Improving Member Contact Rate - ASQasq.org/wcqi/2008/team-award/pdf/2008-silver-presentation.pdfTollgate Define Step A: Identify Project CTQs Step B: Develop Team Charter Step C: Define

© 2008 Healthways, Inc. 0

© 2008 Healthways, Inc.0

Improving Member Contact Rate

May 5, 2008 v8.3

(No text required for this slide. Leave up until the presenter steps up to the podium)



Criteria 1

Project Selection

and Purpose

Mike DavisVice President of Quality

Good afternoon, my name is Mike Davis. I’m the Vice President of Quality for Healthways. Let me introduce the rest of our team:

Mike McMillan,Wendy Faust, andPete Kapolas.

I was honored to be the Champion of the cross-functional Member Contact Rate team and it’s my pleasure to introduce the story of our successful journey using the Healthways to Excellence Improvement methodology.



Company Overview

Healthways develops Health and Care SupportSM solutions for hospitals, health plans, employers and healthcare providers to improve patients' health, enhance the fundamental care experience and reduce the cost of care.

We are the largest, most experienced health and care support company in the industry, providing services to more than twenty seven million people and the physicians who care for them.

The majority of our services are delivered telephonically directly to members and/or physicians.

We are here representing Healthways headquartered in Nashville, TN.

Healthways develops Health and Care SupportSM solutions for hospitals, health plans, employers and healthcare providers to improve patients' health, enhance the fundamental care experience and reduce the cost of care.

We are the largest, most experienced health and care support company in the industry, providing services to more than twenty seven million people and the physicians who care for them.

The majority of our services are delivered telephonically.



Healthways Quality System

The Quality System supports the Quality Management Program by ensuring systematic monitoring and evaluation of Healthways’ processes & procedures, and

execution of process improvement initiatives.

Quality System

Process Excellence

Standard Approaches

Established tools & processes

Dedicated Resources

Process Improvement training

Quality Services

Quality Committee

PE Project Selection

Survey

Internal & External Audits

Research

Regulatory Compliance

Accreditation

Policy & Procedures

Privacy

Government

Risk Management

The Quality System is

supported by three pillars of

quality…

The Quality System supports the organization’s Quality Management Program. The three components of the Quality System are defined as:

•Quality Services•Regulatory Compliance•Process Excellence

Process Excellence provides leadership, tools, and training for the organization’s process improvement activity.



1A.a Types of data and tools used to select the project, and why

Performance Metrics

Operational Reports

Contractual Requirements

Member/ColleagueSatisfaction Surveys

Customer Audits

Member Record Review

Section 1A.a.

Healthways has a vast amount of data available to measure overall performance.

Our contractual requirements typically focus on our ability to decrease healthcare spending for our member populations and improving our members’ quality of life.

Our data showed that Customer satisfaction in the area of member contacts was an area of opportunity and we needed to identify creative ways to improve this in order to meet the needs of our customers and members while assuring scalable growth.

The Member Record Review is used to measure the quality of our telephonic interactions with members.

Member and Colleague Satisfaction Surveys are performed annually to assess elements contributing to member and colleague retention.

Operational Reports provide insight into overall performance indicators such as clinician metrics, member contact rate and other contract specific measures.

Audits are conducted periodically by customers to assess overall program performance, medical integrity and adherence to contractual obligations.



DefineTollgate

DefineDefine

Step A: Identify Project CTQs

Step B: Develop Team Charter

Step C: Define Process Map / SIPOC

1

MeasureTollgate

MeasureMeasure

Step 1: MSA

Step 2: Stability analysis

Step 3: Normality analysis

2

AnalyzeTollgate

AnalyzeAnalyze

Step 4: Establish Process Capability

Step 5: Define Performance Objectives

Step 6: Identify Variation Sources

3

ImproveImprove

ImproveTollgate

Step 7: Screen Potential Causes

Step 8: Discover Variable Relationships

Step 9: Test Performance capability

4

ControlControl

ControlTollgate

Step 10: Develop control plan

Step 11: Determine Process Capability

Step 12: Implement Process Control

5

Key DeliverablesRequiredList of Project CTQsTeam CharterHigh Level Process Map or SIPOC8 waste identification5 S’s

Tools That May HelpProject Risk AssessmentStakeholder AnalysisHigh Level Project PlanIn scope /Out of scopeCustomer Surveys (focus groups,interviews)

RequiredMeasurement System AnalysisDefinition for Project metrics Normality AnalysisStability Analysis

Tools That May HelpData Collection PlanGage R&RDetailed Process MapFMEAPareto AnalysisVSM

RequiredBaseline of Current Process PerformanceCause & Effect DiagramList of Statistically Significant Xs

Tools That May HelpBenchmarkingFishbone DiagramHypothesis TestingRegression AnalysisTakt rateSpaghetti chart

RequiredDevelop & pilot best solutionTest performance against control group for similar prior period

Tools That May HelpDesign of ExperimentsNew Process MapsFMEA on new processProcess ModelingVSMMistake Proof

RequiredPost Improvement CapabilityStatistical Confirmation of Improvements Process Control PlanProcess Owner Signoff

Tools That May HelpControl ChartsHypothesis TestingCAP PlanKanban Visual managementOPE

Key Steps:

Healthways to Excellence Methodology

Kaizen Event for rapid improvement

1A.a Types of data and tools used to select the project, and why

•We utilized the Healthways to Excellence methodology, to assist us in project selection. This methodology uses Lean Six Sigma tools as a systematic approach to Process Improvement.

•The 5 phases of this approach include: Define, Measure, Analyze, Improve, and Control.

•We will highlight the specific tools we chose to use throughout the remainder of our presentation.



Relationships

Strong - 9

Medium - 3

W eak - 1

Target Direction

More is better

Less is better

Specific value

Customer CTQ

A B C D E F G

Products that meet our needs

Reduced member health costs

Healthier membersMember satisfaction and testimony

High member participation

Responsive & easy to do Business withPhysician adherence toguidelines

Reliable and credible indicatorsof product performance

Tele

phon

icIn

terv

entio

ns

Fulfi

llmen

t

Acc

ount

Man

agem

ent

Dat

aM

anag

emen

t

Pro

duct

Cus

tom

izat

ion

New

Pro

duct

Dev

elop

men

t

Out

com

e R

epor

ting

PS

M/H

CC

176 56 62 84 116120 18 87

3

44

245

22

Highest score

House of Quality

1A.b Reasons why the project was selected

Section 1A.b

This house of quality tool was used to obtain insight into the Voice of the Customer.

The Critical to Quality customer requirements were identified.

A few examples include:

• Reduced member health costs • Healthier members • Member Satisfaction and Testimony • High member participation

The score of 176 indicated that telephonic interventions were most important to ourcustomers.

We felt confident that a project focused on telephonic interventions alsodirectly supported our corporate strategic objectives - specifically, Deliver on CustomerPromises and Assure Scaled Delivery .



InteractionsStrongly Positive

Positive

Negative

Strongly Negative

Relationships

Strong - 9

Medium - 3

W eak - 1

Telephonic Intervention

A B C D E F G

Quantity

Telephone Intervention

Quality

Timeliness

Cam

paignR

ules

RN

campaign

assignments

StaffingLevel

StoredProcedures

Mem

berC

ontact Rate

Clinician

Judgment/

knowledge

Dialer logic

1055030909590 90

555

House of Quality

1A.b Reasons why the project was selectedTarget Direction

More is better

Less is better

Specific value

By drilling down into key inputs of the telephonicprocess, we received more insight into the areasof opportunities:

The telephonic inputs included:• Quantity• Quality• Timeliness

The score of 105 indicated that member contact rate is the mostimportant aspect of telephonic interventions.



1A.c Involvement of potential stakeholders in project selection

Clinicians Executive Team

Customers&Members

PEL Team/Quality Committee

Call CenterManagement

Account Managers

Section 1A.cWe received input from a wide variety of stakeholders including:

•Clinicians,•Account Managers,•The Executive Team,•Customers,•Call Center Management.

All were in agreement that we should improve our Member Contact Rate in response to the Voice of the customer and to support our business Model and company objectives.

The next step in the process was to submit the project to the Quality Committee for final approval.



This process also allows insight to Process Excellence projects that are executed at other Business Units to determine if project outcomes may

benefit other Business Units.

Receiveproject

recommendation

Execute approved projects

Recommendprojects for

Quality Committeeapproval

Preliminaryproject reviewDetermine impact & effort

The Enterprise submission process ensures that there is a stakeholder link from the senior executive level to the individual colleague level.


We have a formal project submission and selection process that ensures Process Excellence is involved with the most important enterprise projects.

The Quality Committee ensures representation across the entire organization, and it serves as the quality governing body that helps screen and select the most impactful projects that align with the company strategies and goals.

Key participants include members of the Account Team which represent external customer needs, Product Development, and Call Center Management which represent internal customer needs. This approach ensured the stakeholder link not only at the senior executive level, but at the clinician level as well

This project was presented to the Quality committee and approved.




2. Deliver on Customer Promises 6. Assure Scaled Delivery

This is an example of the form used to define projects during the Quality Committee and project selection process.

A key aspect to be noted is how we ensure corporate strategic objectives are considered during the project selection process.



