Challenge 

A prominent health plan serving millions of members faced multiple, interrelated challenges that were impacting its efficiency and profitability. Key among these was a lengthy end-to-end (E2E) and user acceptance testing (UAT) cycle that extended up to eight weeks per release. This drawn-out testing period meant the health plan could only manage three production releases per year, severely limiting their ability to roll out new features and improvements at a competitive pace. Compounding this issue, their automation coverage was only 25%, leaving most testing processes manual and time intensive. Consequently, approximately 12% of defects were only identified post-deployment, resulting in costly fixes, potential disruptions in service, and a negative impact on the user experience.

Recognizing the need for a strategic transformation in their quality assurance (QA) approach, the health plan partnered with Emids to overhaul their QA processes, aiming to streamline testing, increase automation, and improve release frequency without compromising quality.

Solution 

Emids implemented a robust QA transformation program designed to address these specific challenges and create a scalable, high-quality QA ecosystem. The transformation was grounded in a deep understanding of the client’s unique testing requirements and was executed through several targeted strategies.

QA Best Practices & Quality Tracking

Emids established and enforced stringent QA standards to ensure consistency across all testing phases. These best practices created a foundation for thorough quality tracking, allowing the health plan to monitor the effectiveness of their QA processes at each stage. With these standards in place, Emids was able to increase the reliability and quality of every release.

Automated Backlog Management 

Emids deployed a centralized team focused on identifying and prioritizing backlogged tasks for automation, enabling the health plan to address pending issues and eliminate bottlenecks more effectively. By reducing manual effort, the team helped streamline the testing workflow, making the process faster and more efficient.

Automated Execution and Testing 

Emids committed to significantly increasing automation coverage within the QA process, ensuring that all core functionalities and new features underwent automated testing before release. This automation framework guaranteed consistency in testing, reduced human error, and minimized manual interventions, enhancing both the speed and accuracy of the testing process. This approach not only accelerated release cycles, but also delivered high-quality, reliable products to market with each deployment.

Data Obfuscation for Security and Compliance

To safeguard sensitive member information, Emids implemented advanced data obfuscation techniques, anonymizing production data used in development and QA environments. This step significantly reduced the risk of data exposure, ensuring that all testing adhered to industry standards for data security and compliance.

Self-Service Test Data Generation

Emids introduced a self-service utility that allowed QA teams and developers to generate test data on demand. This tool streamlined the testing process by empowering teams to quickly access the data they needed without dependencies, resulting in enhanced operational efficiency and effectiveness.

Outcome 

The QA transformation initiative delivered measurable, impactful results for the health plan, substantially improving both operational efficiency and product quality. The following key outcomes demonstrate the impact of the initiative.

Faster Time to Market 

By reducing the end-to-end testing duration by 25%, Emids enabled the health plan to accelerate its release cycle. This reduction allowed the health plan to introduce two additional production releases annually, improving their competitive positioning and responsiveness to market demands.

Increased Efficiency and Defect Reduction 

With enhanced QA processes and increased automation coverage, the defect rate in production was significantly reduced. Late defect identification dropped by 70%, resulting in fewer post-deployment issues and improved product reliability. This reduction in defects also led to enhanced user satisfaction and decreased maintenance costs.

Enhanced Automation Coverage

Automation coverage rose dramatically, reaching 75% of the testing processes. This was achieved through the development of a more robust automation framework, featuring reusable components that improved productivity and efficiency by 40%. As a result, the health plan benefited from faster, more reliable, and more scalable QA processes.

Through this QA transformation, Emids empowered the health plan to deliver high-quality products more efficiently and with greater speed. The strategic improvements in quality assurance processes provided the client with a scalable solution that supported rapid growth, reduced operational risks, and positioned them for long-term success in a dynamic healthcare market. 

Learn how Payers with the right approach of Quality Engineering can drive sustainable cost optimization for their business. 

Challenge

A leading health plan with millions of members faced significant operational inefficiencies due to manual processes across multiple departments. These inefficiencies were time-consuming, hindered service quality, and negatively impacted the organization’s bottom line. Key areas such as Claims, Care Management, Enrollment & Billing, and Pharmacy Benefit Management were experiencing bottlenecks, leading to delays, higher operational costs, and reduced productivity. The health plan recognized the need to streamline operations through automation to boost productivity and improve cost-effectiveness.

