Industry Voices—How industrial engineers could help health insurers

Health insurance form payer plan enroll
Insurers applying industrial engineering principles to their processes and systems would be a smart way to identify and make improvements. (Valeriya/Getty)

Early in my career as an industrial engineer, I did some work for the Walt Disney World Resort theme park in Orlando, Florida. A big part of my job was helping figure out how to reduce the time our visitors spent waiting in line.

We did it by taking engineering concepts traditionally used in manufacturing and applying them to people and their behavior. We analyzed throughput and inventory, conducted time studies and applied our ingenuity to arrive at ideas like allowing customers to buy passes that guaranteed certain wait times.

A few years later, I entered the healthcare industry, where I’ve worked ever since. Over the years, I’ve often thought back to the work my team did on wait times. Usually, it’s because I’m thinking about how much payers would benefit from improvements to their customer experience. It’s also because I believe that applying industrial engineering principles to their processes and systems would be a smart way to identify and make those improvements.

The principles could be applied to the experiences of any constituency a payer serves: members, brokers, providers or employers. Each group conducts transactions with payers that are governed by specific workflows. Many of those workflows are badly broken—and that’s why very few customers in any constituency want to interact with health insurers unless they have to.

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It’s also why payers face increasing pressure on their top and bottom lines. As large group employers, individual members and government officials push for better, more cost-effective care, payers should be looking for every opportunity to drive efficiencies in their workflows. That will lead to better customer experiences, which will improve members’ health and strengthen payers’ bottom lines—both by reducing costs and by bolstering their reputations among all the customers they serve.

Start with visibility

Before they make any determinations about improving processes, engineers are trained to first investigate how the processes truly work. That requires full visibility into workflows—the way people, processes and technology interact.

On a factory assembly line, that might start with studying sales data and customer feedback to understand where the product is falling short. Next, the engineers might interview workers at every stage to understand how they perform their tasks in precise detail. Then they’d analyze the workflows to determine which flaws in the process lead to specific breakdowns. Finally, they’d identify the most cost-effective solutions; in manufacturing, that most often means automation that minimizes flaws or speeds up the process (or both).

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In a health insurance setting, visibility into the broker workflow might start with reviewing user data for a broker portal and then speaking to brokers to understand their pain points. Perhaps you determine that brokers selling Medicare Advantage plans are often getting stuck on a particular step as part of submitting an enrollment application, which causes them to either give up, go with a competitor or take inefficient steps like calling the payer for support. Your next step is to look at your internal processes.

Every time a broker submits an application it kicks off a workflow inside the payer. You want to understand every action that makes up that workflow, from application intake to resolution.

Breaking down data silos

Gaining visibility into that or any workflow inside a payer will require access to data from across the organization. And here is where many plans hit a roadblock. Typically, those data live in disparate systems, cobbled together over many years of internal development and acquisitions; they probably don’t share data or communicate with each other, and access likely isn’t spread across departments or roles.

In some cases, those silos may themselves be causing the workflow breakdowns. Let’s say the care management team struggles to communicate with members about new ways to manage their conditions. Ideally, if one of those members happens to call looking for a new ID card, the customer service representatives would immediately be notified and prompted to deliver a care manager’s message so they can close a gap in care. But at many plans, it doesn’t happen. The call center has no way of knowing what the care management team’s goals are for the member. That’s not only inefficient but a poor customer experience—even if the member isn’t aware of it.

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Industrial engineering principles have the power to transform those workflows. But for many plans, understanding their workflows will likely start with attaining 360-degree visibility into their data—for the member, provider, broker and employer—so they can track behavior across multiple market segments and sales channels.

Once they have that visibility into the various touch points with customers and gaps in the workflows, payers can take a page from the industrial engineering books—identify inefficient processes that can be automated, redundancies to eliminate and opportunities to improve the end product—in this case, members’ health.

It’s harder than it sounds, of course. But if it was worth the effort to improve the customer experience in amusement parks, it should be worth the effort for a better health system.

Etugo Nwokah is the senior vice president of product management at Zipari, where he’s regularly advising and working alongside payers to implement tech that will make better use of their data and, ultimately, move toward consumerization.