1 5 10

1

5

10

20060522Z3

ImpactEf

fort

This projecthas low efforthigh impact, thus, an ideal

Enterprise project

Davis


We used a formal selection process that is based on criteria allowing for project prioritization.

The project scoring verified the fact that this project had high impact, low effort status, and therefore was an ideal enterprise project.



Mike Davis

Vice President Quality

Wendy Faust

Process Excellence Leader

Larry PettyWorkforce Solutions

Mgr

Debbie Hatcher

SVP Acct Mgmt

Champion

Pete Kapolas


Mike McMillan


Karen Holland

Clinician Supervisor

Erik Miller

BI/Reporting

Victor Mattingly

Business Technology

Ann Behrens

Clinical Director

Team members representstakeholders, suppliers and

customers

Clinician Focus Group

Representatives


A core leadership team was assembled to ensure alignment and buy-in towards improvement within Healthways.

Team members represented stakeholders, suppliers and customers.



1B.a Affected organizational goals, performance measures, and strategies

Healthways’ goal is defined as:

To be universally acclaimed for having created a healthier world, one person at a time.

The Senior Leadership Team defined 6 Strategic Objectives to support the achievement of this goal this fiscal year.

By improving the member contact rate, we will support the following strategic objectives:

Deliver on Customer Promises (corporate objective #2)Connect with as many members as possible.

Assure Scaled Delivery (corporate objective #6)Define a process that allows us to meet the connectivity needs of our customers as we continue to grow.

Section 1B.a

Healthways’ goal is defined as:

To be universally acclaimed for having created a healthier world, one person at a time.

The Senior Leadership Team defined 6 Strategic Objectives to support the achievement of this goal this fiscal year.

Our project supports 2 of Healthways’ objectives:

First, improving the member contact rate supports corporate objective #2 defined as Deliver on Customer Promises

Secondly, the process that addresses increased member connectivity supports our corporate objective #6 defined as Assure scaled delivery.



Problem Statement:

Project Goal:

Project Success Metrics:

Currently the Care Enhancement Center (call center) is not meeting or exceeding the internal standard or customer expectations for member contact rate.

Explore, analyze and implement initiatives that will improve member contact rate, increase customer satisfaction and improve the productivity of existing resources.

Impact Summary:•Increased member contacts that decrease healthcare spending for our member populations.

•Cost avoidance related to improved efficiency of resources at an estimated $3 million dollars.

•This project supports corporate strategies #2-Deliver on Customer Promises and #6- Solidify Organizational Foundation for Growth.

Key Stakeholders:

Clinicians, Account Managers, Call Center Management, Executive Team, Customers, Quality Committee.

* Proprietary

1B.b Types of project impact on each goal/performance measure

≥ 100%of Standard *

below standardCall Quality

≥ 100%of Standard *

meeting standard

Clinician Availability

≥ 100%of Standard *below

standardClinician

Performance

TargetBaseline

We used the Project Charter tool to clearly define the scope and improvementopportunity for this project.

Our problem statement reflects that we were not meeting our internal standards orcustomer expectations relative to the member contact rate.

The goal of this project was to increase customer satisfaction and improve theproductivity of our existing resources.

The success metrics were• Clinician Performance• Clinician Availability• Call Quality

The anticipated impact was defined as:

1. Increased member contacts that decrease healthcare spending for our member population.

2. Cost avoidance related to improved efficiency of resources at an estimated $3 million.



1B.c Degree of impact on each goal/performance measure, and how this was determined

2. Improved clinician availability

3. Improved Call Quality

1. Performance (Increased number of successful member calls per clinician per hour)# 2 Deliver on Customer

Promises#6 Solidify Organizational

Foundation for Growth

Degree of Impact on Corporate Strategies #2 & #6

Project Impact on Corporate Strategies #2 & #6

Healthways Corporate Strategies #2 & #6

Current State

Desired State

≥ 100%97%Clinician availability

≥ 100%84%Call Quality

≥ 100%60%Clinician Performance ( calls per clinician per hour)

Desired % to standard*

Current % to standard*

Key Metrics to Support Corporate Strategy

*Proprietary

Section 1B.c

Baseline data was used to identify the Current State of the 3 key metrics, whileCustomer and Business Feedback determined the Desired State.

Comparing Current versus Desired states helped identify the degree of impact ourProject would have.

Baseline current performance of key metrics was:

• Clinician performance – 60% to standard• Clinician availability – 97% to standard• Call Quality – 84% to standard

Our target was 100% or better to standard. Please note that our actual standards are proprietary.



1C.a Potential internal and external stakeholders, and how they were identified

Account TeamReportingProductClaims ProcessingDialer

ManagerOperations

Contract Specs.Health Plan

PoliciesWork InstructionsStaffing modelClinical

ResourcesMembershipCall CampaignsCall Flow MGMTClinical Info.

SystemTelephony

SystemTraining

Suppliers Inputs

Member CallsReferrals to

SpecialtyClinicians

Follow up calls

Internal:CliniciansAccount ManagersExecutive TeamCall Center ManagementPEL Team/Quality CommitteeFulfillment

External:CustomersMembersProviders

Outputs CustomersProcess

S.I.P.O.C. Analysis

Member placed call campaign

Member placed call campaign

Auto Dialer placescall to member

Auto Dialer placescall to member

Conversation completed

Conversation completed

DocumentationDocumentation

Next call scheduledNext call

scheduled

Section 1C.a

We then conducted a high-level SIPOC Analysis to identify the potential key internal and external stakeholders as well as to validate process scope.

Internal Stakeholders were identified as being part of our telephonic intervention process: Clinicians, Call Center Management, Account Management and the Executive Team. These stakeholders had representation within the project team.

External Stakeholders were identified as our members and customers which include health plans and employer groups. Member satisfaction surveys and customer audits provided additional project input. Ongoing customer feedback was provided by account managers.



1C.a Potential internal and external stakeholders, and how they were identified

Process Steps Clin

icia

n

Acco

unt M

grs

Cal

l Cen

ter M

gmt

Cus

tom

ers

Mem

ber

Exe

cutiv

e Te

am

Fulfi

llmen

tP

EL/

Qua

lity

Cm

te

Pro

vide

rs

Member Placed in Campaigns X X X X XDialer Places Call to Member X X X X XConversation Completed X X X X X X X XDocumentation X X X X XNext call scheduled X X X

Potential Key Stakeholders

XX

X

X

Each Key Potential Internal and External Stakeholder was assessed againsttheir level of involvement in each of the major process steps from the SIPOCAnalysis.

Based upon this analysis we determined that Fulfillment and Providers werenot key stakeholders.



StrategyAlignment

StrategyAlignment

CostCost

Customer Satisfaction

Customer Satisfaction

Member Call Flow

Member Call Flow

Financial and

Clinical Outcomes

Financial and

Clinical Outcomes

Colleague Morale

Colleague Morale

ColleagueTurnover

ColleagueTurnover

Impact Impact

1C.b Types of potential impact on stakeholders, and how these were determined

Section 1C.b

After we identified our stakeholders, we then examined potentialStakeholder impacts

Examples of our findings included:

• Strategic alignment• Colleague morale• Customer satisfaction• Cost of execution



1C.b Types of potential impact on stakeholders, and how these were determined

Stakeholder AnalysisPosition on Change

Who Strongly Against

Moderate Against Neutral

Moderate For

Strongly For

Clinicians X O

Account Managers X O

Executive Team X O

Call Center Management X O

PELTeam/Quality Committee X

Customer X

Member X O

Section 1C.bA stakeholder analysis was then used to identify the project impact, change position, and influencing strategy on each key stakeholder. As this shows the impact on each stakeholder varied as each listed their specific needs. For example the Clinician perception ranged from ‘Strongly Against’ to ‘Moderate For’.



1C.c Degree of potential impact on stakeholders, and how this was determined

Stakeholder AnalysisPosition on Change



Moderate For

Strongly For Impact

Clinicians X O High

Account Managers X O Medium

Executive Team X O High

Call Center Management X O High

PELTeam/Quality Committee X Low

Customer X High

Member X O Medium

Section 1C.cThe degree of impact on each key stakeholder…high, medium, or low…was determined not only by their level of involvement throughout the process, but also their current position on change versus the desired state of accepting change.

As seen here, the stakeholders with the highest degree of impact were Clinicians, the Executive Team, Call Center Management and Customers.



Criteria 2

Current SituationAnalysis

Mike McMillanProcess Excellence

Leader

Thank you Mike Davis. Hi I’m Mike McMillan and I’m a member of the process excellence team at Healthways.



DefineTollgate

DefineDefine




1

MeasureTollgate

MeasureMeasure

Step 1: MSA



2

AnalyzeTollgate

AnalyzeAnalyze




3

ImproveImprove

ImproveTollgate




4

ControlControl

ControlTollgate




5

Key Deliverables

RequiredList of Project CTQsTeam CharterHigh Level Process Map or SIPOC8 waste identification5 S’s

Tools That May HelpProject Risk AssessmentStakeholder AnalysisHigh Level Project PlanIn scope /Out of scopeCustomer Survey Methods (focus groups, interviews)









Key Steps:



2A.a Methods and tools used to identify potential root causes

Section 2A.aAs previously discussed our standard approach to process improvement is to utilize our Healthways to Excellence Methodology, which incorporates Lean Six Sigma tools. In accordance to this methodology we used a large variety of tools to analyze the current situation.Methods and tools used to identify root causes were as follows….

