Developing High-Performance Operating Models Presented by Musheer Robinson – CEO

Developing High-Performance Operating

Models

Presented byMusheer Robinson – CEO

[email protected] – 314.283.8777

Delivering Deep Insight, Accelerated Excellence & Significant ROIs

Williams-Wallace Management Consultants (WWMC)

mailto:[email protected]

Introducing Williams Wallace Management Consultants (WWMC)

• WWMC is an enterprise process management (EPM) consultant focused on helping its customers create leveraged growth platforms for near-term cost reductions, increased profitability and long term growth

• WWMC customers are senior government leaders and CEO/CFO/COO/CIO’s and/or board of directors and line of business leaders

• WWMC helps its customers to develop action oriented value propositions, enterprise class strategies, business processes and execution capabilities that clearly differentiate our customers from their competition

• WWMC is expert in helping customers optimize their supplier, partner and customer value chain positions including helping them establish (or leave) business relationships fluidly and inexpensively

• WWMC strategies are informed by the voice of our customers’ customers, are flexible and sustainable

• WWMC delivers process management toolsets that leverage customers existing business infrastructure investments

• WWMC consultancies achieve bottom line savings quickly with modest investments increasing profitability quickly

WWMC Links Strategy and Execution

1. Determine unique customer value position and strategic operating goals2. Design operating model to support strategy3. Establish process performance metrics and objectives4. Design and implement process, system and people related changes5. Establish a change management infrastructure

11 22 33 44 55Strategy Customer Value Profile

Enterprise Process Model

Process Performance Model

Operating Model Implementation

Results Assessment & Ongoing Agenda (PMO)

Order Entry AfterOrder Entry Before

WWMC’s Strategy Process is Focused on Value Innovation and the Customer Experience

WWMC Clarifies Accountability and Control Creating controls and methods to link strategy and process execution

WWMC Helps its Customers to Manage ResourcesMore Effectively Through Process Based Budgeting

Mapping operating, capital, fte’s and chart of account budgets to process immediately highlights the need for realignment of budgets & the project portfolio…

“Should WWMC’s client invest more in customer processes or supplier processes?”

June YTD Spending by Business Process

Develop Products & Services $2.0 M

Manage Customers & Products 38.0 M

Develop & Manage Provider Network 43.0 M

Manage & Provide Care 33.0 M

Administer Accounts 5.0 M

Manage Loyalty & Renewals 2.0 M

Strategic Processes 9.0 M

Enabling Processes 6.0 M

$138.0 M

June YTD Spending by Business Unit

Administration $12.0 M

COO .5 M

Corporate Medical Office .6 M

Diversity .2 M

Executive .8 M

Finance 10.0 M

General Counsel / Human Resources 3.7 M

General 19.0 M

Information Technology 40.0 M

Medical Management 15.0 M

Operations 17.0 M

Provider Contracting 2.0 M

Sales & Marketing 16.0 M

Strategic Development 1.0 M

Total General and Administrative $138.0 M

WWMC Assigns Performance Accountability & Enterprise-wide Measurement Systems

Electronic (EDI & HPHConnect) vs.Manual (Commercial Paper) Transactions

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%Electronic Manual

Setup Accounting &Reserves

Bill Premiums• Issue Invoices• Post Premium Payments

Manage Accounts Receivable• Reconcile Premiums• Research & Resolve Non-Payments

Pay Sales Commissions

Prepare Account Financial Reports

Account Reports• Standard• Ad Hoc• Utilization• Reinsurance


Bill Premiums• Issue Invoices• Post Premium Payments

Manage Accounts Receivable• Reconcile Premiums• Research & Resolve Non-Payments




AdministerAccountsAdministerAccounts

Enrollment Form Inventory (Commercial)

