MAXIMIZING THE STAKEHOLDERS EXPERIENCE

Maximizing the Stakeholders Experience

Hattie L. Willoughby

Central Michigan University

Table of Contents

Chapter One: Introduction4

Objective of the Study4

Research Question4

Purpose of the Study4

Purpose of the Study5

Scope of the Study5

Chapter Two: Literature Review6

History of BCBSM6

Providers (Stakeholders Not Stockholders) Definition6

Best in Class Servicing Tools7

Employment Groups Can Help Cost8

Collecting Cost Sharing8

Chapter Three: Methodology13

Research Method13

Chapter Four: Data Analysis14

Identification of Stakeholders17

Selecting Health Issues and Performance Indicators18

Should Performance Indicators Be Standardized?19

Role of Performance Indicators in Stakeholder Accountability20

Community Responses to Performance Indicators21

Implementation: What Does It Take?22

Social Change and Accountability22

Models of Change23

Individual Change23

Organizational Change24

Internet Telephony & VoIP26

E-mail28

IRC29

Videoconferencing29

SMS & Wireless Communications30

Chapter Five: Summary, Conclusions and Recommendations32

Community Interventions32

Targets for Intervention33

Implications for Performance Monitoring34

Determinants of Health37

Health Field Model38

Social Environment40

Genetic Endowment41

Physical Environment42

Behavior42

Health Care43

Linking the Determinants43

Community Experience with Performance Monitoring44

References46

Appendix50

Chapter One: Introduction

Objective of the Study

The primary focus of maximizing the stakeholder experience strategy is to create a sustainable and differentiated stakeholder experience, to influence certain stakeholder behaviors that are most economically beneficial to BCBSM (e.g., choosing BCBSM, recommending BCBSM, etc.) At the same time, BCBSM must maintain an overall administrative cost structure that is highly competitive.

The secondary objective of the research strategy is to provide our stakeholders a single platform computer data base system that will be able to handle the volumes of claim inquires that are received on a daily bases, and allow the medical staff the ability to review claims and rejections via the internet.

The final strategy that I will look at is providing the medical community with real-time communications data system to display new processes, procedures and billing updates.

Research Question

How can Blue Cross Blue Shield of Michigan enhance the web based tools that are currently being utilized by our provider community to maximize their experience? How will this change impact the administrative cost of the providers? Purpose of the Study

The goal of my research will be to supply an effective communication tool that will enhance our stakeholder's experience and reduce administrative cost.

Scope of the Study

The scope of this research is limited to BCBSM participating providers MD, DO and billing office managers. A survey was conducted with monetary incentives offered for completion. The questions that will be focused on are:

Accuracy, ease and timeliness' of claims payments.

Web-Denis experience.



Chapter Two: Literature Review

History of BCBSM

Blue Cross Blue Shield of Michigan has been providing residents affordable access to quality healthcare for almost seventy years. As a non-profit organization, BCBS of Michigan is one of the few insurance companies in the United States that accepts every person, regardless of health history. BCBS is one of the largest insurance providers in Michigan with millions of members and doctors that participate statewide. The health plans include coverage for individuals, families, seniors, and businesses. BCBS of Michigan's history starts with a company called the Michigan Society for Group Hospitalization, founded in 1938. They provided 21 days of hospital care, just like the plans developed by healthcare pioneer and Blue Cross founder Justin Ford Kimball. As the Society spread across the state and into most of Michigan's businesses, they adopted the Blue Cross symbol with the ...