Validating a client's decision to move to an outsource model
The client team and in-plant print shop of a leading health care delivery and pharmacy services company struggled to keep pace with growing prior authorization letter volume — nearly nine million letters annually. This growth in volume also brought to light additional areas of concern:
- Lack of back-up and disaster recovery plans
- An antiquated and inflexible letter template management system
- Limited production visibility and member-level reporting for audits
The company sought external support for its pharmacy (Rx) letter program. However, after working with an initial service provider for three months to migrate approval, denial and appeal letters from its internal print shop to an outsourced partner, the lack of progress made was discouraging.
Left with little confidence that the incumbent partner could complete this project on time, the client team wondered: Is there a solution on the market that would allow them to migrate (rather than recreate) more than 1,000 letter templates? And, is there a partner that could provide a clear path to complete the project?
For this client, the content management tools within RRD’s technology stack were a critical part of an overall solution that would restore the client’s faith and also bring this project to completion, efficiently. The elements in this solution included:
- Template management. RRD’s Critical Letters application replaced a legacy off-the-shelf composition system the client had outgrown. Created specifically for the management of letter communication, the application allows significantly faster creation, editing, and proofing of templates.
- Automated migration of templates. RRD’s flexible template migration toolset migrated the client’s entire template structure — more than 1,000 complex templates — from a legacy content composition system to one that automatically creates template content, formatting, and business rules.
- Real-time integration. Understanding the time sensitive nature of utilization management (UM) letters, RRD’s published APIs were leveraged to integrate the client’s case management system directly with the Critical Letters application. This integration would enable real-time letter generation for any case, as well as detection of data irregularities.
- White glove production. Access to RRD’s network of critical letters facilities would support the client’s need for USPS acceptance of the printed letters within hours. The controls in place at these facilities track each letter to ensure it mails within the time allotted. Letter status is also updated directly into the client’s system, making it possible to track adherence for each case.
20% improvement in staff efficiency through template management
1,000 complex letter templates automatically migrated
60% reduction in time and cost of implementation (compared to typical process)
In the end, the client’s decision to move to an outsource model was validated — and came at a price that was cost neutral. From real-time letter generation to the vast network of critical letters facilities, the client’s Rx letter program was a benefactor of RRD’s experience in critical letter management.
“RRD is a strong partner for the prior authorization letter program and offers multiple national sites for business continuity. We now have the necessary business continuity with a fully tested disaster recovery site,” explains the client’s Director of Communication Operations.
“RRD quickly prioritized this initiative and aligned all resources to deliver on the commitment. We now have the necessary business continuity with a fully tested disaster recovery site. RRD offers 24/7 support so that issues are solved quickly to avoid IREs (Independent Review Entity*) and significant penalties and fines.”
*An Independent Review Entity (IRE) is a separate organization with which Medicare contracts to handle the second level of appeals of a denial of coverage (except for of hospital care) if you are in a Medicare Advantage Plan or Medicare private drug plan (Part D). [source]