How does your company use analytics?
At this time, my organization is not utilizing the analytics reports to maximize its effectively rebuild relationship in the provider community. Due to my organization outsourcing our claims and the providers experienced a delay in claims payments. As a result, there were several complaints made to Department Human Services (DHS), because we were out of compliance without compliance with our DHS contract. DHS contract states we should process claims for payment within 30 days of receipt. Furthermore, some providers have not received payment and our enrollment has dropped.
How should they use analytics?
According to Klein, analytics should be used after your intuition; therefore, in order to determine if the pros and cons outweigh or compromise your intuition. Analytical techniques, should be used to determine how to rationalize complex decisions. Often times, you need both intuition and analytics; however, Klein says, it is better to make good fast than a perfect decisions too late. I believe that is an excellent strategy if it is a last minute decision has to be made. In the past, I would use quantitative analysis to prepare and streamline current processes while forecasting, I believe it depends on the goal or purpose. For example, as a Provider Relations Network Management Consultant, I am the liaison for internal and external communication for contracted transportation providers. As a result, the customer service call center reported that a towards the evening hours they found it difficult to find a vendor to service our members. During the summer months the network appeared we had adequate providers to service our population; however, toward the fall months it was challenging to ...
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...an obtain the necessary data for reporting purposes. The facts remain, we have an excellent ACO model, and enrollment, has declined amongst all ethnic groups. My intuition is the decline in enrollment, is due delay in claims payment. In addition, the provider advises the recipients to switch health plans, due to delay in payment, I believe in order to have realistic operational approach, that includes, enrollment, provider relations, and customer service. The network should be reevaluated from a qualitative and quantitative prospective. In addition, identify claim contrast from current and prior the network should be evaluated from a holistic prospective. I do not believe this organization is identifying barriers appropriately nor dealing with internal issues effectively. As a result, the providers are frustrated and referring our recipients to other health plans.
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