Measurement system analysis, stability analysis, normality test and Mudawalk.



The integration ofLean and Six Sigma

allows us to use the most effective and efficient tools to

drive business results.


The Healthways to Excellence Methodology integrates both Lean and Six Sigma which allows us to use the most effective and efficient tools to drive business results.



Lean is … the creation of Value and elimination of Waste across multiple process steps

Six Sigma is … increased Quality and reduced Variability within a critical process

Lean attacks issues that are a “mile wide”

• Core processes take too long• Time, effort and material are being wasted • Resources are limited and overworked• Processes have bottlenecks preventing flow

Six Sigma attacks issues that are a “mile deep”

• Defective output continually reaches the customer• Past improvements are not sustained • Root causes of problems remain unknown• Inspection and rework consumes resources


Lean is the creation of Value and elimination of Waste across multiple process steps. Lean addresses issues that are a “mile wide”

Six Sigma is increased Quality and reduced Variability within a critical process. Six Sigma addresses issues that are a “mile deep”

We agreed to use both methods to address the depth and breadth of the issues.



OverproductionInventory WaitingTransportationMovement / MotionOver-processing Defects Talent

THE 8 WASTES


The Team then identified process gaps by using the 8 Wastes as a reference. Waste is defined as any activity that creates no value in the eyes of the customer

We conducted a “Muda Walk” with our clinician focus groups to identify a variety of “wastes”. An example included movement/motion involving excessive documentation within member records.

Our improvement initiatives worked toward decreasing or eliminating the identified wastes.



2A.b Analysis of data to identify potential root causes

Wrap Time 2

Wra

p Ti

me

1

9876543210

10

8

6

4

2

0

S 0.503672R-Sq 96.6%R-Sq(adj) 96.4%

Fitted Line PlotWrap Time 1 = 0.0030 + 1.011 Wrap Time 2

Operational reports from Hummingbird application compared with real time

observation

R2> 90% indicates agreement b/w the two sources . Yes our system is accurate.

Extremely important to validate the accuracy of your measurement system!

Section 2A.b

We completed our Measurement System Analysis to validate the accuracy of our reporting system. We did this by comparing data from our reporting application to actual observed telephonic interaction.

Our findings are as follows:We achieved an R2 > than 90% indicating agreement between the two sources. This confirmed that our reporting application system is accurate.



Process Stability Measurement-Baseline

1019181716151413121111Observation

Ind

ivid

ua

l V

alu

e

_X

UC L

LC L

1019181716151413121111Observation

Mo

vin

g R

an

ge

__MR

UC L

LC L

I-MR Chart of Calls/Hour

Variation is stable


Mean is stable

We conducted a stability analysis and determined both our mean and variation was stable. This allowed us to move forward with our analysis and

process improvement initiatives.



Calls/Hour

Perc

ent

99.9

99

95

90

80706050403020

10

5

1

0.1

P-Value 0.196

Probability Plot of Calls/HourNormal

P-value is greater than .05Calls per clinician hour is normal data

Baseline Period


We performed a normality test on the calls per clinician per hour rate and verified our data had a normal distribution. This result allowed us to use the statistical analysis tools designed for normal distributions.



2A.c How stakeholders were involved in identifying potential root causes

Provided Healthways to Excellence Methodology and process improvement expertise.PEL Team/Quality Committee

Set corporate strategic objectives. Executive Team

Member satisfaction surveys.Member

Customer Audits.Customers

Identification of barriers influencing our current dialer and clinical information system capabilities. Identification of 8 wastes within their operating system. Identification of barriers to meeting performance metrics.

Call Center Management

Provided current customer expectations and requirements.Account Managers

Identification of 8 wastes within their operating system. Identification of barriers to meeting performance metrics. Clinicians

InvolvementStakeholder

Section 2A.c

Numerous stakeholders were involved in identifying potential root causes. Each stakeholder brought a unique perspective to the problem and provided us with a comprehensive understanding of potential root causes. This set the stage for the next phase of our project.

For example, the Clinicians helped identify the 8 Waste and barriers to meeting performance metrics.



DefineTollgate

DefineDefine




1

MeasureTollgate

MeasureMeasure

Step 1: MSA



2

AnalyzeTollgate

AnalyzeAnalyze




3

ImproveImprove

ImproveTollgate




4

ControlControl

ControlTollgate




5

Key Deliverables

RequiredList of Project CTQsTeam CharterHigh Level Process Map or SIPOC8 waste identification5 S’s

Tools That May HelpProject Risk AssessmentStakeholder AnalysisHigh Level Project PlanIn scope /Out of scopeCustomer Survey Methods (focus groups, interviews)









Key Steps:



2B.a Methods and tools used to identify the final root causes

Section 2B.a

We continued to use the Healthways to Excellence methodology as we moved into the analyze phase of our project to identify final root causes and opportunities.



These are our project success metrics

Current StateMetric

97.6 X 60 X 84.0= 49.2%Overall Process Effectiveness (OPE)

84.0%Quality* (avg. of 4 quality indicators)

60%Calls per Clinician per Hour-performance to standard*

97.6%Availability to standard*

*proprietary

We had a tremendous amount of opportunity!


In accordance with the Healthways to Excellence Methodology, we performed an Overall Process Effectiveness test (OPE) and determined the following results:

Availability to standard was very high and determined to not be an area of focus.

Quality, at 84%, could be improved but the team determined that the biggest impact to improving the member contact rate could be made by focusing on calls per clinician per hour because the performance was at 60%.

Next we wanted to take a deeper dive to understand the extent of the opportunity.



LSL

S tDev (Within) 0.64745S tDev (O v erall) 0.64745

P rocess Data WithinOverall

Process Capability of Calls/Hour

7.7 % of clinicians are above standard.

The current process is not capable of producing desired results.

Goal- 50% of clinician above standard*

Baseline period


* Proprietary

We performed a process capability test on our baseline data comparing current performance to our desired standard.

This analysis reported only 7.7% of our clinicians were above our standard expectation.

The current process was not capable of producing the member contact rate that is required to meet our internal standard or customer expectations.

As previously discussed we were ready to focus on key inputs to the success metric of calls per clinician per hour.



2B.b Analysis of data to select the final root causes

Provided ideas for improve phase

Provided Key Inputs to calls per clinician per hour and specific factors influencing those inputs

We discussed Root Cause Analysis during our work group brainstorming session.

We used a Fishbone diagram to identify keyinputs to the success metric of calls perclinician per hour. This allowed usto focus on very specific factors that influencethose inputs and served as a good startingpoint for our improvement initiatives. Some of these major inputs include:

1. Availability2. Talk time3. Wrap time4. Unsuccessful call management



Relationships

Strong - 9

Medium - 3

W eak - 1

Telephonic Intervention

A B C D E F G

Availability

Talk Time

Wrap Time

Clear

Expectations

Com

puterSkills/Typing

Dialer strategy

Manual

Processes

Visibility&Tools

Docum

entationG

uidelines

Call

Navigation

17172647230171 45

555

Idle Time 4

Redirection

Skills

49

Unsucc. Call Management 4

Scoring helped to prioritize actions

Productivity Root Causes

Contributing Factors

2B.c Identification of root causes, and validation of the final root causes

Section 2B.c

We used the House of Quality tool to validate our final inputs and contributing factors. Using this approach allowed us to prioritize our improvement initiatives.

Our significant contributors to productivity were clear performance expectations and visibility of data results with the utilization of the right tools.



Root Causes

Makes sense to

me

2B.c Identification of root causes, and validation of the final root causes

We also validated our findings with our key stakeholders to see if our list agreed with their needs. All stakeholders agreed that we were on target.



Criteria 3

Solution Development

Wendy FaustProcess Excellence

Leader

Thank you Mike McMillan. I’m Wendy Faust, also a member of the process excellence team at Healthways.



3A.a Methods and tools used in development of potential solutions

Brainstorming with clinicians to identify potential improvement

Ideas. Interviews with other stakeholders

Benchmarking

The 5 WhysSite Visits

.

Documentation guidelines and training

Computer and typing trainingAutomation of several manual

processesIdentification of best practices

relative to call flowIntensive individualized coaching of

clinicians Lunch n Learns focused on the “why”Call campaign and prioritization

strategiesUnsuccessful Call ManagementTalk Wrap AlertsCall modelingReexamine staffing guidelineCIS modificationsReexamine product modelAlter contractual requirementsHire on-cliniciansRemove LCMs from structureFlexibility in schedulingChange CEC HoursNo metric requirements

Potential Improvement Initiatives

Section 3A.aTo identify potential solutions we did a variety of things.

We benchmarked other successful internal productivity improvements projects and interviewed team members to identify best practices and lessons learned.

Interviews and brainstorming sessions with stakeholders were conducted to gain buy-in and to identify potential improvement ideas. This allowed us to reduce resistance to proposed solutions.

We also took a 5-why approach to help identify root causes. This helped provide insight into actions for improvement.

Finally, team members performed site visits to gain insight into other productivity initiatives going on across the enterprise.



3A.b Analysis of data used in development of potential solutions

.

