims, this initiative not only freed up staff time for other work, but had direct and positive impacts for patient service, allowing us to process claims and thus reimburse patients’ out-of-pocket health care expenses faster.

Process 2: Manual Medical Claims Billing

Background: The Medical Services Branch lean journey started with this initiative. This initiative involved the preparation for payment of manual claims (paper and card claims) received from physicians, chiropractors, optometrists, and beneficiaries.

The Challenge (goal): Our goal was to get the preparation time down for in country manual claims down to 5 days from 24 days which would mean a reduction in the turnaround time to payment to between 18 and 20 days from the then current 39 days for our clients.

Actual Result - 54% Turnaround time improvement (to 18 days)

Current State: The value stream mapping showed that approximately 98,000 manual claims were received each year from physicians, chiropractors, optometrists, and beneficiaries. This means that approximately 410 claims per day had to be processed to meet patuent demand. The time from claim receipt in the mail to data entry completion was an average of 24 days. Factoring in the 2-week payment run cycle, the total turnaround time until payment was 39 days.

Future State: Within 6 months, Lean efforts had enabled staff to reduce processing time for payments from 39 days to 18 days, a reduction of 54%. This reduction freed up time for other work, offering direct and positive impacts for patient service.

2. Vaccine Management

Before

Expired, unnecessary items in inventory
3 Storage areas for inventory (two overflow)
Unsafe supplies in inventory
Time-consuming, manual inventory counts; cumbersome and untrusted spreadsheets

After

20 % reduction in inventory; consistent ordering matched to demand (Just in Time)
1 overflow space returned to office space (40 sq m / $7200 annualized savings in space)
Eliminated expired materials and supplies
Removed potential for medical errors
Improved staff safety
Visual re-order system
Replenishment of supplies – less than 2 minutes

3. Health Information Support Centre – Contract Management