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Sep-00

Oct-00

Nov-00

Dec-00

Jan-01

Feb-01

Mar-01

Apr-01

May-01

Jun-01

Jul-01

Aug-01

Source: "E&B Weekly Statistics", Jill Munroe

Form

s0

1

2

3

4

5

6

7

8

9

Days

on

Han

d

Forms Days on Hand

Commercial Incoming Calls and Abandon Rate

7,9

92

4,4

96

4,3

04

4,5

57

7,8

95

4,3

54

4,4

40

4,3

40

4,9

025,6

06

8,1

97

6,7

09

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Sep-00

Oct-00

Nov-00

Dec-00

Jan-01

Feb-01

Mar-01

Apr-01

May-01

Jun-01

Jul-01

Aug-01

Source: "E&B Weekly Statistics", Jill Munroe

Calls

0%

2%

4%

6%

8%

10%

12%

14%A

ban

don

Rate

Calls Abandon Rate

94

%

92

%

91

% 93

%

94

%

93

%

94

%

93

%

93

%

94

%

89

%

93

%

97%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

Jun-00

Jul-00

Aug-00

Sep-00

Oct-00

Nov-00

Dec-00

Jan-01

Feb-01

Mar-01

Apr-01

May-01

All Forms Standard

Source: "E & B Monthly Statistics", Jill Munroe

Combined Commercial Accuracy Rates

95%

100% Group Retention Rate

63%

83%

50%55%60%65%70%75%80%85%90%95%

100%

Jan Feb Mar Apr May Jun Jul Aug

WWMC Helps its Customers to Manage their Operating Model & the Relationships Between and Among Processes

Organizational Unit

Role ProcessIndividual

Parent-Child

Parent-Child

Parent-Child

ParticipatesOwnsManages

ParticipatesOwnsManages

FillsRepresents

Owns

WWMC Engages Senior LeadershipWe help Start the process management journey from a different vantage point – the top

Why Customers Need WWMC’s Holistic Enterprise Process Management™

ALL Businesses are a Collection of Processes Holistic Enterprise Process Management™ Optimizes the Biz

• Managing the business through innovations and execution in the value platform (product/service/delivery methods)

• Begins with a process model that inventories the processes of the business: we call it an Enterprise Process Model

Determine Network &Contracting Strategy

Create Medical Management Agenda

Manage Formulary

Develop Standards & Policies for:

Medical Policy

Practice Guidelines

Service Standards

Delegation Policy

Create Standard Provider Templates

Determine Provider Reimbursement Policy

Maintain Regulatory Compliance

Negotiate/Renegotiate Provider Contracts

Credential Physicians & Facilities

Configure Provider Contracts

Enroll, Orient & Setup Providers

Produce/Update Provider Directory

Adjudicate & Process Claims/Status

Determine Network &Contracting Strategy


Manage Formulary


Medical Policy

Practice Guidelines

Service Standards

Delegation Policy










Manage Distribution

Channels – Direct, Indirect, Self-Service

Respond to Inquiries & Concerns

License/Commission Brokers & Agents

Target Customers

Advertise & Market Brand/Products

Prospect Customers

Process Census

Underwrite & Determine Rates

Develop Proposals

Negotiate & Close Account Contracts

Configure Account Contracts

Enroll Members

Train Plan Administrators

Initiate Premium Processing

Issue Member Materials/ ID Card

Manage Distribution




Target Customers


Prospect Customers

Process Census


Develop Proposals



Enroll Members



Issue Member Materials/ ID Card

Develop Strategy

Analyze Environment• Consumers• Competitors• Regulatory

Government

Forecast Membership

Segment Markets

Identify Customer Needs & Concerns

Analyze Pricing

Develop Business Plans for New Products• Develop & Maintain

Master Product Plan

Obtain Regulatory Approval

Pilot/Test Products & Services

Launch Products

Develop Strategy

Analyze Environment• Consumers• Competitors• Regulatory

Government

Forecast Membership

Segment Markets


Analyze Pricing

Develop Business Plans for New Products• Develop & Maintain

Master Product Plan



Launch Products

EligibilityManage Utilization• Pre-certification &

Pre-authorization• Referral &

AuthorizationManagement

• Benefits Verification• Case Management• Retrospective

Review/DenialEncounter ManagementEnsure Clinical & Service QualityInfluence Provider Performance• Compensation &

