StudyCorgi Health & Medicine

Anthem Insurance Companies’ Process Improvement

Abstract

Anthem is an organization that provides health insurance plans to its clients and incorporates several subsidiaries. Based on the Balanced Scorecard model it can be argued that the insurer performs well in the domains of finance, customer satisfaction, and learning and growth. However, the internal processes can be improved by enhancing the ethical standards, reimbursement practices, and privacy of information.

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The mission, vision, and ethical values present an understanding of the commitment to being trusted by Anthem’s clients, which is facilitated through accountability. Additionally, the directional strategy cites the improvement of existing healthcare practices that can help simplify current concepts applied to care provision.

Organizations in healthcare need to implement tools that allow them to track performance and set goals based on a variety of quantitative and qualitative indicators. A Balanced Scorecard was created as a tool to enhance the executive’s understanding of the alignment between the existing strategy for growth and development and declared directional statements. This proposal aims to develop recommendations based not only on the financial performance of Anthem but also by using its operational performance, internal business processes, learning and growth, and customer satisfaction measurements.

Description of the Organization

The organization in question is a US-based health insurance company Anthem that has several subsidiaries, including Blue Cross, Blue Shield, and others. It is a large company that provides services to many citizens in the US and reimburses providers for healthcare services.

The existing organizational structures include several subsidiaries that are overseen by the board of directors. Based on the fact that this insurer operates in a variety of states across the US, it can be argued that the structure is appropriate because it allows providing different services and paying more attention to the specifics of a particular area following the mission and vision statements.

The mission of this healthcare insurer is to become a trusted partner to its clients, which emphasizes the focus on tailoring the services to the consumer’s benefit (“Mission and commitment,” n.d.). This customer commitment transpires through an aspiration to present value to individuals through Anthem’s work. The vision is to provide personalized plans that will help meet the requirements of the challenging environment and improve accessibility.

The strengths of Anthem include the variety of healthcare plans, for instance, point-of-service managed care, or health maintenance, which combines the traditional and other approaches to reimbursements. Opportunities for improvement include compliance issues, the privacy of data problems, and ethical risks that Anthem cites as its main concerns (“Ethics & integrity,” n.d.). Based on this information, a quality improvement strategy for the insurer will be proposed in the next section of the paper.

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Balanced Scorecard

Similarly to any business venture, the insurer in question aims to achieve excellence of performance in a variety of domains. According to Kaplan and Norton (1992; 1996), a balanced scorecard allows one to evaluate current performance and determine prospects for future growth. Areas that can be improved in the company include internal business processes. Additionally, communication practices should be reviewed as well to create a proper environment for discussion. The most critical area for improvement in internal processes and learning and growth.

Financial Perspective

This component of the balanced scorecard involves the evaluation of the income that the insurer can generate. Return on investment is one of the measures that the organization uses and in December 2018 is was 8,18% that is a good ratio that indicates a sufficient net profit, which is part of the strategy (“Anthem’s ROI per quarter,” n.d.). The monitoring of risks is another important objective for Anthem that is enabled by the analysis of operations committed by the board of directors.

The revenue in 2018 was estimated at 93 billion, while net income was 3,8 billion and the target for the following year is to improve this statistic (“Anthem’s ROI per quarter,” n.d.). Based on the information about the vision and initiatives it can be concluded that Anthem aims to introduce new services that will help enhance its financial metrics. Table 1 presents a goal evaluation of this performance domain.

Table 1. Balanced Scorecard – financial (created by the author).

Financial Perspective
Goal Measures
Improve the revenue of the company and subsidiaries; ROI and revenue;

Internal Business Processes

Operational excellence is among the main priorities for the company, which is reflected in the organizational strategy statement and the vision of being trusted by clients. Therefore, the goals include adequate reimbursements as this is the primary concern for the insurer. Additionally, the insurer’s initiatives consist of a specific focus on the privacy of data due to prior issues with hacking as Anthem manages information regarding millions of patients and providers. Therefore, the objective is to improve the process within the organization and the target is to enhance the efficiency of claim processing. Table 2 provides an assessment of this balance scorecard element.

