Case Studies

Management Consulting: HBO Key Performance Measures Project

The Medical Services Plan (MSP) and PharmaCare are the two largest programs provided directly to the public by the Ministry of Health Services, and these programs have the largest number of clients of any program in BC government. MSP and PharmaCare Registration form a core business of services that are delivered directly by the Health Ministry, with the objective of ensuring that clients have equitable and timely access to services. As of December 31, 2002, over 4.1 million people, almost all of the eligible residents of BC, were enrolled for health coverage through MSP, and over 23% of the BC population received some form of PharmaCare benefits.

For the Ministry of Health Services, technological advances and rising consumer expectations continue to raise demand on the services offered by Health Benefits Operations (HBO.) The result is widespread interest in the explicit measurement of the performance of health systems, embracing quality, efficiency and effectiveness goals, and in influencing or managing performance.

Innovations, inc. worked on detailed Management Consultancy engagements for the Ministry of Health Services in order to identify business processes, key performance indicators and recommendations related to HBO. The project team conducted and documented interviews with government executives and key staff, and surveyed public and private health insurance providers across North America and Asia-Pacific to determine the "Best Practices" that could potentially benefit the BC government HBO operations environment.

Business processes, information technology systems, and operational data were analyzed to create management reports on HBO telephone services, document processing, online services, and the IMS. This provided a detailed understanding of the operations related to beneficiary enrollment, customer service for beneficiaries, trusted third parties and providers, and administrative transactions related to coverage and claims.

Extrapolating on the Ministry of Health Service's mandate "to fund, monitor and evaluate health system performance," the team identified three high-level indicators that are central to HBO's success (productivity, accountability and performance) and formulated 29 different Key Performance Indicators on related activity areas and program outputs.

The team utilized these measures, the survey and the baseline data information to develop Best Practices and compare the gaps between HBO program delivery and these standards. The team then determined what was necessary to close those gaps.

Reports were delivered to HBO executives in June of 2003 which outlined the project findings. Key recommendations were made on methods to improve and enhance HBO's service delivery performance and performance measurement processes.

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