Incentives• Profile Providers• Track Satisfaction• Analyze Care• Delivery PatternsProvider Group Reports• Standard Reports• Ad Hoc ReportsPromote WellnessManage DiseasesReport Clinical Outcomes & Performance• HEDIS & NCQA

Deliver Care Through:• Staff Model• Group Practice

EligibilityManage Utilization• Pre-certification &

Pre-authorization• Referral &

AuthorizationManagement

• Benefits Verification• Case Management• Retrospective


Incentives• Profile Providers• Track Satisfaction• Analyze Care• Delivery PatternsProvider Group Reports• Standard Reports• Ad Hoc ReportsPromote WellnessManage DiseasesReport Clinical Outcomes & Performance• HEDIS & NCQA

Deliver Care Through:• Staff Model• Group Practice


Bill Premiums• Issue Invoices• Post Premium

Payments

Manage Accounts Receivable• Reconcile Premiums• Research & Resolve

Non-Payments





Bill Premiums• Issue Invoices• Post Premium

Payments

Manage Accounts Receivable• Reconcile Premiums• Research & Resolve

Non-Payments




Solicit CustomerFeedback• Conduct Surveys &

Studies• Track Member Call

Center Concerns• Track Provider Call

Concerns• Analyze Purchased

Research Data

Analyze Customer Feedback Data

Evaluate Internal Performance

Identify Service Improvements

Research Markets

Reward Customer Loyalty

Solicit CustomerFeedback• Conduct Surveys &

Studies• Track Member Call

Center Concerns• Track Provider Call

Concerns• Analyze Purchased

Research Data




Research Markets


Strategic Processes: Brand, Communication, Value Innovation, Resource Management, BudgetingStrategic Processes: Brand, Communication, Value Innovation, Resource Management, Budgeting

Enabling Processes: Finance & Accounting, Human Resources, IT, Project Management, Legal, Audit, Training, FacilitiesEnabling Processes: Finance & Accounting, Human Resources, IT, Project Management, Legal, Audit, Training, Facilities

ManageLoyalty andRenewals

ManageLoyalty andRenewals

AdministerAccounts

AdministerAccounts

Manage andProvide CareManage andProvide Care

Develop andManage Provider

Network

Develop andManage Provider

Network

ManageCustomers and

Products

ManageCustomers and

Products

DevelopProducts and

Services

DevelopProducts and

Services

11 22 33 44 55 66Strategic Processes determine what value propositions, what customers, and the how the organization will invest to deliver to those customers.

Strategic Processes determine what value propositions, what customers, and the how the organization will invest to deliver to those customers.

11

Core Processes develop, produce, market and support the core products and services of the organization. A health plan, as illustrated, has processes for managing a provider network.

Core Processes develop, produce, market and support the core products and services of the organization. A health plan, as illustrated, has processes for managing a provider network.

Enabling Processes allow the organization to be in business, but are not part of the core value proposition. Typically, human resources, facilities management, finance and accounting, and information technology fall into this class.

Enabling Processes allow the organization to be in business, but are not part of the core value proposition. Typically, human resources, facilities management, finance and accounting, and information technology fall into this class.