Documentation guidelines and training

Computer and typing trainingAutomation of several manual

processesIdentification of best practices

relative to call flowIntensive individualized coaching of

clinicians Lunch n Learns focused on the “why”Call campaign and prioritization

strategiesUnsuccessful Call ManagementTalk Wrap AlertsCall modelingReexamine staffing guidelineCIS modificationsReexamine product modelAlter contractual requirementsHire on-cliniciansRemove LCMs from structureFlexibility in schedulingChange CEC HoursNo metric requirements

Potential Improvement

Initiatives

CQIP Update April 2007

CQIP Start Date

Baseline Metrics

Current Metrics^ April 2007

Outstanding Issues as of 4/30/07

Recommended Actions For Implementation in May

May 2006 2.3 CPH 77.5% TOD

2.8 CPH 75% TOD Annual Cost Avoidance based on April metrics= $ 1.63M Increase in successful call volume- 319/day

1. Idle Time

1. Explore opportunities for campaign consolidation to minimize need for clinicians to switch campaigns.

Nearly ready for Control Phase

August 2006

2.3 CPH 84.2% TOD

2.8 CPH* 85.5% TOD Annual Cost Avoidance based on March metrics=$ 3.62 M Increase in successful call volume- 766/day * Significant campaign and server issues

1. NONE

1. Move to Control Phase- action plan complete- at 2.9 CPH exclusive of server and campaign volume issues.

August 2006

2.6 CPH 75.4% TOD

2.4CPH 56.5% TOD Annual Cost Avoidance based on March metrics= 0 Increase in successful call volume- 0

1. Currently focused on Expansion/ Up-sell per BU Leader- over 50% of staff are new hires - causing a temporary drop in CPH and TOD

2. Idle Time

1. Re-start CQIP action plan calls when time permits.

Availability

0

10

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30

40

50

60

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80

90

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7/1/20

06

7/15/2

006

7/29/2

006

8/12/2

006

8/26/2

006

9/9/20

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9/23/2

006

10/7/

2006

10/21

/2006

*

11/4/

2006

11/18

/2006

12/2/

2006

12/16

/2006

12/30

/200

6

1/13/2

007

1/27/2

007

2/10/2

007

2/24/2

007

3/10/2

007

3/24/2

007

4/14/2

007

4/28/2

007

5/12/2

007

5/26/2

007

6/9/20

07

6/23/2

007

TODSpan

Target

SCalls per Hour

Perc

ent

6543210

99.9

99

9590

80706050403020

10

5

1

0.1

MinnesotaNashvillePittsburghRaleighSeattle

Location

Probability Plot of SCalls per HourNormal

Section 3A.b

The team analyzed operational data coupled with our root cause analysis todevelop a list of potential solutions. This allowed us to focus on factors thatinfluenced our success metrics and pointed us to potential interventions toaddress these opportunities.

For example, an identified root cause was related to ineffective computer skills during calls. This lead to the creation of an improvement initiative regarding computer skills.



3A.c Criteria used to select final solution

P o t e n t ia l S o lu t io n sIm p a c t o n S u c c e s s

M e t r ic s E a s e o f E x e c u t io n C l in ic ia n S a t is f a c t io nL ik e l ih o o d o f

S u c c e s s

Im p a c t o n C o r p o r a t e

O b je c t iv e s * S c o r in g

P r o c e s s G u id e l in e s H H H H H 3 5

S u p e r v is o r S u p p o r t T o o ls H H H H H 3 5

C o m m u n ic a t io n T o o ls H H H H H 3 5

R e w a r d s a n d R e c o g n i t io n P r o g r a m s H H H H M 3 2

T r a in in g T o o ls a n d In f o r m a t io n H H H H H 3 5

R e p o r t in g T e m p la t e s H M H H H 3 2

D ia le r S t r a t e g y H H M H H 3 2E l im in a t e P e r f o r m a n c e

E x p e c t a t io n s f o r C l in ic a n s L H H L L 1 7

In c r e a s e n u m b e r o f s t a f f L H M M L 1 7

R E - e v a lu a t e P r o d u c t D e s ig n L L H L M 1 4

M in im iz e t y p e o f C a l ls M L M L L 1 1In c r e a s e u s e o f

T e c h n o lo g y M L L L M 1 1

R e - n e g o t ia t e C o n t r a c t u a l R e q u ir e m e n t s L L L L M 8

H = 7 * C o r p o r a t e O b je c t iv e # 2 a n d # 6M = 4L = 1

Section 3A.c

To select the final solutions, the criteria we used looked at Impact on success metrics, ease of execution, impact on clinician satisfaction, likelihood of success, and impact on corporate strategic objectives.

Each of these were given a rank of High, Medium or Low.



Potential SolutionsImpact on Success

Metrics Ease of Execution Clinician SatisfactionLikelihood of

Success

Impact on Corporate

Objectives* Scoring

Process Guidelines H H H H H 35

Supervisor Support Tools H H H H H 35

Communication Tools H H H H H 35

Rewards and Recognition Programs H H H H M 32

Training Tools and Information H H H H H 35

Reporting Templates H M H H H 32

Dialer Strategy H H M H H 32Eliminate Performance

Expectations for Clinicans L H H L L 17

Increase number of staff L H M M L 17

RE-evaluate Product Design L L H L M 14

Minimize type of Calls M L M L L 11Increase use of

Technology M L L L M 11

Re-negotiate Contractual Requirements L L L L M 8

H=7 * Corporate Objective #2 and #6M=4L=1

3B.a Methods and tools used to select the final solution

Solutions with the greatest scores were selected.

Section 3B. aTo select our final solutions we used our scores from the selection criteria grid that we previously discussed.

Each ranking of high, medium or low was assigned a numerical score.

The solutions with the highest scores were selected. Examples of those we chose include:

•Process Guidelines•Supervisor Support Tools•Communication Tools



3B.a Methods and tools used to select the final solution

Health Plan, CUPS, Davox

Dialer

Call Campaign Via Davox

Dialer

Eligible member, correct phone

number, appropriate dx, due for a call

Member available

and agreeable

to call

Dialer generated

outbound call to member

Clinician dispositions

call as successful

Successful call to

member

Call completed product design at

established frequency and call handling

standard

Members, Health Plan, Executive

Leadership, Shareholders

Process Mapping

Process Assessment

Muda Walk

In addition we enhanced and added details to our final solutions through the use of various methods.

Process mapping was done to identify specific process guidelines that were needed.

Process assessments were completed to identify specific areas of need related to training, rewards & recognition and reporting.

A Muda walk helped with the specifics related to communication and supervisor support tools.



3B.b Analysis of data to select the final solution

LSL

StDev (Within) 0.432934StDev (O v erall) 0.469769

Process Data WithinOverall

Process Capability of Calls per Hour

50.8% of clinicians are above standard.

Goal - 50% of clinician above standard

Section 3B. bWe used a capability analysis to verify that that the implemented solutions improved our key project metrics.

For the performance metric, 50.8% of our clinicians were above our standard, as compared to 7.7% at the beginning of the project.

Because the performance metric standard is a median of individual clinician performance, 50.8% equated to achievement of this standard.



C31C26

Dat

aT Test Pre and Post

T-Test of difference = 0 (vs. not =): T-Value = -5.87 P-Value = 0.000 DF = 184

3B.b Analysis of data to select the final solution

In addition, the 2 sample T-test supported the fact there was a statistically significant difference between the baseline and post results for clinician performance.

This was verified by a p value = to 0.000



3B.c Involvement of stakeholders in selection of the final solution

Clinicians served as SMEsregarding Clinician Satisfaction

Scoring components

Potential Solutions Clinician Satisfaction

Process Guidelines H

Supervisor Support Tools H

Communication Tools H

Rewards and Recognition Programs H

Training Tools and Information H

Reporting Templates H

Dialer Strategy M

Eliminate Performance Expectations for Clinicians H

Increase number of staff M

RE-evaluate Product Design H

Minimize type of Calls M

Increase use of Technology L

Re-negotiate Contractual Requirements L

Section 3B.cStakeholder involvement in final solution selection was determined based on their subject matter expertise. Throughout the entire project all stakeholders worked closely together to determine project goals, potential and final solutions.

Clinicians served as the subject matter experts for the clinician satisfaction criteria, providing the rankings of high, medium or low for each potential solution.



Other stakeholder groups served as SMEs regarding Likelihood of

Success


Potential SolutionsLikelihood of

Success

Process Guidelines H

Supervisor Support Tools H

Communication Tools H

Rewards and Recognition Programs H

Training Tools and Information H

Reporting Templates H

Dialer Strategy H

Eliminate Performance Expectations for Clinicians L

Increase number of staff M

RE-evaluate Product Design L

Minimize type of Calls L

Increase use of Technology L

Re-negotiate Contractual Requirements L

Other stakeholder groups including the account team, call center management and the executive team served as subject matter experts for the selection criteria pertaining to Likelihood of Success.



