As the largest affiliation of healthcare plans in the Pacific Northwest/Mountain Region, and the Blue Cross Blue Shield insurer for Oregon, Washington, Idaho and Utah, nonprofit Regence works with 30 provider networks, 200 hospitals and 47,000 individual healthcare providers. The inefficiencies associated with managing contracts with those providers through a combination of spreadsheets, proprietary templates and manual workflows drove the Portland, Ore.-based carrier to seek an automated solution in May 2006.
Among the benefits Regence sought from a solution were the abilities to establish a unified enterprise contract management process, improve access to provider agreements and rate exhibits across divisions, and mitigate the legal exposure related to contracts, according to John Wagner, VP, (provider) network strategy, Regence. "An automated system will allow Regence to respond more quickly and accurately to litigation and audit for contract compliance," he says.
In December 2006, Regence found its solution in Hillsboro, Ore.-based Kryptiq's Choreo Contract Manager Suite. The carrier favored Kryptiq over alternative solutions owing to the vendor's relevant solution expertise and its alignment with Regence's vision and core healthcare transformation strategy, Wagner says.
A combined Kryptiq/Regence team began implementing Choreo in June 2007. The project, which Regence describes as a "medium effort," required some custom development on the part of Kryptiq, the addition of server hardware at the carrier, and overcoming the challenges of data synchronization and reconciliation of differing data structures within disparate systems, Wagner relates. He notes that total project costs were less than $3 million.
Regence completed its first phase of the rollout in August 2007, successfully producing 27,000 contracts with related amendments, Wagner reports. A second phase will be completed in April, and by July 2008, says Wagner, "We will have doubled [the 27,000 contracts] and have reached our full implementation for all contract types, including medical, dental and pharmacy. Additionally, we will have aligned business processes for contract management across the organization."
Choreo gives Regence a single system for contract management that provides the carrier with provider data connectivity, storage and workflow management, according to Wagner. Once the implementation is complete, it will "provide a productive, efficient and common method to contract with providers, amend existing contracts and other key functions," he adds. "The installed system will also provide a method to manage and control the information and documents associated with the process."
The solution is expected to deliver improved internal controls, storage and retrieval of mass volumes of provider agreements, and efficiencies related to both the reduction of postage costs and the human resource benefits of reduced overtime and redirection of talent into more value-added activities rather than on the production, auditing and tracking of provider contracts, Wagner explains.
Since the initial phase of implementation, Regence already has seen an improvement in its ability to produce, store and query contracts and amendments supporting its core business, Wagner comments. "The most significant impact of Choreo is the ability to manage contract compliance to our dynamic business," he says. "As an organization, Kryptiq is enabling us to be responsive to regulation, nimble to meet changing market conditions and confident in our business processes."
Case Study Profilecompany
Regence (Portland, Ore.; $8.5 billion in 2007 revenue).
lines of business
Health, dental, vision and life insurance.
Kryptiq's (Hillsboro, Ore.) Choreo Contract Manager Suite.
Automate standardized provider contracting across the enterprise.