Quality Management at Empire Blue Cross Shield Insurance Company

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Table of Contents

Company brief history
Problem identification
Study of the problem and the chosen measurement tools
Presentation of results
Result Analysis
Proposed action plan
References

Company brief history

Empire Blue Cross Shield Company is a US-based hospital insurance firm. This insurance firm offers a broad range of insurance products; all in various funding arrangements (Empire Blue Cross Blue Shield Homepage, 2008). Boasting of over 75 years experience in the insurance industry, the company has expanded its activities to cover all market segments.

Throughout its existence, the company has operated a unique quality policy differentiated by the following key factors:

Diverse product portfolios
Robust employee and member websites
Use of cutting-edge technologies
Superior services
Seamless implementation processes
Strong and data integrated business partnerships

Problem identification

Before the year 2007, Empire Blue Cross Shield used to apply a fixed co-payment to all insured clients. This meant that whether the insured clients were purchasing prescription drugs, visiting offices or undergoing emergency X-rays, they had to part with the same co-payment figure (estimated at $ 20).

However, things changed in the years succeeding 2007 when the company reviewed its health policy. During this time, the company established a new co-payment plan. This plan required that each insured members co-payment was to correspond to the contributions or the policy insured against. This requirement meant that the company had increased its workload since it had a large of clients under its membership. As the insured members continued to frequent offices, hospitals and chemists for various services, the management could not successfully establish the exact co-payment quotations to be paid by each member. At some instance, the insurance firm quoted $ 15 for office visits, $ 10 for emergency services such as, X-rays and $ 8 for prescription drugs. The determination of the exact co-payment proved a difficult challenge for the firm management.

As the management lagged behind in determining the members co-payments, most members health bills kept on increasing as they kept checking in for their services. A dispute therefore arose when members started complaining about the insurance firms delay in settling their health bills. When the situation worsened, some members contemplated withdrawing their membership.

Study of the problem and the chosen measurement tools

Being a survey kind of study, the researcher chose to use conclusive descriptive research approach in carrying out the study. This approach was chosen based on its suitability in answering the; who, what where, when and how questions of any quality assessment research which formed the core questions of the study (Housden, 2008, p.62). The study population consisted of the firms insured members in New York. The study area was chosen because being the global headquarters of the giant insurance firm; it emerged as the best location on which the qualitative studies could be carried out and inferences to other locations derived.

The researcher used random sampling technique to select 20 insured clients for interviewing. This technique was preferred since a very large population was to be involved. The technique gave each user an equal chance of being interviewed thus ensuring that objective inferences were made to the study population (StatPac, 2011).

Presentation of results

When the researcher interviewed respondents to establish their levels of satisfaction in the reviewed co-payments, the following table 1 captured their responses. 5 represented highly satisfied while 1 represented less satisfied.

Measurement variables	Rating/Score
Suitability of the reviewed plan	2
Accuracy of the reviewed plan	2
Reliability of the reviewed plan	3
Matching of expectations	1

Table 1 capturing respondents results on the quality of the new co-payments

Bar graph depicting table results — Bar graph1 depicting table 1 results

Result Analysis

From the two diagrams above, it clearly emerged that the insured members, at Empire Blue Cross Blue Shield, were dissatisfied with the companys reviewed co-payment scheme. Though most members had high expectations when the plan was reviewed, the same members were ready to express their dissatisfaction with the suitability of the new scheme. Members who had taken multiple medical covers thought that by subscribing the multiple and split payments, they were likely to be paying more for their services. A good example can be taken of a parent who insured his 8 family members with different covers. To stress that each of the insured members needed to subscribe to the above plan, meant that this parent was making repetitive payments for the services. This interpretation was as expressed by these categories of such members.

Beside, small contributors were of the view that the system could exploit them especially in instances where they were purchasing prescribed drugs of fewer amounts. They justified their claims by stating that by purchasing drugs of fewer amounts and paying the stated co-payment figures, they were likely to be benefiting the insurance firm by covering part of its costs.

Members also feared that the delayed settlement of health bill could result in their household belongings being auctioned by health institutions to recover their costs. Likewise, they could be restricted from seeking hospital services.

Proposed action plan

The researcher, after presenting and analyzing results, proposed that the insurance firm should revise its adopted structure to cater for the wishes of its insured members. This is so because for many businesses to survive, the customer should always come first. The insurance firm should hire a reputable consultancy firm to carry out studies on the above subject. In carrying out its studies, the consulting firm should start by providing a framework on which it is going to achieve its stated aim and goals.

The researcher proposed interviewing of affected insured members as the best method to be used by the firm in the collection of data. A review of old co-payment articles would also be ideal in this study.

Having collected and analyzed its data, the consultancy firm should present its findings to the insurance firms management. The management should then study the reports findings and recommendations after which they will be in a position to establish a suitable co-payment scheme for its members since in any service business, the customer is the only one who judges quality; and thus will always be right (Fitz-enz, 2000, p.239).

Conclusively, to help assimilate the proposed solution, the researcher proposed that the management should evaluate the performance of the proposed scheme. This was to be attained by subjecting the new scheme to measurement variables. For example, the management of the insurance firm could decide to carry out studies to establish the number of new members. Increasing numbers will point to the success of the scheme and thus more improvements to anchor the changes.

References

Empire Blue Cross Blue Shield Homepage. (2008).The Empire difference: Our company.

Fitz-enz, Jac. (2000). The ROI of human capital: measuring the economic value of employee performance. New York: AMACOM.

Housden, M. (2008). CIM coursebook: Marketing information and research. Oxford: Butterworth-Heinemann.

StatPac Inc. (2011). Survey sampling methods.

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