The PEL Team/ Quality committee served as the SME regarding Ease

of Execution and Impact on Success


Selection Criteria

Potential SolutionsImpact on Success

Metrics Ease of Execution

Impact on Corporate

Objectives*

Process Guidelines H H H

Supervisor Support Tools H H H

Communication Tools H H H

Rewards and Recognition Programs H H M

Training Tools and Information H H H

Reporting Templates H M H

Dialer Strategy H H HEliminate Performance

Expectations for Clinicans L H L

Increase number of staff L H L

RE-evaluate Product Design L L M

Minimize type of Calls M L LIncrease use of

Technology M L M

Re-negotiate Contractual Requirements L L M

The Process Excellence team and the Quality Committee provided input on three key scoring criteria:

•ease of execution•Impact on the project’s success metrics•Impact on strategic corporate objectives.



Process GuidelinesCall flows and documentation guidelines

Supervisor support toolstraining modules focused on coaching techniques

Communication toolsVisual controlsFeedback mechanisms for all employee levelsSetting Clear expectations

Reporting templatesStandard report matrixAnalysis support tools

Rewards & Recognition ProgramsTraining tools and information

Computer and typing skillsCustomer trainingUnderstanding the “big picture” that defines why we are doing what we are doing

Comprehensive dialer strategy createdCampaign and team size increasedStandard dialer settings established to minimize unsuccessful calls

3C.a Final solution, and solution validation

Section 3C.aThe team then defined specific improvement strategies and finalsolutions.

Some of these strategies included:

• Process Guidelines• Supervisor support tools• Communication tools• Reporting templates

Process Guidelines for example included, suggested call flows forspecific call types and guidelines for the efficient use of the computersystem.



3C.a Final solution, and solution validation

Expected BenefitsFinal Solutions Performance Availability Quality Indicators

Process Guidelines X X

Supervisor SupportTools X X

CommunicationTools X X X

ReportingTemplates X X X

Rewards andRecognitionPrograms

X X

Training Tools and Information X X

X

Dialer Strategy X X

An example of a final solution was the Supervisor Support Tool.

This solution provided close interactions between direct supervisors and their clinicians. Supervisors provided one-on-one coaching and call flow training over a specific period of time.

Stakeholder team members validated our final solutions by assessing the impact of each solution on our project success metrics. As previously discussed, the project success metrics were performance, availability, and quality indicators.



3C.b Tangible and Intangible benefits expected to be realized

Tangible Benefits

Increase in clinician performance

Increased clinician availability

Improved call Quality

Overall Increase in Member Contact Rate

Cost avoidance related to increased efficiency of existing resources

Positive impact on program outcomes / Return On Investment

Intangible Benefits

Improved morale for clinicians External VOC heard!! Simplified work process for

managersAllowed for measuring productivity

and fostered consistency across the enterpriseInvolved employees that own the

processClear line-of-sight to corporate

strategies and shareholders beneficiariesEncouraged camaraderieLaid the groundwork for

collaboration and support of future projects.

Section 3C.bThere were numerous tangible benefits that we expected from this project including:

A positive impact on project success metrics- specifically clinician performance as measured by median calls per clinician per hour, availability and call quality.

Additionally, we expected that the solutions would impact our overall objective of anincrease in member contact rate and improve program outcomes and Return On Investment.

We also anticipated a significant cost avoidance due to increased efficiency ofexisting resources.

Anticipated intangible benefits were provided via colleague surveys and brainstormingsessions. Examples of intangible benefits included:

• Improved morale for clinicians • External VOC heard!! • Employee involvement



3C.c Use of data to justify implementation of final solution

Jul Aug Sept Oct Nov Dec

Calls/clinician/hour

Goal Achieved103% of standard

Starting Point60% baseline

Section 3C.c

Through the implementation of our final solutions, we nearly achieved all of our project success metrics

This slide outlines Clinician Performance, specifically the improvement in median calls per clinician per hour. This represents an improvement from 60% to greater than 103% of our standard. This put us well on our way to achieving the project goal of an improved member contact rate.

In addition we saw an improvement in clinician availability to 98% of the standard.



J u ly M et P erce n t

D ec em b er M et P er cen t

8 4 .6 4 %

1 0 0 .0 0 %

8 3 .3 3 %

9 4 .1 9 %

7 9 .3 7 %

1 0 0 .0 0 %

7 0 .0 0 %

8 6 .6 7 %

0 .0 0 %

1 0 .0 0 %

2 0 .0 0 %

3 0 .0 0 %

4 0 .0 0 %

5 0 .0 0 %

6 0 .0 0 %

7 0 .0 0 %

8 0 .0 0 %

9 0 .0 0 %

1 0 0 .0 0 %

P H I - 5 .2 8 % Im p r o v em e n t M in o r P er m iss io n

0 .0 0 % Im p ro v em en t G o a l M a n a g em e n t1 3 .3 3 %

Im p ro v em en tS O C M a n a g em en t

7 .5 2 % Im p ro v e m en t

* F or q u es tio n 1 D , th ere w a s on ly o n e m em b er a u d ited th a t w a s ap p lic a b le in ea c h m on th

T r e n d o f Im p r o v e m e n t fo r N a sh v ille C E C Call Quality Indicators

Indicator A

AIndicator B

Indicator CIndicator D

Baseline

Post Implementation


We achieved our desired outcome in terms of all four quality indicators. We improved from 84% of the standard to 100% of the standard.



Project resulted in a 65% increase in successful member contacts within the project call center$ 3.3M in cost avoidanceThe Overall Process Effectiveness increased from 49.2% to 88.3%Call Quality improved on 4 major indicatorsA Healthways Center for Health Research study supporting the project demonstrated a strong correlation between the increase in call volume and a decrease in member hospitalization and ER visits.


In addition to achieving the project success metrics… we realized the overall project goals. Specifically:

•This project resulted in a 65% increase in successful member contacts within the project call center with $3.3M in cost avoidance.

•The Overall Process Effectiveness increased from 49.2% to 88.3%. and call Quality Improved on all 4 major indicators

•A Healthways Center for Health Research (CHR) study supporting the project demonstrated a strong correlation between the increase in call volume and a decrease in member hospitalization and ER visits.



Criteria 4

Project Implementation

And Results

Pete KapolasProcess Excellence

Leader

Thank you Wendy Faust. I am Pete Kapolas a member of the processexcellence team at Healthways.



4A.a Types of internal and external stakeholder involvement in implementation

Stakeholder Implementation Activities

CliniciansAssisted in design/piloting/revision of call process flowsProvided input for documentation guidelinesParticipation in ongoing communication activities

Account Managers Communicated changes to their Health Plan CustomersTracked impact of changes to program outcomes and ROI

Executive Team

Incorporated stretch goals into performance evaluationsEnsured clinical and program integrity were maintainedConducted clinician and member satisfaction surveysCreated Business 101 training for clinicians

CEC Management Team

Implemented dialer solutions/settingsChanged supervisor job duties- reassigned tasksImplemented call process flows/visual controlsCreated/Implemented Rewards and Recognition Program

PEL Team/Quality CommitteeFacilitation and coordination of all improvement activitiesCreation of standard reporting templates and analysis processesProvided oversight to the call quality monitoring process

Customers None

Member None

Internal Stakeholders

External Stakeholders

Section 4A.a

Stakeholder involvement was crucial to the successful implementation of our final solutions.

Our team of stakeholders assisted in the implementation of solutions that were supported by their process knowledge.

Some highlights include:

Clinicians were involved in the implementation of call flows, documentation guidelines and ongoing communication and feedback activities.

The Call Center Management Team took the lead on the implementation of:

•dialer solutions, •job duty modification,•the creation of visual controls,•and the rewards and recognition program.



4A.b How types of resistance were identified and addressed

Response

• Monthly Communication

• Incorporation of Feedback

• “Marketing” the Project

• 1 on 1 meetings to address individual concerns

Stakeholder GroupLearning New

ProcessesCall Quality

Impact

Impact on Clinician

SatisfactionClinician Turnover

Impact on Program

Outcomes/ROI CostClinicians X X X X XAccount Managers X X XCall Center Management X X X X X XCustomers X XMember XExecutive Team X X X X XPEL Team/Quality Cmte X X X X X X

Area of Resistance/Concern

Section 4A.b

The project team identified several areas of potential resistance from thevarious stakeholders. This resistance was identified during meetings,stakeholder surveys and one-on-one interviews.

Examples of resistance included:

• Learning “new” process flows• Call Quality Impact• Potentially negative Impact on culture

Monthly communication, feedback, and “marketing the project” helpedovercome internal resistance and allowed for operational buy-in.



4A.c How stakeholder buy-in was ensured

Lean Six Sigma 4UP ReportProject Phase/Deliverables and Key Indicators:

Mike McMillanMBB / BB Mentor:

Wendy FaustGB / BB:

Pete Kapolas, Larry Petty, clinicians, account team, BT, Reporting

Team Members:

CEC Management TeamProcess Owner:

Mike DavisProject Champion:

1- 08- 07Status Date:

Project Objective/Value to be Delivered:

• Achieve the Healthways standard for calls per clinician per hour while maintaining clinician availability and maintaining/improving quality at the CEC

Problem Statement: Currently the CEC is not meeting or exceeding the internal standard of a median of 3.0 calls per clinician per hour. This is resulting in less than optimal member contacts and is causing concernwith our external customers.

