Business Questions

Description

Strengths

-Product offered allows for healthcare affordability

-Claim turn-around time

-Large workforce

-Well-known name

-Quality of Service Weaknesses

-Customer Service improvement

-Limited healthcare coverage

-Limited products offered

Opportunities

-Merger with other forms of insurance

-New products offered within the scope of the original products

-New customer service programs to ensure customer satisfaction Threats

-Government regulations by Healthcare Reform Act

-Pricing of products

-Stronger marketing by other insurance firms

Planned Administrator's Incorporated is a third-party subsidiary of Blue Cross Blue Shield of South Carolina. Planned Administrator's seeks to slow the rising costs of healthcare by administering limited benefits and self-funded healthcare programs with quality and effectiveness. Planned Administrator's, Inc. provides solutions to employer groups to assist in adding value and reducing costs to the health benefits offered. This is done by offering services that include health management programs, provider networks, and stop loss coverage. The services provided by Planned Administrator's Inc. are especially helpful to employers with a heavy concentration of part-time or hourly employees. The services provided are alternatives for affordable healthcare (Suzanne Miller, Personal Communication, February 7, 2013).

SWOT

Balanced Scorecard

According to Blocher (2010), the balanced scorecard is a report created in accounting that uses four areas of critical success factors. The four areas included in the scorecard are: 1. financial performance, 3. customer satisfaction, 4. internal processes, and 5. learning and growth (Blocher, 2010). The following is a balanced scorecard for Planned Administrator's Inc.

Critical Success Factor Objective Measure Target Initiative

Financial Increase Revenue Annual growth of revenue from insurance sales +12% by end of fiscal year 2013 Provide more add on products, such as Accident Insurance and Critical Illness

Reduce overhead costs Annual Expenses -8% by end of fiscal year 2013 Combine job responsibilities in Compliance and Marketing departments

Customer (Agent) Keep Current Members Member turnover -10% by end of fiscal year 2013 Improve member and insurance agent communication

Enroll New Members Member enrollment count 20 additional accounts by end of fiscal year 2013 Improve marketing campaigns and products offered to entice new members

Internal Process Increase Claim Turn-Around Time Days to process claims < 30 days from filing of claim to approval or denial Implement strict policy and procedure for the process of processing claims

Learning and Growth Improve Customer Service through innovative technology and training classes Number of customer service representatives who have not gone through new customer service program, Ulysses Increase by 60% by end of 2013 Implement a companywide training program, providing Ulysses training opportunities each month

Discussion of CSFs

"Critical success factors (CSFs) are measures of those aspects of the firm's performance that are essential to its competitive advantage and, therefore, to its success (Blocher, 2010, p. 10)." In order to deliver quality healthcare for affordable prices, Planned Administrator's Incorporated must address the cost and quality of service provided to members. The critical success factors can be used to break this process into categories. Planned Administrator's, Inc. does this by focusing on financial and clinical goals that are aligned. One main way in which this is done is by Planned Administrator's providing a change in the way in which the company reimburses doctors and hospitals for services, as well as the company's claims turn-around.

Financial

The critical success factor (CSF), financial, is imperative because profitability and market value helps with the satisfaction of owners and shareholders (Blocher, 2010). By increasing revenue and decreasing overhead, the ultimate finances of the company are positive. The choices of these critical success factors helps meet the profitability that helps satisfy owners. This critical success factor is essential and works in tandem with the other three critical success factors to keep Planned Administrator's Inc. successful and open for business.

Customer (Agent)

The critical success factor (CSF), customer, is imperative because quality service and low costs help satisfy customers, and ensure customer retention (Blocher 2010). Under the category of customer, the success factor objectives chosen are retaining customers and obtaining new customers. It is essential to retain customers because they keep the money coming into the company, then additional customers help increase revenue, which helps the financial critical success factor too. One critical success factor is to look for ways that a company can position themselves to bring on additional carriers (Stalling, 1995). This is done by bringing ING on at Planned Administrator's Inc.

A recent poll of the healthcare field found that within the top five CSFs were membership, financial operation, communication, and staff expertise ( O'Sullivan, 2008). These same CSFs can be found in the choices for Planned Administrator's Inc. Under the financial CSF, the financial operation can be found. Communication is essential to the learning and growth CSF. The membership CSF can be correlated with the retention and increase of members. The staff expertise CSF can be found under the internal process of improving the turn-around time for the claims department.

Internal Process

The critical success factor (CSF),