Q3 2006: Productivity Survey

SURVEY COMPLETED AND CLOSED. The Productivity survey included three questions and three survey controls.

Question 1. Claims Productivity Average number of claims processed per hour...

1. ___ 5 claims
2. ___ 10 claims
3. ___ 15 claims
4. ___ 20 claims
5. ___ 25 claims
6. ___ Other Claims

Question 2. Calls Productivity Average number of calls answered per hour...

Member Calls

1. ___ 5 calls
2. ___ 10 calls
3. ___ 15 calls
4. ___ 20 calls
5. ___ 25 calls
6. ___ Other calls

Provider Calls

1. ___ 5 calls
2. ___ 10 calls
3. ___ 15 calls
4. ___ 20 calls
5. ___ 25 calls
6. ___ Other calls

Survey Controls.

Health Plan Size Membership of you healthplan...

1. ___ under 100,000 members
2. ___ 100,000 to 500,000 members
3. ___ over 500,000 members

Organization How do your claims and customer service teams organize themselves...

1. ___ Same person takes calls & pays claims
2. ___ Claims and calls handled seperately

Lines of Business Number of lines of business...

1. ___ 1
2. ___ 2
3. ___ 3
4. ___ 4
5. ___ >4

Productivity Survey: Question 1

Health plans responding to the survey had an average claims productivity rate of 22 claims per hour.

Question 1. Average number of claims processed per hour...

Summary. Health plans responding to the survey had an average claims productivity rate of 22 claims per hour.

Health plans responding to the survey had an average claims productivity rate of 22 claims per hour. (2 minutes and 45 seconds per claim) -- as shown by the graph below. The distribution of survey responses puts the range between 10 and 30 claims per hour (between 2 and 6 minutes per claim). Three health plans responded that their productivity was between 35 and 40 claims per hour. For certain types of manual claims, this may be an appropriate level of productivity, but as with some of the outlier call responses — 40 claims per hour is an unusually high level of productivity.

The most interesting claims related finding is that small health plans (under 100,000 members) are significantly less productive in processing claims than mid-size plans (between 100,000 and 500,000 members). Only 1 of 8 small plans responding processes more than 20 claims per hour. On the other hand 6 of 10 mid-size plans responding process more than 20 claims per hour. If the four responses from large plans (over 500,000 members) are added, 7 of 14 plans with membership over 100,000 processed 20 or under claims per hour. A possible explanation for the difference in productivity rates: Larger plans are able to allocate claims analysts to specific tasks (i.e. a particular pend or benefit plan) while volume constraints limit smaller plans ability to segment work by specific task.

Other claim productivity findings include the following: Organization is not a factor for claims productity, with 25 of the 27 responses handling claims and calls separately. As well, number of lines of business were not found to affect claim productivity rates.

Productivity Survey: Question 2

Health plans handle between 10 and 15 member calls per hour and between 5 and 10 provider calls per hour.

Question 2. Average number of calls answered per hour...

Summary. Health plans handle between 10 and 15 member calls per hour and between 5 and 10 provider calls per hour.

A comparison of member and provider calls (excluding outliers -- responses with productivity rates over 20 calls per hour) indicates that provider calls are marginally more difficult -- as shown in the chart. With outliers excluded, health plans handle between 10 and 15 member calls per hour and between 5 and 10 provider calls per hour.

Other member call productivity findings include the following. Unlike claim productivity (see Claim Productivity Results), member call productivity does not appear to be impacted by plan size. Similarly, organization is not a factor, with 25 of the 27 responses handling claims and calls separately. Finally, number of lines of business were not found to affect member call productivity rates.

As shown by the graph below, 80 percent of health plans responded that provider call productivity rates are either 5 or 10 calls per hour (between 6 and 10 minutes per call). As with member calls, productivity at the top end is probably 20 calls per hour (3 minutes per call).

Four health plans responded that their call centers handled 25 or 30 provider calls per hour – an unusually high level of productivity for a health plan call center. Also as noted above (see Member Call Results), provider calls take slightly longer than member calls.

Other provider call productivity findings include the following. Provider call productivity does not appear to be impacted by plan size -- as claim productivity is shown to be (see Claim Productivity Results). Similarly, organization is not a factor, with 25 of the 27 responses handling claims and calls separately. Finally, number of lines of business were not found to affect provider call productivity rates.