100%Control Phase- Implement Control & Reaction Plan

100%Improve Phase• Action plan established and

implemented• Reaction plan implemented

100%

100%

100%

% Complete Status

Analyze Phase • Process Mapping• C&E matrices• Normality Testing

Measure Phase• Obtained baseline metrics• Process Stability and Capability• MSA completed• OPE

Define Phase • Completed CT- trees, SIPOC• Obtained voice of the customer

Phase/Deliverable

Project: Improving Member Contact Rate

Recent Accomplishments:• Implemented Reaction plan to assist in use of reports to focus efforts• Sustaining cph for last 3 months, • Decreased unsuccessful talk and wrap minutes over the past month

Planned Accomplishments Next Period:• Move to control phase- will include response plans for cph, unsuccessful

cph, idle, availability and quality measures.

Project Savings / Benefits:• Using approved cost avoidance methodology- $ 3.3M• An increase of successful calls per day- 65%

Project Metrics to Standard* Baseline Target CurrentCalls per Hour 60% ≥ 100% 100%

Availability 97.6% ≥ 100% 98%

Quality Indicators A,B,C,D- sustained or improved.

* Proprietary

4up to have same fonts.

Section 4A.c

The 4-UP report is a project summary document and was used as the basis for ongoing meetings and conversations with the stakeholder groups to ensure buy-in.

During these routine status updates, issues, concerns and barriers were discussed and resolved.



4B.a Plan developed by team to implement solution

Standard Implementation Process

Coordinate pre-visit logistics

Obtain and analyze baseline date

On-site assessment Recommended actions

Action Plan created/implementation by

stakeholders

Ongoing Action plan facilitation by PEL

CQIP Assessment Executive Summary

Overview: The CQIP assessment summary was conducted the week of 7/31/ on-site at the CEC. Participants included the entire CEC Leadership team, 4 LCMs and a clinician focus group consisting of 8 clinicians. Wendy Faust and Mike McMillan led the assessment process. Larry Petty the dialer manager was also part of the assessment team, focusing specifically on opportunities related to dialer and campaign strategy. The recommendations made to the CEC complement current initiatives recently implemented by Ray Schuler and Carla Dunn. Summary of Findings:

Strengths: There were several strengths noted during the assessment. These include:

o High quality of member interactions, o Outstanding enthusiasm and commitment of the entire

leadership team toward process improvement initiatives o Comfort utilizing data to manage the operation o A great deal of Pride and a desire to be the best o High level of morale throughout the CEC o Tenure of the Leadership Team o Collaboration with the account management team o Responsive to customer issues/concerns/goals



CQIP Work Plan Priority Area of

Focus Action Responsible

Person Timeline RYG

1. Dialer Strategy

Historically AMD and pacing were utilized in a very limited manner. The belief was that AMD was yielding return calls. Data has shown that there is only a 2-4% return rate for answering machine messages.

Action items Timeline & Responsible Person

Comments RYG

AMD to be used on all campaigns and contracts continuously except on those contracts that require preview and contracts which have not approved the use of AMD

George

Nowick, Andy Petrini

6/22/06

6/20- Permission to use AMD on all contracts has been received except for Wellmark and HPN. Wellmark is conducting an automated message pilot so AMD cannot be implemented. 7/13-HPNV query results received show an 8.8% return YTD- Andy and AM to determine next steps. No data yet available on Wellmark automated messaging pilot- data available mid-late August.

Utilize Target Percent connect for pacing strategy- pacing to 10% abort rate standard by campaign.

George Nowick

6/28/06-

Pacing being utilized on almost all contracts/campaigns in CEC- exception is 006 campaigns and Wellmark.

Campaign forecasting tool to be utilized and adhered to for all contracts

George Nowick,

DCMS, Andy Petrini

6/27/06

Implemented for all contracts. Strategy implemented to share resources ensuring equal impact of off dialer activities for all contracts. 7/13- staffing allocation for teams “retooled” to ensure more adequate coverage of contracts especially in FMLA situations.

Begin to use campaign tracking grid George Nowick

6/30/06

713- George requested copy of pre-process team tracking grid from Larry Petty. To be implemented week of 7/17

Continue use of specialty campaigns to target BSC members with successful contacts and/or attempts currently below contractual requirements

George Nowick

6/27/06

7/13-Specialty campaigns expired as of week of 7/10. Scott Sivik sees a continued need. Andy to request continuation from BI.

Seattle LT to work with account teams to develop a strategy to consolidate contracts into fewer campaigns to maximize dialer efficiency

Account teams, ED, DCMS, DM

TBD

7/13- consolidation being discussed and analysis of potential combinations underway.

State Licensure must be factored into consolidation strategy

ED

ongoing

Process to ensure 100% of staff have CA/NV licensure is well underway. This will assist with campaign consolidation.

Andy Petrini, George Nowick

99.9

99

95

90

80706050403020

10

5

1

0.1Calls per Hour

Perc

ent

MayJunJulAugSepOctNovDec

C1

Probability Plot of Calls per HourNormal

Section 4B.a

The implementation plan included both formal documents and frequentmeetings to ensure deliverables were met on time and stakeholderbuy-in.

Examples of these documents include:

• Assessment documents detailing the onsite assessment and identified issues

• Standardized reporting packages included the 4UP as well as project success metrics.

• Action plans detailing the implementation of final solutions.

These documents were used as the basis for ongoing stakeholdermeetings. We found that these ensured that the project was kept ontrack and provided a forum for ongoing stakeholder input.



4B.b Procedure, system or other changes made to implement the solution, and to sustain the results

Old ProcessInconsistent call flowsSupervisor primarily task orientedDocumentation non-

standardized/excessiveNo visual controlsLimited Reporting/AnalysisNo formal reward or recognition

programNo technical skill supportClinicians lacked understanding of

relationship of metrics to stakeholders

New ProcessStreamlined standard call flowsSupervisor transformed to coach

roleDocumentation guidelinesVisual controls/feedback

mechanismsStandard reporting templates and

analysis processReward and recognition programBusiness 101 training for all

clinicians

Section 4B.b

The project resulted in the creation of new key processes.

Examples included:

• Streamlined standard call flows• Supervisor transformed to coach role• Standard reporting templates and analysis process.

• To elaborate on this one, we designed and rolled-out standardized call handling reports used at all the call centers.

The Process Excellence team lead meetings with key stakeholders usingstandard reporting templates that focused on project success metrics. Thishelped to ensure consistency of roll-out and timely completion of project actionitems.

These meetings and reports validated process changes were sustained.



Lessons Learned

Use of data and reports are essentialDocumentation efficiency remains a challengeChange is difficult for many- the “why” must be frequently reviewedQuality and Quantity must be balanced to ensure positive impact on outcomesClinician buy in is key!Coaching and persistence are the only way to sustain success.

4B.b Procedure, system or other changes made to implement the solution, and to sustain the results

Lessons learned were used to improve the execution plan. These insights further enhanced the ability to sustain project results and overcome anticipated resistance to change.

Some examples of the lessons learned include:

•Use of data and reports are essential•Quality and Quantity must be balanced.•Clinician buy in is key!•Coaching and persistence are the only way to sustain success.



4B.c Creating/Installing a system for measuring and sustaining results

Call Quantity Response PlanReaction Plan

Defect Per Million Opportunities (DPMO)Control Method

Weekly / MonthlyFrequency

All callsPopulation

Control chartBar graph

Measurement System

≥100% for each inputTarget

Performance, Availability, Call QualityCharacteristic Input (X)

Overall Process Effectiveness (OPE)Characteristic Output (Y)

Hummingbird ApplicationReporting Tool

Member Contact ImprovementProcess Name

Section 4B.c.The intent of our process control plan was to control the associated process variables to ensure stability over time.

The control plan was defined and adopted by the stakeholders and process owners.

The key data elements were performance, availability and call quality. These elements directly tie to our company strategies of Deliver on Customer Promises and Solidify Organizational Foundation for Growth.

Our previous measurement system analysis validated that our reporting application, was an accurate source for this data.

The data was tracked using both control charts and bar graphs over both weekly and monthly timeframes



Immediate Response Plan Process as of 1-18-2007Process to be followed daily until metrics achieved for 60 days


A key element of the control plan was a detailed response plan to ensure a timely correction of any process variance.

This plan utilizes standard reporting metrics to address results outside expectations. This plan requires a drill down to find root cause of why target was not meet, and action plans are then created to address variance.



Monitor progress of each site monthlyDiscuss any unusual variancesReporting findings to Quality Committee quarterly

Availability by CEC/BU As of July 31, 2007

Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site 9

BaselineJanuaryAprilMayJuly

Calls per Clinician per Hour by CEC/BU AS of July 31, 2007

Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site 9

BaselineJanuaryAprilMayJuly


These are examples of the bar graphs reports of key success metrics used in conjunction with the response plan. The bar graphs were posted in the call center and shared with the Quality Committee. This kept all stakeholders informed and helped to ensure that results were sustained.