22

33

Holistic Enterprise Process Management™ Moves business & gov. entities beyond traditional operating models

• Enterprise Process Management— an approach that places business process at the center of business management – Tied to customer value delivery– Supported by alignment in key business dimensions — organization, partners,

technology, budget, content, change– Monitored through process-based performance metrics

FromTraditional Organizational

Management

ToProcess

Optimization

ToHolistic Enterprise Process

Management ™

Benefits of WWMC’s Holistic -Enterprise Process Management™

Improve Performance. Managing processes allows leaders to affect directly the sources of value and the sources of costs of the organization

• Customers experience business processes, not org charts and budgets • Operational metrics (e.g. call abandonment rates) tie to customer experiences and strategic

objectives• Applying the right control intervals

Improve Accountability. Process Owners are identified and held accountable for the effectiveness and efficiency of their processes – and rewarded for performanceImprove Investments. Process management enables better investment and resource allocation decisions by linking capital budgets to the processes that directly impact customer experiences and financial performanceImprove Agility. Process management creates agility, enabling an organization to design and implement process changes to respond to market opportunities and competitive threats. In addition, effectives responses to changes in the legal and regulatory environment, like Sarbanes-Oxley, begin with a knowledge of the underlying business processes

Enhance Competitive Advantage. Competitors are unable to duplicate the operating model

11

22

33

44

55

WWMC Institutes a Holistic Process-Centric Operating Model The Model clarifies “What Do We Do?” and “Where do we start?”

The Example Below is restructuring a failing HMO

Determine Network & Contracting Strategy



Medical Policy

Practice Guidelines

Service Standards

Delegation Policy










Determine Network & Contracting Strategy



Medical Policy

Practice Guidelines

Service Standards

Delegation Policy










Manage Distribution




Target Customers


Prospect Customers

Process Census


Develop Proposals



Enroll Members



Issue Member

Manage Distribution




Target Customers


Prospect Customers

Process Census


Develop Proposals



Enroll Members



Issue Member

Develop Strategy

Analyze Environment

• Consumers

• Competitors

• Regulatory Government

Forecast Membership

Segment Markets


Analyze Pricing

Develop Business Plans for New Products

• Develop & Maintain Master Product Plan



Launch Products

Develop Strategy

Analyze Environment

• Consumers

• Competitors

• Regulatory Government

Forecast Membership

Segment Markets


Analyze Pricing

Develop Business Plans for New Products

• Develop & Maintain Master Product Plan



Launch Products

EligibilityManage Utilization• Pre-certification & Pre-

authorization• Referral & Authorization

Management• Benefits Verification• Case Management• Retrospective


Incentives• Profile Providers• Track Satisfaction• Analyze Care• Delivery Patterns• Provider Group Reports• Standard Reports• Ad Hoc Reports

Promote WellnessManage DiseasesReport Clinical Outcomes & Performance

EligibilityManage Utilization• Pre-certification & Pre-

authorization• Referral & Authorization

Management• Benefits Verification• Case Management• Retrospective


Incentives• Profile Providers• Track Satisfaction• Analyze Care• Delivery Patterns• Provider Group Reports• Standard Reports• Ad Hoc Reports

Promote WellnessManage DiseasesReport Clinical Outcomes & Performance

Setup Accounting &

Reserves

Bill Premiums

• Issue Invoices

• Post Premium Payments

Manage Accounts Receivable

• Reconcile Premiums

• Research & Resolve Non-Payments



Account Reports

• Standard

• Utilization

• Reinsurance

Setup Accounting &

Reserves

Bill Premiums

• Issue Invoices

• Post Premium Payments

Manage Accounts Receivable

• Reconcile Premiums

• Research & Resolve Non-Payments



Account Reports

• Standard

• Utilization

• Reinsurance

Solicit Customer

Feedback

•Conduct Surveys & Studies

•Track Member Call Center Concerns

•Track Provider Call Concerns

•Analyze Purchased Research Data




Research Markets


Solicit Customer

Feedback

•Conduct Surveys & Studies

•Track Member Call Center Concerns

•Track Provider Call Concerns

•Analyze Purchased Research Data




Research Markets


Strategic Processes: Brand, Communication, Value Innovation, Resource Management and BudgetingStrategic Processes: Brand, Communication, Value Innovation, Resource Management and Budgeting

