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PlanLogix Value Chain Impact

Introduction

PlanLogix lowers health plan providers’ operating costs by reducing the number of non-standard plan components, improving the accuracy and completeness of plan information, and giving users across the provider organization a single, complete and accurate view of each plan and client. PlanLogix does this through software and consulting services based on PlanLogix partners’ years of experience in developing healthcare information systems, with delivery tailored to the needs of each PlanLogix client. The benefits of PlanLogix can also extend beyond operating cost savings to include other parts of the health plan value chain such as product development, sales, customer service, and more.

System Overview

The PlanLogix system has three key elements: plan structure (“building blocks”), company structure, and supporting tools.

PlanLogix’s plan structure is based on “building blocks” that represent plan benefits and definitions. Each building block represents a benefit and contains complete detail about that benefit and its definitions, including only copays, limitations and more. Plans are built by assembling building blocks; each building block can be used by many plans. These health care plan building blocks can easily be copied and changed, and can accommodate any benefit.

Building blocks are stored in libraries that store a single representation of each benefit and allow the creation of new plans from a set of standard benefits and definitions. The libraries support the propagation and communication of updates of existing benefits to all plans that use those benefits. But, most significantly, the libraries ensure that there is one version of the complete and accurate truth about a plan, and that all authorized users can see it.

The PlanLogix company structure builds companies from their own set of building blocks - employee groups, divisions, and locations. This allows providers to create a common plan for a client organization and, through PlanLogix, automatically adjust that plan to accommodate for differences in the ways client company policy and state regulation apply to any group of employees. Moreover, as policies and regulations change, PlanLogix allows for automatic updates and complete tracking of plan history.

PlanLogix provides several supporting tools that flag any non-standard items, ease plan creation and maintenance, and provide workflow alerting and integration. PlanLogix also supports document creation and links to relevant ICD-9 and CPT-4 codes. PlanLogix is simple enough for new sales and service people to use, yet detailed enough to provide the information and features experienced operations people need. Finally, PlanLogix’ architecture and use of XML ensure ease of integration with other systems.

Sales Impact

PlanLogix supports the sales process by giving sales people, clients and participants a simple, guided set of choices for constructing plans. Further, PlanLogix supports document creation, improves coordination with underwriting, and ensures that all parties that communicate with a client can see and communicate the same information.

PlanLogix’ guided choice for selling is based on PlanLogix’ plan libraries and building blocks. Salespeople can use simple PlanLogix interfaces to create the exact plan that will have the best chance of securing a sale. However, PlanLogix guides the sales force to choose standard or preferred plan options where possible. Guidance can include wide-open choices, suggestions and/or restrictions, and can be different for each option faced.

With guided choices, salespeople can match exactly what the client is asking for, or provide a close match that is based on standard components that lower costs and/or speeds the sales process. This matching can be done at the point of sale using a simplified view. PlanLogix can load demographics and, where only standard items are chosen, give pricing estimates. Where non-standard items are required to complete the sale, PlanLogix can capture them, flag them for underwriting and operations, and, if desired, make them available for reuse. PlanLogix can also print out a benefits summary on the spot.

PlanLogix improves coordination between sales and underwriting in several ways. The most significant ways include the reduction of non-standard plan components and the specific flagging of non-standard items for attention. The detailed building blocks also reduce the number of clarifications underwriters need, leading to fewer and shorter cycles between underwriting and sales.

PlanLogix’ single, detailed view ensures that underwriting, customer service, contract fulfillment and other departments that communicate with customers see and communicate the same information. Benefit summaries, legal and cert books, booklets and more are all consistent with each other when using PlanLogix. As a side benefit, much of the time spent running around to gather information for material creation can be reduced.

In summary, PlanLogix offers “guided choice” and POS customization in the sales process, while ensuring that the plan sold is the plan that is communicated and implemented. For consultant sales, PlanLogix offers the ability to exactly match requirements. When selling to client executives, PlanLogix can customize on the spot and get rapid feedback on price impact. In selling to employees, PlanLogix supports the implementation of employee choice within a plan.

The PlanLogix information structure can also be used to offer employees benefit choices that stay within contribution limits. PlanLogix can also support providers who offer greater employee choice of benefits. In all sales situations, PlanLogix supports plan views and comparisons and eliminates conflicting information. The net impact is greater sales effectiveness, more profitable sales, and improved service in the selling process.

Case Setup

PlanLogix’ detailed building blocks and single repository provide case setup with complete, accurate plan information, reduce feedback loops, and eliminate the forms proliferation that can be the bane of case setup. Alerts for non-standard items further help focus effort where it is most needed, and PlanLogix’ ability to instantly propagate and communicate changes to a plan minimizes problems in case setup and downstream.

These improvements directly reduce case setup time. Setup processes that take as much as 90 days or more can be cut to 45 days or less, yielding not only cost reductions but also better customer service.

Underwriting

As discussed above, PlanLogix reduces the number of non-standard plan components and flags the remaining ones with alerts that tell underwriting what any exception is. Underwriting has fewer issues to clarify and can respond quickly with questions, suggestions, and price input. PlanLogix’ workflow features also allow underwriting to direct its questions to the appropriate party and track responses.

Our experience shows that PlanLogix can shorten the sales – underwriting cycle by as much as 50% and have a substantial impact on the cost of the underwriting function.

