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Let's use customer service as an example. At one time, providing exceptional customer service was a meaningful way to differentiate a PBM. Today it is an expectation and what makes a customer service model distinguishable from one PBM to the next is the ability to consistently perform beyond client expectations. Simply put, it's about operational excellence.

Operational excellence involves leveraging people, processes and technology to consistently deliver platinum service that gets results, according to Mike Brandenburg, executive vice president of operations for Progressive Medical.

Embracing a culture of operational excellence is enabling Progressive Medical to take its philosophy to "do the right thing" a step further. By integrating its data analytics capabilities, commitment to client service, network penetration solution and clinical expertise, Progressive Medical is focused on consistently creating solutions that help its clients attain unmatched results.

"Operational excellence means fulfilling our promise to give our clients quick and concise results and telling them what it means to them," said Bill Erwin, vice president of operations for Progressive Medical. "It is the catalyst for providing our clients cutting-edge solutions to their toughest challenges. We believe this is a key differentiator that sets us apart from our competitors."

Progressive Medical's new approach to the way data is used to predict potentially expensive claims earlier in the lifecycle is just one example of how it is applying principles of operational excellence.

"When you focus on helping your clients achieve exceptional results, you do not hesitate to rethink the way a particular problem or issue is approached," said Erwin, who oversees the company's quality and metrics. "For example, traditional predictive analytics models only examine a few triggers to identify high-cost claims and are rarely integrated into an effective clinical program. Most of the claims identified with this approach have already escalated, which doesn't help our clients avoid unnecessary expenses. We believe it needed to go a step further, so we built a multivariate statistical model that quantifies relationships earlier in the claim. We then apply the appropriate clinical solution to help our clients gain more control over costs."

Quality outcomes are driven by quality assurance

Instituting a quality assurance process is essential for an organization to truly attain operational excellence. For Progressive Medical, every tool, system, process and procedure is continuously reviewed to ensure it aligns with the goal of achieving operational excellence.

Helen Bradburn, quality assurance manager at Progressive Medical, explains that there is a continuous circle of quality between the company's internal teams and its clients.

"We want to constantly be aware of how well we are doing and are seeking new ways to get feedback from our clients," Bradburn said. "We have created a statistical process within our service environment to help us more effectively measure, analyze and improve our performance."

Bradburn added that having this type of process in place enables the client service team to address potential issues before the client notices.

"We don't have to wait to take action," she said. "We are already working on a solution by the time a client even realizes there is an issue. Without quality assurance we cannot have a streamlined operation or fulfill our commitment to operational excellence."

Citing another example, Erwin said that part of Progressive Medical's strategy is to put a microscope on what the company's associates do when working a claim.

"Most quality assurance programs measure how associates perform during calls, focusing on what is said," Erwin said. "However, a program that only involves the review of phone calls may be missing critical data that factor into the quality of overall service performance. Measuring decision points occurring throughout a call to know what was done or not done, is a stronger indicator of whether or not a service quality issue or training opportunity exists."

Business continuity is integral to delivering exceptional service

Another component of operational excellence is business continuity. This entails ensuring clients continuously have resources available to meet their needs. Progressive Medical has implemented a bevy of processes and procedures to ensure clients are not impacted by potential outages or adverse events.

"We believe having four operation centers located in three different states, in three time zones, enables us to provide a business continuity solution that is unparalleled in the industry," Brandenburg said. "It allows us to quickly scale our staff to meet a client's requirements while also ensuring that service continues if, for example, a weather-related incident occurs."

The customer is truly king

By integrating operational efficiency, quality assurance and business continuity with the knowledge and service-driven mentality of its people, Progressive Medical's operational excellence helps achieve dramatic results for its clients. This is evidenced by the PBM's client retention rates, which are among the strongest in the industry.

"No matter what, we are always listening to and thinking about the customer," Erwin said. "We tailor our process to our client's expectations. We expect more of ourselves and are ever curious when it comes to finding a better way of doing things, not just for the sake of change, but because we know continuous improvement within our organization means better outcomes for the customer -- whether a payor or an injured worker. We want our customers to expect more from Progressive Medical. And, if we are truly fulfilling our commitment to operational excellence, we will deliver on that and more at the end of the day."

(The above piece is part of our continuing Perspectives series designed to highlight key products and services to our readers. This paid-for Perspective was written and edited by Risk & Insurance® on behalf of our marketing partner. Additional Perspectives can be found on our Web site at www.riskandinsurance.com/.)

October 11, 2012

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