Enabling Processes: Finance & Accounting, Human Resources, IT, Project Management, Legal, Audit, Training, FacilitiesEnabling Processes: Finance & Accounting, Human Resources, IT, Project Management, Legal, Audit, Training, Facilities

Manage“Loyalty” &Renewals

Manage“Loyalty” &Renewals

AdministerAccountsAdministerAccounts

Manage &Provide CareManage &Provide Care

Develop &Manage ProviderNetwork

Develop &Manage ProviderNetwork

ManageCustomers &Products

ManageCustomers &Products

DevelopProducts &Services

DevelopProducts &Services

11 22 33 44 55 66

Core

Proc

esse

s

WWMC Aligns the OrganizationHelping the Executive team to develop an agenda for the turnaround by getting

the team aligned on priorities

Before

After

WWMC answers the critical value proposition questions and provides efficient actionable solutions

Is business strategy clearly understood?

Is business strategy valid?

Are customers identified?

Is customer value and customer experience understood?

Is customer value differentiated?

Is operating strategy understood (Make, Buy, Ally)?

Is operating strategy feasible?

Are executives aligned on process link to strategy and performance?

Can operating model be expressed as Enterprise Process Map (EPM)?

What are process families?

What are major processes & sub-processes?

Do budgets and people map to the EPM?

Do systems map to the EPM?

Are processes formally defined?

Are process owners identified?

Do processes clearly create value for customers?

Are processes measured?

Are incentives aligned with process results?

Are processes managed end-to end and across functions?

Do IT systems support all processes?

Are process metrics integrated with enterprise objectives?

Are process changes coordinated and measured?

Is process documentation accessible to process participants and owners?

What are major business performance gaps?

What are major process performance gaps?

What processes are inadequately designed or documented?

Where are resources incorrectly applied to processes?

Where are IT systems not matched to processes?

What are major people issues?

Training Management Incentives

How should improvement opportunities be prioritized?

How should process management capabilities be strengthened?

What training and change management needs must be addressed?

Before we even leave

the gate – the team gathers

Working with broad cross-functional team including process

owners and participantsWith WWMC Partners

WWMC Creates Timelines for results, not simply a menu of consulting activities. We don’t stop with system implementation

Build EPM Gain Executive Alignment

Process Managed

EnterpriseMethodology

Define Process Metrics & Dashboard

Map EPM toSystemsOrganizationBudgetsProjects

Assess Performance Gaps Prioritize Opportunities

wk 8 wk 15 wk 22 wk 34 wk 46

Define Process Redesign Projects

Launch PMO Agree Outcomes, Baselines

and Measures Agree Methodology

Enterprise Process Management

Change Management Complete Project Planning Identify and On-Board

Team Initiate “Quick Wins” Develop Systems Plan Develop Training and

Development Plan Process Redesign

Workshops / Lab

Complete Quick Wins Roll-out Process

Performance Incentives Pilot Wave 1 Process

Changes Complete Enterprise

Process TrainingProcess OwnersProcess Participants

Install System Changes

Roll-out Wave

1 Process Changes Transition Process

Ownership Identify New

Opportunities Drive Results

Generation

Agreed Results Delivered Demonstrate

SustainabilityBehaviors ChangedNew Management

System Functioning Incentives Aligned

Enterprise Processes Directly Support Customer Value Innovation

Timeline for

Illustration

Only

ImplementationAssess &

Design EPM

Develop

Pilot & Install Changes

Deliver & Accelerate Results

Have Your Advisors Helped You Achieve These Three Fundamental Goals ? If Not, Call WWMC!

High performance requires both excellence in customer experience AND operations

A new operating model is required - supported by strategies with every day utility for MANAGEMENT processes

The new enterprise model must engage senior leadership – in both operating model design and ongoing management processes

Point 1Point 1

Point 2Point 2

Point 3Point 3

Developing High-Performance Operating Models Presented by Musheer Robinson – CEO

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