Table 2. Balanced Scorecard – Internal business processes (created by the author).

Internal Business Processes
Goals Measures
Achieve operational excellence;
Enhance data privacy measures;
Amount of sold insurance plans;
Number of personnel members educated regarding informational technology safety;

Learning and Growth

The vision of the insurer is to apply innovation for the growth of the organization and to create more value for its clients, which is reflected in its initiatives, for instance, telemedicine. The essential objective is creating a culture that facilitates the process and encourages Anthem’s employees to gain new knowledge and the target is to create a system of simple healthcare service delivery. Table 3 presents an assessment of this element based on the organizational strategy of Anthem.

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Table 3. Balanced Scorecard – learning and growth (created by the author).

Learning and Growth
Goals Measures
Develop new strategies for new healthcare plans;
Apply innovation to simplify care provision and enhance accessibility to provider’s services;
Number of new plans offered to clients;
Implemented programs that apply innovation;

Customer Satisfaction

The primary component of this balanced scorecard’s perspective is customer perception, which is essential according to the insurer’s vision. Additionally, the quality of healthcare plans, their cost, and the company’s performance are part of the improvement strategy. One initiative is ensuring high customer satisfaction rates because the organization received an award provided by the National Committee of Quality Assurance for its work in Indiana (“Anthem Blue Cross and Blue Shield,” n.d.).

Thus, the objective is to achieve excellence in all states where the insurer has subsidiaries. The evaluation process involves reviewing targets such as customer satisfaction, customer service, and efficiency of health care programs that the establishment offers. Table 4 assess the goals and measures for this component.

Table 4. Balanced Scorecard – Customer satisfaction (created by the author).

Customer Satisfaction
Goal Measure
Continue to be a trusted insurer for the clients Customer satisfaction rate

Values

Anthem dedicates a specific attention to communicating its ethical values to both the employees and customers. According to the company’s corporate responsibility statement, accountability and integrity are guiding the decision-making process of the executives (“Ethics & integrity,” n.d.). This provides the basis for understanding its ethical strategy that is based on responsibility before people purchasing the insurance plans.

Organizational values include a commitment to ensuring that customers can receive affordable and accessible care services (“Mission and commitment,” n.d.). This is enabled by the strategy to improve the quality of services within the industry. From an ethical perspective, the values that Anthem communicates are critical because they emphasize the importance of caring about individuals using insurance plans. Additionally, Anthem states that its organizational values include “improving lives and communities, and making healthcare simpler” (“Stats & Facts,” n.d., para. 1). Directional statements of the company emphasize the need to make healthcare services easier. Besides, due to the nature of operations, patient data privacy is necessary for the insurer.

All the ethical statements described above emphasize the need to improve existing practices and be accountable for all operations. The lean model is justified by D’Andreamatteo, Ianni, Lega, and Sargiacomo (2015), as a valid approach to managing quality improvements because the authors argue that healthcare establishments that prioritize value delivered to customers can benefit from the plan. Therefore, Anthem should adopt a strategy, such as lean, to impact the needed change for quality improvement.

Practices for Monitoring and Improving Discussions

Applying best practices for improving discussions can help insurers such as Anthem enhance the quality of their services. Younberg (2011) argues that modern healthcare organizations have to use the proactive model under which they engage in the application of evidence-based practices for the improvement of performance. The author states that the issue of professional communication through contemporary resources such as emails or social media is especially important.

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Antoun (2015) reports that companies should target the perception of information technology, perceived barriers, as well as the importance of communication in general. Additionally, the author offers directives issued by governmental organizations as a resolution to discuss problems that will outline appropriate strategies. In regards to monitoring interactions with customers, Anthem can use satisfaction rates to evaluate this component (Antoun, 2015). Feedback from personnel can be assessed to examine the applied practice as well.