4C.a Tangible and Intangible results realized

Expected Tangible Benefits

Increase in median calls per clinician per hour

Increased clinician availability

Improved call Quality

Overall Increase in Member Contact Rate

Cost avoidance related to increased efficiency of existing resources

Positive impact on program outcomes/Return On Investment

Tangible Results Achieved

67% increase in median calls per clinician hour

Clinician availability improved to nearly the Healthways standard

Call Quality indicators improved or maintained

65% improvement in member contact rate

$3.3 M in cost avoidance

Project Research study showed strong correlation b/w increased member contacts and improved member outcomes/Return On Investment

Section 4C.a

The tangible results for this project were:

•A 67% increase in median calls per clinician hour•An improvement in Clinician availability to 98% of the Healthways standard•All Call Quality indicators improved or maintained

These improvements resulted in :

• A 65% improvement in member contact rate• $3.3 M in cost avoidance

In addition, A Project Research study showed strong correlation b/w increased member contacts and improved member outcomes / Return On Investment



4C.a Tangible and intangible results realized

Expected Intangible Benefits

Improved morale for clinicians External VOC heard!! Simplified work process for managersAllowed for measuring productivity and

fostered consistency across the enterpriseInvolved employees that own the

processClear line-of-sight to corporate

strategies and shareholders beneficiariesEncouraged camaraderieLaid the groundwork for collaboration

and support of future projects.

Intangible Results Achieved

Significant improvement in Colleague Opinion Survey results.

Lower turnover rate as compared to previous years.

Clinicians had metrics presented in a real time format to see how well they were performing.

This initiative set the stage for other employee-led improvement projects.

The intangible results for this project were:

•A significant improvement in Colleague Opinion Survey results

• Achievement of a lower employee turnover rate as compared to previous years.

•Clinicians had metrics presented in a real time format to see how well they were performing.

•This initiative set the stage for other employee-led improvement projects.



4C.b How project results link to organizational goals, performance measures, and/or strategies

2. Improved clinician availability

3. Improved Call Quality

1. Performance (Increased number of successful member calls per

clinician per hour)# 2 Deliver on Customer Promises

#6 Solidify Organizational Foundation for Growth

Degree of Impact on Corporate Strategies #2 & #6

Project Impact on Corporate Strategies #2 & #6

Healthways Corporate Strategies #2 & #6

Current State

Desired State≥ 100%98%Clinician availability

≥ 100%100%Call Quality

≥ 100%103%Clinician Performance

Desired % to

standard*

Current % to

standard*

Key Metrics to Support Corporate Strategy

Performance StatusClinician

PerformanceClinician

Availability Call Quality

Baseline 60% 97% 84%Result 103% 98% 100%

* Proprietary

Result

Section 4C.b

There were three key metrics that our project set out to improve:

• Clinician Performance; • Clinician Availability; • Call Quality;

Baseline data was used to identify the Current State while Customerand Business Feedback determined the Desired State.

Results were as follows:

• Clinician performance achieved 103% to standard• Clinician availability achieved 98% to standard• Call Quantity achieved 100% to standard

Our target was 100% or better to standard. Please note, the actualstandard is proprietary.



4C.c How results were shared with stakeholders

Process Improvement Communication



Person Timeline RYG

1. Dialer Strategy

Historically AMD and pacing were utilized in a very limited manner. The belief was that AMD was yielding return calls. Data has shown that there is only a 2-4% return rate for answering machine messages.

Action items Timeline & Responsible Person

Comments RYG


George


6/22/06

6/20- Perm ission to use AMD on all contracts has been received except for Wellmark and HPN. W ellmark is conducting an automated message pilot so AMD cannot be implemented. 7/13-HPNV query results received show an 8.8% return YTD- Andy and AM to determine next steps. No data yet available on Wellmark automated messaging pilot- data available m id-late August.


George Nowick

6/28/06-

Pacing being utilized on almost all contracts/campaigns in CEC- exception is 006 campaigns and Wellmark.


George Nowick,

DCMS, Andy Petrini

6/27/06



6/30/06



George Nowick

6/27/06


Seattle LT to work with account teams to develop a strategy to consolidate contracts into fewer campaigns to maximize dialer efficiency


TBD



ED

ongoing



Ongoing reporting of Key Performance Indicators

CQIP Update April 2007

CQIP Start Date

Baseline Metrics

Current Metrics^ April 2007

Outstanding Issues as of 4/30/07

Recommended Actions For Implementation in May

May 2006 2.3 CPH 77.5% TOD

2.8 CPH 75% TOD Annual Cost Avoidance based on April metrics= $ 1.63M Increase in successful call volume- 319/day

1. Idle Time

1. Explore opportunities for campaign consolidation to minimize need for clinicians to switch campaigns.

Nearly ready for Control Phase

August 2006

2.3 CPH 84.2% TOD

2.8 CPH* 85.5% TOD Annual Cost Avoidance based on March metrics=$ 3.62 M Increase in successful call volume- 766/day * Significant campaign and server issues

1. NONE

1. Move to Control Phase- action plan complete- at 2.9 CPH exclusive of server and campaign volume issues.

August 2006

2.6 CPH 75.4% TOD

2.4CPH 56.5% TOD Annual Cost Avoidance based on March metrics= 0 Increase in successful call volume- 0

1. Currently focused on Expansion/ Up-sell per BU Leader- over 50% of staff are new hires - causing a temporary drop in CPH and TOD

2. Idle Time

1. Re-start CQIP action plan calls when time permits.

Availability

0

10

20

30

40

50

60

70

80

90

100

7/1/2006

7/15/2

006

7/29/2

006

8/12/2

006

8/26/2

006

9/9/2

006

9/23/2

006

10/7/

2 006

10/21/

2006*

11/4/2

006

11/18/2

006

12/2/

2006

12/16

/2006

12/30

/2006

1/13/2

007

1/27/2

007

2/10/2

007

2/24/200

7

3/10/200

7

3/24/2

007

4/14/2

007

4/28/2

007

5/12/2

007

5/26/2

007

6/9/2

007

6/23/2

007

TODSpan

Target

SCalls per Hour

Perc

ent

6543210

99.9

99

9590

80706050403020

10

5

1

0.1

MinnesotaNashvillePittsburghRaleighSeattle

Location

Probability Plot of SCalls per HourNormal

Routine updates with Senior Leadership and Key StakeholdersFeedback and revision

Section 4C.c

Key performance indicators were tracked continually to monitor performance, provide feedback to the Senior Leadership Team, identify improvement opportunities with process stakeholders, and implement improvement actions.

This closed-loop feedback system has led to several enhancements, ongoing removal of any barriers, and improvements aligned to the changing needs of external customers as well as business needs.

Results were shared during Quality Committee meetings, call center leadership and town hall meetings, and during senior leader executive update meetings.



Criteria 5

Team ManagementAnd ProjectPresentation

Wendy FaustProcess Excellence

Leader

Thank you Pete Kapolas. Hello again, I am Wendy Faust, a member of the Process Excellence Team at Healthways.



5A. How the team members were selected, and how they were involved throughout the project

Improving Member Contact Team

Process Steps Clin

icia

nAc

coun

t Mgr

sC

all C

ente

r Mgm

t

Cus

tom

ers

Mem

ber

Exec

utiv

e Te

am

Fulfi

llmen

tPE

L/Q

ualit

yC

mte

Pro

vide

rs


Potential Key Stakeholders

Process Steps Clin

icia

nAc

coun

t Mgr

sC

all C

ente

r Mgm

t

Cus

tom

ers

Mem

ber

Exec

utiv

e Te

am

Fulfi

llmen

tPE

L/Q

ualit

yC

mte

Pro

vide

rs


Potential Key StakeholdersPosition on Change



Moderate For

Strongly For

Clinicians X O

Account Managers X O

Executive Team X O

Call Center Management X O

PELTeam/Quality Committee X

Customer X

Member X O

Section 5A

Using our SIPOC and Stakeholder Analysis as a frame of reference, a cross-functional team was selected that included members from each key process area.

The team met throughout the project life cycle to provide action plan status, to ensure progress was ongoing and timelines were met.

Members of this team provided constant updates and received consistent and productive recommendations throughout the project life cycle.



5A. How the team members were selected, and how they were involved throughout the project

Project Team Function Team Role Involvement

Mike DavisVice President,

Quality Project Champion Executive Support, Buy-In and Conflict Mitigation

Mike McMillan Process Excellence Master Black Belt Adherence to Healthways to Excellence Methodology

Wendy Faust Process Excellence Project Manager Lead Meetings, Track Assigned Items, Promote Project

Pete Kapolas Process Excellence Quality Compliance Adherence to Healthways Quality System

Larry PettyWorkforce Solutions

Manager Subject Matter Expert Lead Change in Dialer Strategies

Debbie HatcherSVP, Account Management Process Owner-Customer Represent Voice of External Customer

Ann Behrens Clinical Director Process Owner- Program Monitor Program Outcome Results

Erik Miller ReportingProcess Owner-Data/Reporting Provide Data and Reports for Analysis of Project Results

Victor Mattingly Business TechnologyProcess Owner-

Technology Lead Change to Clinical Information System/Workflow

Karen Holland Clinician Supervisor Subject Matter Expert Represent Voice of Internal CustomerClinician Focus

Group Clinicians Subject Matter Experts Represent Voice of Internal Customer

This chart shows team member involvement throughout the project. Here’s how they were selected…

Criteria for member selection included multi-skill and multi-tasking capability effective communication and people skills, and the ability to think outside the box.

Members from our Account Team, Business Technology, Process Excellence and call centers were selected based on their knowledge, skill set and ability to represent voices of internal and external customers.



