Case Studies
Competitive Intelligence
Challenge: A regional health plan engaged The Tay Group to develop an individual health insurance product to compete with an initiative being rolled out by a key competitor.
Solution: The Tay Group conducted a market assessment. During the course of this assessment, the Tay Group uncovered that the competitor was not introducing a new product and had leaked false information to disadvantage the client.
Results: Based on this competitive intelligence and The Tay Group’s recommendations, the client ceased product development, thereby saving the health plan approximately $1 million in R&D costs and conserving resources.
Interim Executive Services
Challenge: A tech-first Medicare Advantage plan did not have leadership for its clinical programs, including its Complex In-home Care Practice, In-home Evaluation Service, and Behavioral Health program, comprising a third of its workforce and operating budget.
Solution: The Tay Group provided an Interim Vice President of Clinical Operations. The interim leader redesigned the operating model, transformed the organization, and improved throughput and outcomes.
Results: The number of visits completed per day increased by 60 percent. It became easier for patients to make appointments and wait times to see a provider dropped to less than 10 days. Appointment cancellations dropped by 5 percent.
Product Development & Innovation
Challenge: The nation’s largest health insurance company engaged The Tay Group to improve bottom-line growth and respond to customer demand for an integrated, large group insurance product that combined health insurance, disability insurance and workers compensation for a holistic plan to keep employees healthy, happy and productive.
Solution: The Tay Group team developed a product concept, designed the benefits, built the support infrastructure, led the implementation and launched the product, which uses active care management to reduce health care costs and increase employee productivity.
Results: The new product generated more than $20 million in net income over five years and to increased employee productivity in a single market.
Decision-making
Challenge: A regional Blue Cross Blue Shield plan needed to understand the feasibility of adding a telehealth benefit to its plans.
Solution: Under a tight deadline, The Tay Group conducted a feasibility study including a study of the cost, legal, regulatory, operational and customer experience implications of adding the benefit, as well as operational and implementation plans to ensure a positive customer experience. The study was completed well ahead of schedule and the team provided leadership for implementation.
Results: The new benefit enhanced products for three lines of business and was rolled out to 1.5 million members at no incremental cost to operating budgets. The new benefit improved access to care for members, while providing a lower-cost method of delivering care, which reduced emergency room and urgent care visits.
Cost Reduction
Challenge: A $3 billion regional health plan selected The Tay Group for a consulting project focused on reducing costs, particularly those related to benefit designs and claims payment policies that were triggering unnecessary provider payments.
Solution: The team addressed the flawed policies, procedures, and processes, and designed and executed solutions to reduce claims spending.
Results: The solution yielded a $14 million reduction in the cost of care for the health plan over a two-year period.
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Email: info@thetaygroup.com