Case Study: Leveraging Business Intelligence to Streamline Disability Case Costing in Healthcare
Client Challenge
A healthcare company specializing in disability case management approached us with a significant problem: despite careful case costing efforts, the actual costs were consistently exceeding estimates. This company had a contract with a major client, managing disability cases at a fixed price regardless of the complexity or time required for each case. However, unexpected cost surges were challenging their financial projections and impacting profitability. The management team was at a loss to understand the root cause of these spikes, as their historical data and experience with this client suggested the current approach should have been sustainable.
Background
The company’s case management process involved multiple layers of handling based on complexity and expertise:
- Entry-Level Team: Disability cases initially went to an entry-level team with basic training, where handling costs were minimal.
- Case Managers: Cases that required further attention were escalated to case managers, who could resolve moderately complex issues at a mid-level cost.
- Care Managers: The most complex cases were handled by care managers, typically healthcare professionals whose involvement came at a high cost. At this level, insurance companies were expected to contribute to the case cost.
Despite these tiered handling protocols, costs were unexpectedly high, particularly at the care manager level. The client wanted to know at which stage (entry-level, case managers, or care managers) the cost contributions were escalating and how insurance coverage might be offsetting these costs.
Our Solution: Data-Driven Analysis with Power BI and SAP Crystal Reports
To uncover the true cost drivers, we reviewed the client’s database and implemented a comprehensive data analysis using SAP Crystal Reports and Power BI. Our approach included:
- Data Segmentation by Handling Level: We grouped case data by each handling level—entry-level, case manager, and care manager. This allowed us to track the time spent and associated costs for each case at each stage.
- Aggregation of Case Costs: Costs were aggregated both at an overall level and per case, providing management with detailed insights into how resources were allocated. This breakdown enabled visibility into specific cases that required high levels of involvement from care managers.
- Analysis of Insurance Contributions: We identified cases where costs were being borne by the company rather than the insurance provider, particularly at the care manager level. This analysis helped isolate instances where costs could have been more appropriately offset by insurance contributions.
Key Findings
Through our analysis, we discovered several critical insights:
- Frequent Escalation to Care Managers: A significant portion of cases, including some that could have been resolved at lower levels, were being escalated to care managers. This was due, in part, to a lack of training at the entry and case manager levels, which led to over-reliance on care managers.
- Inefficient Resource Allocation: Care managers were often spending substantial time on existing cases instead of prioritizing new cases. This led to a bottleneck effect, driving up costs as care managers were engaged for longer periods.
- Insurance Contribution Gaps: In many instances, costs that should have been covered by insurance were absorbed by the healthcare company, particularly in cases where care managers provided additional time and resources without offsetting insurance claims.
Results and Recommendations
Our analysis empowered the client’s management team to take corrective actions:
- Enhanced Training Programs: We recommended that entry-level and case managers receive targeted training to better equip them for handling cases at their respective levels. This reduced unnecessary escalation to care managers.
- Resource Reallocation: By tracking and limiting time spent on individual cases at each level, management implemented stricter case review protocols, ensuring that only the most complex cases reached the care manager level.
- Cost Recovery from Insurance: Clear guidelines were established to ensure insurance companies covered a fair share of costs for cases handled by care managers, relieving the company of these financial burdens.
Conclusion
Through the strategic use of SAP Crystal Reports and Power BI, we delivered a clear understanding of cost drivers and provided actionable insights to streamline operations. This case study underscores the transformative power of business intelligence in managing complex, layered workflows within the healthcare industry. By reassigning resources and reclaiming costs, the company achieved substantial savings, making their disability case management process more efficient and financially sustainable.