You Can’t Manage What You Can’t See – Thoughts from the Optimizing Appeals & Grievances Conference

Much of the discussion last week at the Optimizing Appeals & Grievances and Improving ODAG & CDAG Outcomes Conference centered around accountability and company culture.  There was also a great deal of attention given towards the ability to pull Universes on demand.  These topics along with better ways to manage your day to day workloads are common challenges we hear from health plans all the time. How do we better manage the process, report on it and hold our team accountable – while creating a culture where employees thrive and member service is the highest priority? It’s easier said than done but it starts with a very simple focus – “you can’t manage what you can’t see.

  • In our experience most plans are manually generating reports in a batch process.  Because it’s a time-consuming, manual process that usually requires the involvement of your IT team, by the time you receive the report the data is obsolete and useless. Your A&G solution needs to have the ability to deliver real time reports providing you with the data you need – RIGHT NOW. For example: how much more efficient could you be if your personal dashboard could immediately let you know how many active cases you currently had, which cases are due today or in the next 72 hours? The data image below provides that…and more.

  • If you asked one of your A&G professional to describe in one word the department culture, what adjective do you think they’d use? It’s unfortunate and unnecessary that so many A&G departments are surviving and not thriving.   What I mean by that is often times the A&G department is so busy and has so many cases that teams process incoming cases almost like the checking of tasks: a case comes in, a case is added to a workload, a case gets processed and then rinse and repeat for every incoming case.  This is okay and a portion of the time you and your team may be able to complete the necessary work within the required deadlines. What happens when that isn’t enough, when the workload exceeds the bandwidth or when your employees start burning out? Forward-thinking managers are developing strategies NOW for future improvement and focusing on ways to speed up processing times, avoid bottlenecks and crafting innovative and creative ways to empower employees to improve customer service. Health plans with a focus on employee and member satisfaction are not just sitting back content with accomplishing the status quo, instead they are utilizing the tools and technology that will put them ahead.  Your real time reports should be delivering you the data analytics to make changes that can improve the service you are providing your members and avoid employee burnout.

  • Once you have the tools to see into your process and start identifying improvement opportunities, you are now armed to to tackle any audit or Universe generation – ON DEMAND. Innovative A&G solutions have built-in CMS data to automate report generation with the click of mouse. It is no longer necessary to involve IT or wait on others to access the information you need whenever you need it. Personalized dashboards enable you to customize your views with the info, reports and activity you use/need most.


We know it doesn’t just stop there. In the world of Healthcare Payers and Appeals & Grievances, reporting demands change and evolve all the time. We’ve already started on the 2019 Universe table changes and as your partner we are committed to keeping you one step ahead. Your success is our focus. I’d like to close up my thoughts by thanking Tim and Audrey of RISE, all of the presenters, and the conference sponsors. We were honored to be a part of the event and to continue offering you dialogue, ideas and solutions to your biggest process challenges. On behalf Jon and Matt, we had a wonderful time and look forward to seeing everyone next year.