Self-service done right: New England health plan combines IT consolidation, outsourcing, Web-based technology and process redesign to achieve its business
Author: Health Management Technology

From airport kiosks to online shopping, self-service is today's watchword. In healthcare, no one knows this like health plans. With a multitude of constituencies to serve including members, employers, brokers and providers, health plans are prime candidates to reap the business efficiencies and customer satisfaction opportunities out of self-service--as it should be.

Headquartered in Wellesley, Mass., Harvard Pilgrim Health Care (HPHC) services about 800,000 New England members with HMO, PPO, POS and Medicare plans. The organization's provider network includes more than 22,000 physicians and more than 130 hospitals.

Harvard Pilgrim Health Care began its journey down the self-service path in 2000, after experiencing a multimillion dollar loss the year before. For 11 years, the nonprofit organization grew by acquisition, and by the late 1990s found itself supporting 55 disparate IT systems that impaired its ability to efficiently invoice, collect payments, administer claims and manage accounts receivable (A/R). It was a case of too much IT, not too little, as well is ill-defined business processes. Adoption of self-service capability represented one component in HPHC's resolution strategy to strengthen profits and bolster customer satisfaction.

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