The Organization: TriWest

TriWest manages health benefits under the United States Department of Defense (DoD) TRICARE program in the 21-state TRICARE West Region. They serve our nation’s Veterans and military community by providing customer service and access to local health care networks and programs. BizFlow develops solutions that comply with Federal regulations that directly impact Veteran care, such as the Veteran’s Accountability Choice Act.

Business Challenge: Coordination Among Multiple Stakeholders

Establishment of a critical new program to provide Veteran’s access to community care providers required rapid yet accurate implementation. Multiple stakeholders – Veteran’s and their caregivers, VA personnel, and healthcare providers – all required different solutions to meet their needs. Successful implementation of this program required a strategic approach, implemented through prioritized and coordinated projects.

BizFlow BPM Solution

BizFlow developed and implemented a multi-generational plan to improve Veterans’ access to healthcare. Leveraging the process improvement expertise and the BizFlow technology platform, this plan led to significant advancements in operational efficiency and Veterans’ experiences. This plan included 4 primary projects:

Project 1: Contact Center Process Establishment
11 new end-to-end processes were established, including issuance of member ID cards, credentialing and contracting with out-of-network providers, and verification of eligibility for care. In 28 days, over 800 Customer Service Representatives were trained to launch the VCP.

Project 2: Process Oriented CRM
A software solution was developed and deployed within 6 weeks, effectively eliminating all data errors in the scheduling of Veteran appointments and providing a consistent experience for the Veteran and their caregivers.

Project 3: Streamlined VA Portal Solution
In 10 weeks, the BizFlow team applied a seamless user interface to provide visibility and access to document creation, transactions, and communications for VAMC personnel.

Project 4: Accuracy Driven Data Improvement
To ensure exclusion of inaccurate data from the system, new business rules were tailored to provide real-time data validation. This reduced the learning curve from 6 months to 1 month.


BizFlow Benefits

– Met aggressive contractual deadline for standing up 2 new contact centers, quickly improving access of Veterans to community healthcare providers.
– Effectively error-proofed and streamlined the appointment schedule process, saving over $10M annually.
– Provided visibility and improved data communication between provider scheduling processes and VA personnel.
– Within provider data services, increased individual productivity by 1.8x and team throughput by 2.6x by reducing rework by 90% and reduced the learning curve for data processing from 6 months to 1 month.

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