Process Improvement Spotlight: Mapping Out New Solutions in Insurance Verfication


Even routine work can get confusing quickly around here. As our hospital grows and technology advances, new complexity arises in the day-to-day. Marion Galeckas, an Insurance Verifier in Patient Access Services, has been making sense of that change throughout her twenty-two years working at UMass Memorial. She works in the Insurance Verification Department specializing in auto liability encounters, where the problems are naturally complex.
Not long ago, in the Idea Board huddle in this area, the staff recognized that they could solve some problems by changing how they communicate about them. I talked with Marion a little bit about their process. It’s a model worth sharing.

Marion is part of the team that makes sure a patient’s hospital bills get sent to--and paid by--the correct insurance plan, whether that’s the patient’s health-insurance or auto-insurance company. Marion spends a lot of time investigating accidents. She speaks with local police departments. She collects a lot of details about automobiles and their owners. She’s been at this for a while. She’s sharp. She’s learned a lot. She’s a professional, and treats her work with professional care. And still, she was frustrated.

The trouble was, the folks in Insurance Verification weren’t the only ones collecting this information. “Sometimes I didn’t know how far to take it,” Marion explained, not knowing the point where an employee in another financial department might pick up the work. In the end, the investigatory work was sometimes even being done in triplicate. And still, sometimes, something could somehow get dropped, leaving no-one in the hospital holding a particular piece of important information.


Marion was frustrated with what felt like a very uncertain and wasteful process, so she put an idea on her department's idea board to pull together all the different people involved. They would do a deep-dive into the process. This idea led the groups involved, including Billing and Care Coordination departments, to come together with for two intense, focused sessions. They mapped the workflow, who should do each piece of it, and how they would communicate about it. The result is a system that’s working much more smoothly. Multiple departments now dedicate a SharePoint site to manage each particular case. And the SHARE members who participated know that if glitches arise in their new process, they have a way to call together another meeting with other front-line employees to make corrections . . . although their new process is working well after the first few months, and they haven’t had to do so.

Marion says that she’s now more regularly satisfied with her work, knowing that she’s handling her part of the process from a clear starting point to a clear finish, and can better review a complete case for accuracy in the end.

Beyond that, it’s in describing the mapping events that Marion seems to me the most enthusiastic. Before the meetings, Marion had been speaking with many of the other participants over the phone, sometimes for years. And yet, this was the first time she’d ever seen many of them face-to-face, and understood the frustrations from their perspectives. “It was really good to have the time to do that,” she said. “We even shared some laughs.”

These personal interactions reminded Marion of the regular rounding that UMass Memorial employees once did. She enjoyed shadowing the work that others were doing, and learned by comparing experiences. She’s excited to see more of this kind of sharing again.

This process map is making big differences in the way the work gets done in Insurance Verification. And it’s only one of many conversations that together can transform our hospital. As we continue to build our network of information among members and across campuses, please let us know if you have an opportunity for improvement in your area, and stay tuned for more here on the SHARE blog.