Case Studies

CASE 1: Service cost management - how rising sick pay expenses can be stopped

Topic: Conception and realization of a statutory health insurance’s adjusted sick pay controlling
Client: Medium sized, nationwide active statutory health insurance, with more than 2.5 million insured clients

Challenge

      • In the years prior to the beginning of the project, the client recorded well above average increases in service expenditures for sick pay this being 11,5% (compared to the market average of 6,7% during this period) and was experiencing a steadily growing shortfall. The causes for this were not evident.
      • Due to its extensive experience with sick pay projects SKC was assigned to rapidly identify the causes, to develop a new controlling strategy and to then prepare the decentral organization according to the new controlling philosophy whilst simultaneously implementing the IT-support for the processes.
      • The changes in the controlling set-up were implemented from day one.

Solutions and Overall approach

      • SKC has developed a modular sick pay program which takes the various key influence factors of sick pay dynamics within insurance into account.
      • These include a sophisticated case selection, a risk-based, cause-specific management, the work support through resources and organization, as well as an intensive collaboration with the objective to find solutions for the individual members and as a result the controlling of the resource utilization in the organization.
      • A communication and training program which contained strong team development elements was carried out for the decentralized organization after the first project weeks were completed.

Outcome

      • Significant shortenings of sick pay duration were accomplished with the implementation of the concept and as a result expenditure cuts of up to 15% in individual insurance groups.
      • The client is the only statutory health insurance which was able to attain decreasing sick pay payments contrary to the trend of the total market in the past years.

CASE 2: Service cost management – how integrated care can be really effective

Topic: Utilization of selective contracts acc. to § 140a SGB V to provide special care for selected insured groups
Client: Medium-sized, nationwide active statutory health insurance
Field of application: Migraines, chronic headache

Challenge

    • Many SHI’s have entered into IV-contracts which, from the payer’s perspective, have neither had a positive effect on the medical quality of the care at the same cost nor a positive effect on the efficiency whilst retaining the same quality.
    • On behalf of a SHI, SKC has demonstrated that this can be done differently based on the example of migraine in cooperation with the university hospital Essen.
    • Solutions and Overall approach

      • Critical success factors were considered in the selection of the topic and its implementation: these include the selection of appropriate insured persons for the special care, the in-depth knowledge of the care and quality problems in the care reality, the collaboration with experienced and successful hospitals with a special care concept and last but not least, an appropriate implementation plan as well as continuous monitoring of quality and economic parameters.
      • Migraine / chronic headache is a condition in which patients have more than ten days of headache a month, usually go from doctor to doctor for more than eight years until they get the correct diagnosis, and in therapy rely on care from clinics and medical specialists using expensive drugs.
      • A modularly structured care program was developed, which organized the entire chain of care and united it in one service provider network. Likewise, modular service packages which were distributed in the network covered the additional costs.
      • Services, organization, contracts and the implementation plan were developed within a period of five months and the launch was carried out only two months later.

      Outcome

      • The recruitment targets were achieved within a short period of time. Patients reported a reduction of headache days of more than 60% as well as a more than a 60% reduction of pain intensity. The total costs of the SHI rose only slightly overall compared to the comparison group without IV.
      • After one year of exclusivity for the client, other health insurances joined the contract, among others the AOK and the Knappschaft. In total, all participating insurances represented 50% of the regional population insured.
      • The set-up and result of the project were published as a Harvard Business Case (No-9-707-559) by Prof. Michael E. Porter.

CASE 3: A brand management which is also consistent in health delivery strengthens the client base.

Topic: Strengthening of the brand and improvement of the brand experience
Client: Medium-sized, nationwide active statutory health insurance

Challenge

  • At the beginning of the project, our client was in an economically tense situation. A program for service cost reductions had just been implemented.
  • At the same time the customer satisfaction surveys indicated that the insurance was losing its positive standing although it had invested in individual care programs in the last few years.
  • SKC was assigned to support an initiative that was designed to strengthen the customer orientation and the collaboration among the employees of critical business operations in which important customer groups were involved.

Solutions and overall approach

  • Studies have shown that insured persons do not rate their insurance based on individual interactions, but instead form an opinion in the course of their relationship with the insurance. Loyal customers are satisfied with the overall impression which they have built throughout the journey. Enthusiastic clients know how to tell stories with very positive impressions.
  • SKC exploited the idea of the value journey. The value journey is the client’s travel together with its health insurance throughout their insurance relationship.
  • The value journey works well and creates value
    • for the customers, if the insurance fulfills their expectations as a healthy or sick person and gives them support when they want and need it and
    • for the health insurance, if customer satisfaction and customers’ recommendations lead to an increase in loyalty and recommendation rates and if the allocation of loyal customers covers the costs throughout their entire life cycle.
  • In health care, typical value journeys can be identified and successfully created. Especially in care situations, insurances can demonstrate their benefits or yet lose their image or even negatively influence the brand experience.
  • Objective: Our aim was to re-focus the shared vision of the employees back to the customers via a few but critical interaction points which run through the entire company and for the employees to consider the customer’s perspective in their actions.

Outcome

  • The diffuse sentiment could be reduced through the joint work in key activities and the sharpening of the awareness for customer needs.
  • Numerous initiatives and suggestions for improvements were initiated and are still being implemented into the major customer-orientated service processes.
  • Customer satisfaction has demonstrably increased as well as the loyalty and the value added contributions of the relevant customers groups as multipliers.

Clients

  • AOK Niedersachsen
  • AOK Hessen
  • Alte Oldenburger
  • Allianz Private Krankenversicherung
  • Barmer GEK
  • BIG
  • Deutsche BKK
  • Die Schwenninger BKK
  • Hanseatische Ersatzkasse (HEK)
  • Knappschaft Bahn See
  • Kaufmännische Krankenkasse (KKH)
  • Provinzial Private Krankenversicherung
  • Siemens Betriebskrankenkasse (SBK)
  • Zukunftswerkstatt GKV
  • vdek Verband der Ersatzkassen

Your Contact Person

Heike Kielhorn-Schönermark, MBA
kielhorn[at]skc-beratung.de