Simplyhealth is one of the UK's leading health cash plan providers and has been established for almost 140 years. Simplyhealth helps 1.2 million customers afford the cost of their everyday healthcare. Customers can claim back up to 100% of the cost of visits to the dentists, opticians, physiotherapists and other healthcare professionals, up to an annual limit. As an organisation with mutual values, Simplyhealth is committed to improving customer service and increasing efficiency to keep their operating expenses low. Simplyhealth plans represent value for money with innovative marketing and distribution, which remains at the forefront of its continued success.
Simplyhealth receives 15,000 claims per day from its customers and each claim usually involves associated receipts and paperwork so a typical document is around 3 pages. All claim documents were manually filed and kept onsite for 3 months and offsite for a further 9 to 12 months. This simple process involved a whole section of staff to file and retrieve paperwork on a request basis, whilst manually date stamping, fine sorting and delivering day-to-day post to the departments. The cost to Simplyhealth of this process was many thousands of pounds each year.
Customer's Business Issues:
- Difficult to maintain real-time statistics for volumes of claims at differing stages of the settlement process
- Large volumes of documents with huge amounts of human intervention
- Difficult and time consuming searches for correct documentation
- High cost and complexity of processing claims
- Customer response slow, impacting customer satisfaction Customer's Business Objectives
- Eliminate manual document retrieval, reducing the cost of processing claims
- Automate the claims process, improving accuracy and consistency
- Remove filing area, recovering space and reducing the cost of storage
- Ensure a more prompt response to members, improving customer satisfaction
- Obtain an overall view of policy holders claims, rapid response and fraud prevention
- Allow Simplyhealth to redeploy valuable customer service staff to customer facing roles
Simplyhealth was using an IBM Document Management system that employed first generation scanning techniques, manual data entry and had no integration into the processes or back end applications. This existing system was used by a small number of people with a low volume of documents. Predominantly a paper-based system, using DB2/400 and an inhouse iSeries bespoke application, incoming claims were sorted into groups, in paper batches and passed to teams; information was entered from forms into the legacy application manually. Paper files were passed internally for payments, with a further manual update to the iSeries server. Once approved for payment, batches of paper were passed to the 16 strong filing department for manual filing.
Initially, Logicalis were engaged to redevelop the existing archiving and retrieval system, which catered for a small number of users and low document volumes. By introducing IBM Content Manager it was possible to increase the number of users accessing the central source of the documents, whilst maintaining full control and security. This improved customer satisfaction by enabling all of the information to be available to the customer service specialists when dealing with a claim.
Once completed, Logicalis were asked to assist further by working on a scoping exercise to help Simplyhealth in understanding what would need to be done to gain further benefits. The Simplyhealth project manager, Joan Irwin commented "We spent quite a while understanding the business processes and, wherever we could, streamlining them. This resulted in us being able to redesign the system quickly to reflect best business practices and, in reality, implement a very successful solution".
By using a Business Workflow specialist and the consultancy and implementation skills of Logicalis, Simplyhealth now have a streamlined operation for their claims processing which has resulted in some major benefits. The study revealed that there would be additional benefits from further integration but that this would mean fundamental changes to the existing system. Logicalis implemented a data capture solution that allowed the claim forms to be passed into Kodak scanners and to be read by Kofax Ascent Capture software.
This involved the redesign of the forms to be more scanner friendly. Once the forms were redesigned the software could be configured to read vital information and integrate to the claims application. "We then looked at how we could automate even further the processing of some low-value claims by using data capture techniques," continued Joan Irwin, "The claim forms are now received and data is read from them by the software, with the captured information being validated and updated automatically onto our iSeries bespoke claims processing system. Inbuilt system flexibility means that automatic payment of claims can be varied, depending on volumes and skill levels. Streamlining this process has brought increased job satisfaction for the claims processing advisors, enabling them to concentrate on more complex claims".
Simplyhealth has seen a significant improvement in terms of reducing the amount of human intervention, driving down costs, and increasing the flexibility that could be built into the workflow, now that the information is captured directly from the claim form. In addition, those people previously tied up in processing low value claims can now be deployed in customer facing areas, helping to increase business. Dramatically improved response times provide significant improvements in customer satisfaction. The end-to-end solution from Logicalis involved a combination of Services, Software, Hardware and ongoing support.
Solution: Expansion for archiving and retrieval system, secure and recoverable WORM document store, Data Capture, Forms redesign, Application Integration.
Services: Scoping study, design and implementation of solution, project management, bespoke application development, training, ongoing support.
Software: IBM Content Manager, Kofax Ascent Capture, Notability MaxImage TM
Hardware: IBM iSeries, IBM 3995 Optical Library,Kodak 3520 scanners
Simplyhealth has received a number of key benefits from implementing this solution.
- Users across different sites have access to stored documents at the same time.
- Customer Service roles have become more varied and challenging with the removal of much of the routine, repetitive tasks.
- Document retrieval time has been reduced from hours to seconds.
- Secure archiving - documents are stored in a write once, read many (WORM) system.
- Saving of storage space and reuse of office space previously used for storing paper.
- Accelerated business process and improved customer service by having images of claims available as early as possible.
- Introducing workflow via the Document Management system ensures they can process and monitor throughput to agreed Service Level Agreements.
- Customer service and satisfaction is higher - retrieving documents while a customer is on the phone has been particularly helpful.
- Cost reductions from removing paper store and multiple access to documents.
- Removal of human intervention, improving efficiencies.
Logicalis brought a wide variety of skills, and worked closely with the existing business consultants to develop the best solution for Simplyhealth.