Improvement Recommendations

The main issue with the process improvement is the compliance and reimbursement guidelines that physicians have to follow to receive payments. According to Downing, Bates, and Longhurst (2018), medical professionals often experience burnout and job dissatisfaction due to a need for filling out a variety of forms in the electronic health records that are necessary to receive timely payments. Therefore, the insurer should focus on improving the process and minimizing the amount of information that has to be presented. This will allow avoiding “overburdening physicians with administrative responsibilities” and dedicating more time to the actual examination of patients (Downing et al., 2018, p. 50). Anthem will be able to achieve its objective of operational excellence.

The primary objective of quality improvement is in enhancing the plans offered to clients by tailoring them to their needs. D’Andreamatteo et al. (2015) emphasize that lean has tools that can be applied to strengthen this element. Lean practices applied in the healthcare setting can significantly improve organizational efficiency as well. D’Andreamatteo et al. (2015) state that this concept is a “revolution for a better, improved, value-based healthcare” (p. 1197). The aim is to maximize the value of services using the existing resources and mitigate unnecessary practices.

Learning implementation should be based on the upgrade of reimbursement efficiency and coding practices because it is a critical aspect of the insurer’s operational activity and main work objective. Thus, mistakes that occur during the process can adversely affect the outcomes and lead to a lack of payment for services that impact both customer and provider satisfaction. Hartl Rice, Gupta, and Goode (2018) suggest creating standardized checklists, especially for interdisciplinary care that will help providers avoid unnecessary mistakes when filling out forms. This will help both teach the medical personnel the appropriate practices and standardize their workflow.

Implementation and evaluation can be enhanced by applying a coaching framework. Andreasson, Eriksson, and Dellve (2015) argue that within healthcare companies and medical establishments have difficulty integrating new approaches into their operations. The authors point out that the perception of the strategy that a leader of an organization has can significantly affect the outcomes of the process. Andreasson, et al. (2015) state that “‘coaching for participation’ emerged as a central theme for managers in handling top-down initiated process development” (p. 219). Evaluation can be facilitated using a similar model in which executives interact closely with the employees to define the efficiency of work.

Conclusion

All in all, Anthem is an insurance company that prioritizes the value of plans it provides to clients and accountability in its work. The Balanced Scorecard analysis revealed that in most domains Anthem’s performance corresponds to its vision, mission, and ethical values. For improving communication, the company can use standardized guidelines and educate employees about the common misconceptions of professional discussions using contemporary technology. Additionally, in this paper, several process improvement strategies are proposed for improving organizational fitness.

References

Andreasson, J., Eriksson, A., & Dellve, L. (2015). Health care managers’ views on and approaches to implementing models for improving care processes. Journal of Nursing Management, 24(2), 219-227. Web.

Anthem Blue Cross and Blue Shield earn a top quality rating in Indiana. (n.d.). Web.

Anthem’s ROI per quarter. (n.d.). Web.

Antoun, J. (2015). Electronic mail communication between physicians and patients: A review of challenges and opportunities. Family Practice, 33(2), 121-126. Web.

D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: A comprehensive review. Health Policy, 119(9), 1197-1209. Web.

Downing, N. L., Bates, D. W., & Longhurst, C. A. (2018). Physician burnout in the electronic health record era: Are we ignoring the real cause? Annals of Internal Medicine, 169(1):50-51. Web.

Ethics & integrity. (n.d.). Web.

Hartl, S., Rice, A., Gupta, D., & Goode, V. (2018). Preprocedural checklist for magnetic resonance imaging patients undergoing general anesthesia. The Health Care Manager, 37(3), 205-210. Web.

Kaplan, R. S., & Norton, D. P. (1992). The balanced scorecard: Measures that drive performance. Harvard Business Review, 70(1), 71-79.

Kaplan, R., S., & Norton, D. P. (1996). Linking the balanced scorecard to strategy. California Management Review, 39(1), 53-79.

Mission and commitment. (n.d.). Web.

Stats & facts. (n.d.). Web.

Younberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones and Bartlett.

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StudyCorgi. (2020, December 22). Anthem Insurance Companies' Process Improvement. Retrieved from https://studycorgi.com/anthem-insurance-companies-process-improvement/

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StudyCorgi. 2020. "Anthem Insurance Companies' Process Improvement." December 22, 2020. https://studycorgi.com/anthem-insurance-companies-process-improvement/.

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