5B. How the team was prepared to work together

Healthways “Basic training”

Finance “101”

Change Management

Code of Conduct

Cultural infusion training

Basic Facilitation Skills

Clinical Outcomes Training

Meeting Skills

Brainstorming

Consensus Decision-Making

Prioritization Techniques

Basic Project Management

Process Excellence MethodsStakeholder Analysis

Waste Identification

Waste Elimination Techniques

SIPOC Analysis

Gap Analysis

Process Failure Mode & Effects Analysis

Root Cause Analysis

Visual Management & Standard Operating Procedures

Action Planning

Key Performance Indicators

Section 5B

The Process Excellence Training supported the methods outlined in the Healthways to Excellence approach to Process Improvement. These included instruction on a wide variety of methods including stakeholder analysis, waste identification and SIPOC techniques.

Healthways Basic Training focused on team skills that would be needed for success as well as the financial and outcomes aspects associated with this project. This included training on meeting skills and consensus decision making techniques.

This training ensured strategic alignment and provided the team with the skills needed to achieve the desired project results.



5C. How the team managed performance to ensure effectiveness



Person Timeline RYG

1. Dialer Strategy

Historically AMD and pacing were utilized in a very lim ited manner. The belief was that AMD was yielding return calls. Data has shown that there is only a 2-4% return rate for answering machine messages.

Action items T imeline & Responsible Person

Comments RYG


George


6/22/06

6/20- Permission to use AMD on all contracts has been received except for Wellmark and HPN. W ellmark is conducting an automated message pilot so AMD cannot be implemented. 7/13-HPNV query results received show an 8.8% return YTD- Andy and AM to determ ine next steps. No data yet available on Wellmark automated messaging pilot- data available mid-late August.


George Nowick

6/28/06-

Pacing being utilized on almost all contracts/campaigns in CEC- exception is 006 campaigns and W ellmark.


George Nowick,

DCMS, Andy Petrini

6/27/06



6/30/06



George Nowick

6/27/06


Seattle LT to work with account teams to develop a strategy to consolidate contracts into fewer campaigns to maximize dialer effic iency


TBD



ED

ongoing



M e e t in g M i n u t e s C Q I P P r o je c t T e a m D A T E : 6 / 2 9 / 0 6 A t t e n d e e s : A n d y P e t r in i , G e o r g e N o w i k , S c o t t S i v i k , D e b o r a h G r a y , J e r i Y o u d - O ls e n , T a m m y P u t n a m , S h e r r y T a p p e r o , J a n e P o w e r s , L e s l i e M c G r e g o r , M i k e K e n n e d y , L a r r y P e t t y . T o p i c s D i s c u s s e d

R e v i e w o f C Q IP A c t i o n P la n

♦ D i a l e r s t r a t e g i e s i n c l u d in g i n c r e a s e d u s e o f A M D , u s e o f c a m p a i g n f o r e c a s t in g to o l in m e e t i n g s , a n d h a v e b e g u n u s e o f c a m p a i g n t r a c k i n g g r id .

♦ I n c r e a s in g u s e o f t a r g e t % c o n n e c t p a c i n g w h i le m a in ta i n i n g a c c e p ta b l e a b o r t r a t e .

♦ D M i n t r o d u c e d T a lk / W r a p A l e r t s t o th e L C M ’ s i n c o n j u n c t io n w i th U n s u c c e s s f u l C a l l s R e p o r t . T a l k / W r a p A l e r t s c u r r e n t l y s e t a t 3 0 m i n . e a c h w i th lo s s o f 3 F T E ’ s /d a y a n d lo s s o f 1 . 5 F T E ’ s / d a y o n U n s u c c e s s f u l C a l l s R e p o r t .

♦ T a l k / W r a p A l e r t s t o b e i m p le m e n t e d w i t h s t a f f s t a r t i n g o n 7 / 1 5 . ♦ C o a c h i n g i n i t i a t i v e s c o n t i n u i n g r e g a r d i n g T O D w i t h w r i t t e n a c t io n p l a n s f o r

c l i n i c i a n s b e lo w 8 0 % T O D d u e b y 7 /1 2 . ♦ U s e o f a s t h m a f i l t e r f o r B S C t o b e g i n th i s w e e k . A l s o e x p l o r i n g u s e o f 0

a t t e m p ts f i l t e r . ♦ T o w n H a l l s c h e d u l e d f o r 7 / 1 1 t o i n c lu d e “ T h e B i g P i c t u r e ” p r e s e n t a t io n . ♦ M a n u a l p r o c e s s e s b e i n g e v a l u a t e d a n d s o m e c o n t r a c t s C M m e m b e r s h a v e b e e n

p u t i n t o th e i r o w n c a m p a i g n a s s ig n m e n t , s o t h o s e c a l l s c a n b e m a d e o n d ia l e r . ♦ C a l l f l o w a n d d o c u m e n t a t i o n g u id e l i n e t r a in in g i n t h e p la n n in g s t a g e s a w a i t in g

r e tu r n o f T r a i n e r f r o m v a c a t i o n o n 7 / 1 0 . ♦ N e w H i r e c l a s s o f 8 c l i n i c i a n s s t a r t s o n 7 /1 0 .

C o m m e n ts ♦ E D a d d r e s s e d i s s u e r e g a r d i n g s t a f f in g c o v e r a g e o f B S C c o n t r a c t l a s t w e e k a n d

w i l l m e e t w i t h A M . ♦ J u n e w r a p t i m e i m p r o v e d f r o m 7 . 3 m in . d o w n t o 6 . 7 m i n . ♦ A c c o u n t m a n a g e r s lo o k i n g f o r w a r d t o r e p o r t s s h o w i n g p r o g r e s s . ♦ A c c o u n t m a n a g e r s r e p o r t e d n o p r o b l e m s w i t h t h e n e w c o m m u n i c a t io n s t r u c t u r e

w i t h th e S e a t t l e C E C . ♦ 6 /2 2 - S c o t t S i v i k m e n t io n e d a n i s s u e th a t w i l l i m p a c t C Q I P a c r o s s th e e n t e r p r i s e

r e g a r d i n g m e m b e r s t r a t i f i c a t io n l e v e l s . H e r e q u e s t e d th a t Q u a l i t y p r o v i d e a s s i s t a n c e w i th t h i s . K a t h y E l s a e s s e r r e p o r t s t h a t t h e r e i s a g r o u p o f i n d iv id u a l s w o r k i n g o n th i s i n c lu d i n g C U P S , T i m A r tz a n d M a r k H a d e n . K a th y t o s e n d e m a i l w i t h d e ta i l s t o M i k e D a v i s a n d W e n d y F a u s t . M ik e t o d e te r m i n e n e x t s t e p s .

F O L L O W - U P I T E M S - I n a d d i t io n t o t h o s e n o t e d o n A c t i o n P la n

D a t e d i s c u s s e d

I t e m W h o D u e D a t e

1 . 6 / 2 9 /0 6 R e q u e s t s u b m i t t e d t o B I f o r a n a l y s i s o f H P N m e m b e r s r e s p o n s e to a n s w e r in g m a c h in e m e s s a g e s w i t h d u e d a t e o f

W e n d y 7 /6

Agenda, Minutes, Action Plans Agenda, Minutes, Action Plans customized for each call centercustomized for each call center

Ongoing status updates per call Ongoing status updates per call center to Project Championcenter to Project Champion

Routine updates with Senior

Leadership and Key Stakeholders

Feedback and revisionTo each call center

Site % of Potential Achieved Days into CQIP CQIP PhaseTime to Control Phase (days)

Cost Avoidance Increase in calls/day Cost Avoidance Increase in calls/day

Pittsburgh 3.6M 766 4.8M 1024 75% 300 Control 270

Phoenix 1.45M 331 1.98 452 73% 210 Control 150

Hawaii 295,058 69 719,778 169 41% 150 Improve

St Louis 2.35M 496 4.75M 1007 49% 90 Improve

Seattle 1.0M 196 3.9M 771 26% 360 Improve

Baltimore 1.5M 285 3.87M 748 39% 210 Improve

Minnesota 133,371 30 2.1M 469 13% 270 Improve

Nashville 1.5M 242 3.28M 560 46% 630 Control 90

Raleigh 1.2M 239 3.57M 724 37% 300 Improve

Overall 13.0M 2654 29M 5924 45%

Results to DatePotential Results

3.0 cph and 85% TOD

Section 5C

The team used a standardized agenda and minutes template to record weekly meeting results and decisions. Team progress reports were posted on the Process Excellence Intranet site and updated as progress occurred.

The Champion, Process Owners, and team members received a Project Status report consistently with %-Completed-Indicators and barriers addressed.

Our Champion met with the project Sponsor on a monthly and as-needed basis to review project status & escalate any barriers.

This closed-loop communication system ensured any resource constraints, barriers, or emerging requirements were surfaced and addressed in a timely manner. This proved an effective approach to managing this project to successful completion.



On behalf of our team, thank you for your time and the opportunity to present our project.

Are there any questions?

Improving Member Contact Rate - ASQasq.org/wcqi/2008/team-award/pdf/2008-silver-presentation.pdfTollgate Define Step A: Identify Project CTQs Step B: Develop Team Charter Step C: Define

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