Solution

The health plan partnered with Emids to deploy an enterprise-wide intelligent automation solution. Leveraging UiPath’s automation platform, Emids implemented a comprehensive suite of automated processes across multiple business functions. The solution included:

1. Automation Center of Excellence (COE) Setup: Emids established an Automation Center of Excellence (COE) to identify high-impact automation use cases and ensure alignment with the health plan’s business objectives. This COE developed a long-term automation roadmap, ensuring the successful deployment of automation across the organization.
2. Intelligent Process Automation Strategy and Roadmap: A comprehensive automation strategy was created to prioritize and streamline processes across departments. This roadmap served as a guide for automating various business functions and driving continuous improvements.
3. Automation of Key Business Processes: Emids automated critical processes in areas such as:
   • Claims Processing
   • Care Management
   • Enrolment & Billing
   • Pharmacy Benefit Management
   • Customer Service and Appeals

These automations significantly reduced manual efforts and increased operational efficiency across the board.

• Savings Dashboard: A customized savings dashboard was implemented to provide real-time tracking of the financial and operational impacts of automation. This allowed the leadership to monitor performance and adjust strategies based on data-driven insights.

Outcomes

The implementation of intelligent automation delivered significant results for the health plan, leading to improved productivity, cost savings, and operational efficiency. Key outcomes included:

• 650,000+ hours saved across the organization through process automation.
• 370+ processes automated across claims, billing, and enrolment.
• Cumulative savings of over $12M within the first three years, delivering a 400% ROI.
• 14,000 COVID-related claims adjustments processed within three weeks, showcasing the agility and responsiveness of the automation system.
• 40% reduction in processing time for primary care provider (PCP) change requests.
• More than 30% reduction in clinicians’ administrative tasks, allowing for more time to focus on patient care.
• $600K savings from the automation of the claims process alone.
• Real-time reporting of bot performance, providing operational insights and enabling continuous refinement of the automation strategy.
  

By integrating intelligent automation into their core processes, the client achieved significant operational efficiencies, cost savings, and service improvements. The success of this initiative positioned them to leverage automation as a key component of its long-term strategy, ensuring a competitive edge in the healthcare industry.

Explore how Payers can unlock sustainable cost optimization by enhancing their operational efficiency.

Overview

Our client is a Fortune 500 payer and is a leading provider of traditional and consumer-directed healthcare insurance plans and related services. This includes medical, pharmaceutical, dental, behavioral health, long-term care and disability plans, provided primarily through employer-paid (fully or partly) insurance and benefit programs and Medicare. The organization’s network includes 22.1 million medical members, 12.7 million dental members, 13.1 million pharmacy benefit management services members, 1,200,000 health-care professionals, over 690,000 primary care doctors and specialists and over 5,700 hospitals.

At emids, we have a team of ServiceNow experts who help organizations implement IT Service Management solutions via the ServiceNow tool designed to boost IT productivity and performance, and the overall impact of IT, by automatically assigning mundane tasks such as routing requests to relevant assignment groups and auto-categorization.

The client had been utilizing our ServiceNow tool to manage information technology services for various subsidiaries for a number of years. However, following an acquisition by another large organization, they embarked on a series of integration projects that challenged the tool’s ability to scale quickly and effectively.

Three primary issues concerning the usability of the ServiceNow tool needed to be addressed:

• Lack of innovative speed and scale due to disparate ServiceNow instances. Use of different ServiceNow instances meant reliance on multiple point tools, making it difficult to support new innovation. Manually routing and categorizing incidents is quite time-consuming.
• Absence of visibility creating risk and keeping IT stuck in maintenance mode. The organization stored data in multiple systems, making it difficult to get a single, actionable view of their IT performance.
• Increase cost of ownership on old applications with outdated hardware. Significant time and resources were being spent maintaining existing IT systems without receiving new benefits.

Solutions     

We developed three effective solutions that significantly increased the client’s usability of the ServiceNow tool.

First, we created a broad IT app portfolio on an extensible, scalable platform that future-proofs the organization’s investment. Our solution was to help the client easily extend its IT management capabilities without having to invest in costly and complex integrations and hardware. This was achieved by bringing data and processes into a single ServiceNow instance.

Next, we produced a single system of action and machine learning, allowing fragmented data to be replaced by automated work. We enabled the organization’s IT services to be managed from a single system of action with simplified reporting and machine learning, driving higher levels of automation.

Last, we achieved security and domain separation to ensure personalized services to subsidiaries. A domain-separated infrastructure made it possible to deliver services fast, with built-in proven practices, from a secure cloud with 99.995% uptime, all while ensuring employee records, service catalogs and workflows were customized to meet the needs of each subsidiary.

Results

Because of our proposed solutions, the organization can now:

• Drive digital transformation and new efficiencies with automation. We helped the company drive automation and gain more visibility into IT performance. By gaining more insight into service metrics, it became easier to implement new innovation and improve customer satisfaction.
• Deliver reliable IT services quickly from any device, anywhere, at any time. The client can now find and resolve IT issues more quickly than ever before.
• Manage continual improvement using built-in analytics and shift the budget to innovation. With a single ServiceNow instance, the organization realized infrastructure cost savings simply by having to pay for a single instance, saving up to $500k in the process.