Success Story: Driving Business Transformation in Healthcare Insurance

A major health insurer used AI-powered process intelligence to streamline operations and identify $10 million in cost savings.  Skan's solution provided real-time insights, improved efficiency, and helped optimize claims processing, call centers, and legacy applications.  This success story highlights the power of AI for healthcare business transformation.

Faced with intense competition in the healthcare sector, even Fortune 500 companies continue to search for innovative approaches to streamline operations and cut costs. This blog dives into the success story of one of Skan's clients, a leading health insurance provider that serves millions of people across the U.S. When faced with the challenge of streamlining operations while maintaining quality care, the company embarked on a strategic business transformation initiative. Their goal was to achieve significant cost savings through optimized processes, technology integration, and resource management.

The organization prioritizes five key areas for growth: value-based care delivery, health benefits, health technology, financial services, and pharmacy care. To achieve these goals, the company had to reduce operational costs, but traditional process improvement methods lacked the precision to pinpoint opportunities for enhancement. The company knew that to reach its goals, it required a more comprehensive understanding of its people, processes, and technology.

Enter Process Intelligence: Unveiling the Hidden Landscape

To address these challenges, the client organization turned to Skan's AI-powered Process Intelligence (PI). Skan's solutions served as a powerful lens, offering a panoramic view of the client's operations. Within a mere 8 weeks, Skan's technology was implemented and deployed to 500 users, delivering detailed, real-time insights into the utilization of both core and non-core applications.

To spearhead Skan’s implementation of Process Intelligence across various departments, our client established a Process Discovery Center of Excellence (CoE). The success of this project hinged on seamless collaboration:

• Business Unit Ownership: Each department had a dedicated lead who reported to the CoE. These leads played a crucial role, guiding Skan re-engineering team through the project lifecycle.
• Subject Matter Expertise: The re-engineering team partnered closely with Subject Matter Experts (SMEs) within each department. The SMEs provided deep process knowledge, ensuring the team had a clear understanding of the work being analyzed.
• Data & Analysis: The re-engineering team gathered required documentation for task and process mining, analyzing captured data, and compelling value stories that translated insights into actionable recommendations for business leaders.

Change Management: The Human Side of Transformation

Our client understood that technology adoption thrives on a strong foundation of change management. A comprehensive strategy that addressed employee concerns was implemented:

1. Assessment and Planning: Evaluating the impact of Skan on existing workflows.
2. Stakeholder Engagement: Keeping key decision makers informed and involved.
3. Training and Development: Equipping employees with comprehensive training on Skan.
4. Pilot Programs: Testing the waters in a controlled environment to address potential resistance and concerns.
5. Monitoring and Celebration: Tracking progress, measuring success metrics, and celebrating milestones.

Skan delivered insightful dashboards of each business use case. These dashboards weren't just data dumps – they were visual stories showcasing Process Intelligence, workforce insights, automation potential, and even comparison analysis. Additionally, Skan offered custom visuals tailored to the client's specific needs and ‘clickstreams’ features that showcased user actions over time.

Before we delve into the results achieved by our client, let's take a closer look at the inner workings of this data-driven transformation. The infographic below deconstructs the key elements that fueled their success, exploring the formula that empowered them to achieve significant cost savings and efficiency gains:

The Payoff: Millions Saved, Efficiency Gained

The results were nothing short of impressive. Our client framed over $10 million in potential savings through process improvements identified with Skan. Here are some of the game-changing insights:

• Cracking the Claims Code: Understanding root causes for Manual Claim Adjudication and streamlining error resolution process.
• User Behavior Trends: Identifying unnecessary data validation steps due to lack of trust in pre-filled information.
• Call Center Optimization: Discovering call intent variations, agent handling times, and external resource usage for informed automation opportunities.
• Legacy Application Insights: Identifying variations in application usage across teams and locations, leading to cost-saving opportunities.

This success story exemplifies the power of Process Intelligence in driving business transformation. By leveraging this innovative approach, a leading health insurance provider gained valuable insights into their operations, identified significant cost-saving opportunities, and improved overall efficiency. This data-driven approach empowered them to achieve their strategic goals, and to deliver an enhanced experience to their customers.

Ready to delve deeper? Check out our blog "What Should Insurers Know About Generative AI" for insights on how this cutting-edge technology can further enhance operational efficiency and unlock new possibilities.

Join the Gen AI-Powered Process Revolution and watch your transformation take off, book a demo to talk to one of our experts!

Ready to unlock the power of AI in your healthcare operations? Join our upcoming webinar, "Transforming Healthcare Operations with AI-powered Process Intelligence," and learn how Skan’s advanced technology aligns with strategic business priorities to drive significant, scalable improvements across your organization. Register Now!