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Telus Health

Business to Business Portal that Saved Millions

“Business transformations based on information technology improvements will drive major bottom-line benefits, in all cases.”

Dave Johnston, Partner, Bay Consulting Group

WorkSafeBC knew it had a smouldering problem. It was 2009, and the government agency responsible for treating and compensating injured B.C. workers had just completed a new electronic claims management system for workers and employers. The system was performing well, but one of the agency’s critical stakeholders had been excluded. The province’s thousands of approved health-care providers, from acupuncturists to speech-language pathologists, still had to rely on 20th century methods to file claims and other matters.

Understand the Problem

“We had a paper-based system that was cumbersome and error-prone,” says Andrew Montgomerie, WorkSafeBC Director of Health Care Services, responsible for relations with the agency’s health-care providers. “We were under great pressure to get with the times.”

Other senior managers agreed. Something had to be done. Invoices were sometimes lost or paid twice. Both providers and WorkSafeBC staff spent too much time handling payments, as well as setting up and monitoring treatment plans for injured workers.

The agency’s chief financial officer, Steve Barnett, favoured an electronic portal as the solution. “But,” he adds, “we wanted to make sure we got it right.”

To get it right, WorkSafeBC ultimately turned to Bay Consulting Group and Dave Johnston. At the time, Dave was working with TELUS Health Solutions, Canada’s largest IT health solutions provider. TELUS had been helping WorkSafeBC for some time and contracted Dave to help design, build and implement the agency’s new 21st century provider portal.

“Dave is obviously a leading expert in the worker compensation field,” says Dan Polomark, TELUS’s senior director, solutions consulting. “He brought a deep understanding and business analysis with the technical requirements for implementing the portal.”

(One of the reasons TELUS picked Dave was his previous success in helping to design a similar system for Ontario’s Workplace and Safety Insurance Board - click here to read about it.)

Determine the Needs

Dave’s first task: determine the health-care providers’ needs. “We realized,” says Montgomerie, “that it was vital that these stakeholders had a stake in the new system. We had to make sure they were happy with the result, so we engaged them in the process.”

Adds Barnett: “Dave really helped us get the provider input. We asked him to ask the providers, ‘What drives you nuts about the current system?’ We realized we could be opening a Pandora’s Box, but we were prepared to take the risk to learn what was on their minds. We had to be driven by their needs, not ours.”

Dave heartily endorsed this approach. “I told WorkSafeBC that the portal had to be the providers’ portal, not their’s.”

The providers welcomed this inclusive approach. “WorkSafeBC clearly wanted to create provider solutions,” says Steven Kupidy, B.C. Area Manager for LifeMark Health, operator of more than 120 rehabilitation and physiotherapy clinics across the country.

Adds Kupidy: “We provided a wish list from soup to nuts. Payments were the major problem. They had to become automated and timely. But there were other problems, too, especially around referrals and clinical reporting requirements. WorkSafeBC listened. They kept it open and transparent. They were responsive to our needs.”

Over a 24-month period starting in the summer of 2009, Dave met monthly or more frequently with a representative group of 25 providers. “I needed to understand their problems, needs and requirements,” he says.

Develop a World-Class Solution

A smaller provider group helped with the business requirements followed by the design and testing of the portal as it evolved. “Dave took the 30 top ‘asks’ from the providers and developed a world-class portal solution,” says TELUS’s Andrew Stroud, solutions director for western Canada. “He knew the business as well as the client.”

But in bringing forward the providers’ concerns, Dave also considered the client’s requirements. Says the agency’s Montgomerie: “Dave listened. He did a great job of picking the providers’ brains. But he had a vision from early on that would be helpful to us as well, as he understood our needs.”

As a result of the consultation process, the portal took on a much larger role than ensuring expedited and accurate invoice payment. The providers had complained about the lengthy process in assigning care and rehabilitation programs for injured workers as well as the follow-up reporting requirements on treatment plans. Again, the paper-based system was the culprit. 

Incorporate Referrals and Clinical Reporting

Through Dave’s guidance, WorkSafeBC agreed to incorporate the some 30,000 to 35,000 annual referrals and subsequent clinical reporting in the new portal. Now, a case manager enters a recommended treatment plan into the system, triggering an electronic referral to an approved provider located near the injured worker.

“With the new portal, an appropriate provider can be lined up within an hour,” says Dave. “Before, it could take the case manager several days on the phone to connect a provider with a patient.”

Reap the Benefits

But the real-time referral, clinical reporting and invoicing system achieves more than WorkSafeBC staff-time savings. It results in workers being treated sooner and returning to work quicker, a key agency objective. As well, the sooner a worker is treated, the less chance the original injury becomes worse through lack of care or infection.

Before the electronic portal was launched in August 2011, as example, for cases requiring extended care programs, the care life cycle could take an average of 94 days from point of decision to refer and his/her return to work. Thanks to the new system, that average off-work period is expected to reduce by three weeks, producing a considerable saving for an agency that in 2011 paid out $1.6 billion in worker benefits/claims costs.

Says James Watson, Program Director, Health Care Projects:  “The results are validating expectations. Sometimes, reality does not match the promise, but in this case, I am happy to say that it does.” “Referrals that took two to four days are now done in hours.”

Providers are now able to deliver assessment, progress and outcomes/discharge reports electronically, and case managers are alerted only when there is a problem rather than having to wade through mounds of paper to discover one.

Dave says his work for TELUS and WorkSafeBC is among his top five satisfying projects during his four decades as a consultant. “I’m delighted,” he says. “The client understood the business benefits of a major IT transformation, and we saw the vision come to life.”

Staged Implementation

The new portal is being introduced in stages, allowing for fine-tuning along the way, as needed. So far, there hasn’t been much of a need. Providers and the agency are pleased with the results.

“It’s been great,” says LifeMark’s Kupidy.

For its part, WorkSafeBC welcomes the speed in handling invoices, referrals and reports. As well, the portal enhances the security of workers’ confidential information, improves data accuracy and reduces the agency’s environmental footprint.

Says Barnett: “We’re very happy with how the system is working. But it’s just as important that the providers are happy. Everyone is happy.”