Deliverable: Workshop
Nobody wants to get an unexpected $5000 insurance bill for a procedure they thought was covered. That’s what happens when reimbursement paperwork isn’t filled out exactly the way the insurance company wants to see it. The chances of this happening skyrocket for complicated conditions with expensive treatments.
High risk for reimbursement problems
This is exactly the sort of treatment that our client offered. They provide a treatment for a rare disease. It is administered by infusion in a doctor’s office to patients off and on over a period of months or in some cases, indefinitely. As with most treatments for rare diseases, the economics require a high per unit cost in order for the company to be able to continue providing it. In a treatment context like this, when a reimbursement issue arises, it can be costly either for the patient or the doctor. With high-cost treatments insurers will scrutinize reimbursement requests much more carefully and use far stricter evaluation criteria (i.e. are more likely to deny requests based on smaller administrative problems).
To minimize reimbursement problems, the company decided to expand its team of Field Reimbursement Managers (FRMs). FRMs work with health practices to set up and follow optimal procedures and troubleshoot issues that arise. It’s a critical role with a direct impact on the business. If reimbursement becomes a chronic, time-consuming problem for a practice, it may simply elect to use other treatments. Further, all of the activities FRMs are involved in are highly regulated, which means great care must be taken to avoid getting into compliance problems.
The old way was not going to work
The company needed to get the new FRMs up to speed as quickly as possible, so it brought in BCL to help develop a plan. We quickly realized that a non-traditional strategy would be needed. FRM training customarily involves walking through forms for hours on end. But with so much of the work of an FRM centering on troubleshooting problems, it made more sense to center the training around problem-solving. If the FRM can learn to handle and, even better, prevent the most common issues that arise during reimbursement, that can remove significant friction in all corners of the system.
BCL worked with the client to identify the most common and burdensome problems that can arise during the reimbursement process. Those then became the center pieces of a two-day workshop that was organized as a quest. A Greek mythology theme was woven into the program to align it with important aspects of the company’s history and culture.
Navigating a fictitious sales territory
In the workshop, learners were broken into teams and given a fictitious territory, complete with accounts and reports. They were instructed to make a plan for managing the territory that week. As learners made their plans, unexpected wildcard problems were thrown at them. They had to work together to triage and then solve the priority problems. While they did this, senior FRM regional managers walked around providing guidance and coaching. After the teams had worked the problem for a while, they all reconvened to talk through various approaches. Then they returned to their teams to continue the quest.
A new model going forward
The program was a big success. One of the most valuable outcomes was the impact on camaraderie. Participants reported that they developed a strong rapport with their peers and supervisors that carried over into their work – an important dynamic when working in a fluid, ever-changing problem-solving environment. FRM leadership reported that the new FRMs entered into their jobs better prepared than usual. And the program structure has now been institutionalized into a template within which all other FRM training programs, regardless of product, will be fit.
