Independence Blue Cross, a licensee of the Blue Cross Blue Shield Association, and the largest health insurer in the Philadelphia area, had an opportunity to significantly reduce administrative expenses and increase risk adjustment operational efficiencies for annual wellness visits (AWVs). They had previously contracted with an external vendor to deliver, retrieve, and code AWVs.
The insourcing of this capability is a key foundational block to expanding risk adjustment operational efficiencies and provider network relationship building—ultimately creating a better healthcare experience for Independence members.
Independence engaged Guidehouse to conduct an end-to-end AWV program evaluation, identify operational risks, create a business case and model, and develop an in-house SAASbased program implementation plan.
Guidehouse conducted internal multidisciplinary interviews, reviewed processes and protocols, and gathered external stakeholder feedback to understand Independence’s current AWV vendor delivery system and operations, as well as generate a strategic roadmap assessment and financial impact analysis.
Observations: Determined whether the in-house system should be expanded and replace the current external vendor. Evaluated various functional activities and suggested improvement opportunities.
Recommendations: Developed actionable recommendations for in-house SAAS rollout, including a visualization of existing processes for AWVs and a revised process flow for the new in-house tool.
Process flows: Compared Independence’s current process with the external vendor and created proposed future-state in-house workflow for SAAS.
Business model: Created a pro forma financial statement, modeling economic impacts based on various rollout dates for SAAS.
Guidehouse then worked with Independence to generate AWV system implementation, deployment, and project plans outlining the strategic build and execution activities required for a successful transition from current vendor to SAAS. This included provider rollout, training, incentive, and engagement strategies, as well as tiered support workflows and executive dashboards.
Based on Guidehouse’s qualitative and quantitative analysis and insights, Independence switched from their external vendor to the recommended in-house system. This new program reduced administrative expenses, generating $4 million in net revenue improvements.
About Independence Blue Cross
Independence Blue Cross, a licensee of the Blue Cross Blue Shield Association, is the largest health insurer in the Philadelphia area, serving nearly three million people in the region and more than eight million nationwide. Independence participates in the Medicare Advantage program and covers approximately 100,000 people.
Guidehouse’s Medicare risk adjustment experts have driven meaningful performance improvement at Independence Blue approach broke down silos, created efficiencies, and facilitated good governance and accountability within our organization. Their collaborative partnership made project initiation smooth for all stakeholders, allowing us to achieve more aggressive goals than anticipated, earlier than expected.
Vice President of Government Markets Performance
Independence Blue Cross