CASE STUDIES

Real solutions, real ROI.

Large health plan sees fast results

As of January 1, 2013, one of the nation’s largest health plans expanded ikaEnterprise for Medicare to the plan’s full Medicare population. Based on the following remarkable results achieved during the pilot, the plan expects to see a 45%-60% reduction in its operational costs.

  • 88.8% first-pass rate for claims
  • 99.5% financial accuracy
  • 44.6% overall reduction in system and BPO costs

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UCare’s Medicare enrollment productivity and membership jump

UCare, one of Minnesota’s largest health plans, was weighed down by the volume and cost of its Medicare annual enrollment period. The plan struggled with accuracy and high administrative costs resulting from the dual entry of enrollment applications, which was labor-intensive and required hiring and training temporary employees during the annual enrollment period. As membership expanded, the process did not scale, substantially increasing administrative costs. UCare selected ikaMedicareGateway to achieve accuracy and automation to assist with regulatory compliance and help the plan transform its enrollment process. The results were greater efficiencies that cut costs and enabled UCare to add more members with no temporary employees hired in 2011, versus 11 hired in 2010.

  • 102% increase in productivity per FTE
  • 56.3% reduction in total discrepancies
  • 84% reduction in false positives (ROLs)
  • 40% membership growth

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