System Setup

PlanLogix provides system setup with detailed plan information that has already been adjusted for common problem areas like state regulations. This, plus PlanLogix’ standardized plan components, simplifies the interpretation and the coding required for system setup and improves both setup time and accuracy.

PlanLogix’ building blocks provide detailed and accurate plan definition, ensuring that setup information is true and reliable for all downstream systems. PlanLogix’ flags for non-standard items provide further specific details that reduce the need for interpretation and new code. Plus, by using standard components and code libraries, PlanLogix increases the amount of code reuse in the setup process.

A further benefit comes from the way PlanLogix handles updates and changes. Changes are made in one place in PlanLogix, and propagate throughout the system with appropriate alerts. This reduces cycles between system setup and all other parts of the operation.

One of the toughest challenges we have seen in system setup is the interaction between new salespeople who have one conception of how a plan should work and tenured system setup staff who have been trained and become accustomed to a different way of coding. Confusion often wins out, producing higher costs and dissatisfied clients. PlanLogix’ detailed and accurate information significantly reduces the room for such confusion.

In summary, the impact for system setup is shorter setup times, the near elimination of setup errors, and a substantial reduction in claims errors due to the cleaner setup and the consistent definition of benefits. The net result is improved performance at lower cost.

Contract Fulfillment

PlanLogix’ single version of the truth about a plan simplifies contract fulfillment. Plan definitions discussed in the sales process stay in sync with the legal and cert books; the same definitions are also transmitted to the call center. PlanLogix also supports document creation, resulting in greater accuracy and speed in fulfilling and transmitting contracts.

Claims Processing

PlanLogix simplifies the work of claims processing upfront by reducing the number of non-standard benefits and improving the speed and accuracy of system setup. PlanLogix also goes beyond this to include ICD-9 and CPT-4 codes, helping claims processing link directly to provider codes and systems.

PlanLogix’ detailed building blocks give claims processing staff a more consistent approach and set of rules. Deductible accumulators and other features provide greater clarity on claims payment. The net result of this is greater accuracy and lower cost.

Billing

PlanLogix’ representation of clients based on employee groups, divisions, and locations, plus PlanLogix’ accurate and detailed plan representation allow billing to generate bills that accurately allocate costs across the different parts of a client organization. Bills can roll up by division, subsidiary, state, location, and employee group – and any combination of the above. Billing can be both faster and more accurate, which can result in faster collections.

Customer Service

PlanLogix provides customer service with detailed, accurate plan information as well as complete and accurate history for any client or consumer. PlanLogix helps with booklet and benefit summary creation, and includes powerful alerting, tracking and annotation features to ensure that customer service is aware of any issues, changes or updates.

The PlanLogix building blocks provide the complete detail that customer service needs to answer client and employee questions. Since plan information is contained in a single repository, customer service will be seeing the same information that other parts of the organization is seeing and will not run the risk of passing on inaccurate information. PlanLogix’ history and versioning will also let customer service see the complete details of the plan that was in effect for a particular person at any point in time. PlanLogix can also help customer service creates booklets and benefit summaries that are consistent with plan details. Further, PlanLogix’ standardization of plan components will reduce the amount of time customer service reps need to spend learning and researching plan benefits.

PlanLogix’ flags and alerts will tell customer service reps when there are special provisions or non-standard features, legislative updates, and any and all other changes to plans. In addition, when issues and questions arise, PlanLogix includes facilities for posting annotations and FAQ’s so that reps can quickly and consistently identify and resolve problems.

The bottom line is that, with PlanLogix, customer service can always be in sync with what has been sold. This results in in improved service (as well as rep job satisfaction) and can lead to a decline in customer service costs.

Administration and Reporting

PlanLogix provides administration and reporting accurate and complete details on plan features – benefits, copays, etc. It also provides a facility for inquiries across all plans in force, and a master library to manage, modify, and roll out benefits and other plan components.

Renewals

PlanLogix supports the renewal process through improved information and tools to facilitate the renewal process as well as improved customer satisfaction that makes renewal more likely.

PlanLogix’ plan maintenance ensures that there are fewer “collisions” in the renewal process and less need for special handling. This, plus the accurate representation of plan information, can reduce renewal-processing time by 30-40%.

Training

A substantial benefit PlanLogix brings is an increase in the speed at which new employees become fully productive. We have found that it takes nearly 18 months to get an operations employee fully up to speed. This is unfortunate, and is made worse by the fact that average tenure in many positions is less than 18 months.

PlanLogix reduces the time it takes for new employees to become effective by reducing the number of exceptions in the system and simplifying and clarifying plan components. This allows training to focus on rules rather than exceptions, and plan structures and components rather than the peculiarities of individual customers. With PlanLogix, the time for a new employee to become fully effective drops from 18 months to 6-9 months.

Product Development

PlanLogix’ plan components and libraries serve as a CAD/CAM system for health plan design. This allows product development to create and model new and updated plans in minutes or hours, instead of days and weeks. The completeness of PlanLogix’ building blocks ensures that the plans that are created are robust and, as far as possible, standard. This ensures that the plans developed and sold are those that can be effectively delivered.

In addition, the PlanLogix implementation process typically identifies several ways in which plans can be further standardized and improved. The net result is that product development can be more responsive and create and manage more profitable plans.

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