Speedy recovery

Humana Inc is on a mission to do what many US consumers would consider nothing short of a miracle: simplify buying and using health insurance. Its most recent target audience is the millions of Americans eligible for Medicare Part D, the government's revamped prescription drug plan for senior citizens.

Since enrollment began last November, the $US13 billion health insurer has signed up more than 1.7 million new customers for its Medicare Part D prescription plans. Moreover, a sizable chunk of that new business came in electronically via Humana's self-service Web site, a cornerstone of the company's IT-enabled growth strategy known as Perfect Service.

Providing "perfect service" has required a radical shift in role for Humana -- from transaction processor to consumer advocate, says Bruce Goodman, chief service and information officer. "One of the key goals is to deliver a total, integrated experience for all stakeholders," he says. That means making information quickly and easily accessible to physicians, hospitals, employers and Humana employees, all of which directly affect a Humana customer's experience. Think of it as an ATM usable by all parties involved in health care.

At the centre of this strategy is Humana's IT organization, which in the past few years has made a big shift of its own, from a traditional software development and support group to a highly flexible and ultra fast team of systems integrators. "This was especially important, because in this consumer-oriented world, speed to market is essential," Goodman says.

Now, rather than seeking people with technical skills, Goodman says, Humana's IT group looks to hire people who work well with the business as relationship managers and people who can gauge the value of IT vendors to bring in as strategic partners (see story, next page).

On the technology side, Humana has built a foundational IT infrastructure and a highly sophisticated set of analytical software tools that let various kinds of users tap into a single data repository to retrieve a wide range of customized information. This infrastructure, built on a service-oriented architecture, essentially shields users from the complexities of Humana's massive installation of legacy systems and software while enabling them to gather information they need to make decisions.

Goodman says the planning for Medicare Part D began about nine months before the enrollment period opened in November 2005. Ease of use was a key consideration in creating the Web-based Medicare prescription system, known as SmartSummaryRx. That's because the primary users of these online tools would be senior citizens who Humana assumed would have minimal experience with the Internet and Web-based self-service systems.

"We developed some very complex tools that let a senior or primary caregiver go to the Web site, enter the drugs they're taking and then price out what their total out-of-pocket premium and co-pay expenses would be for 12 months," Goodman explains.

"We've gotten good at developing software wizards that provide guidance around what to choose," he adds.

But SmartSummaryRx's users aren't just health care consumers. Claims-processing and billing personnel, doctors, nurses and hospitals can all tap into the system for a customized view of the information they're seeking.

People working in various Humana sales channels can also access SmartSummaryRx to generate pricing information and sign up new customers. These include Humana-employed agents who work in Wal-Mart stores, selling co-branded prescription drug plans; State Farm Insurance and USAA agents who exclusively sell Humana's Medicare plans; independent agents and brokers; and even people using the government's Medicare.gov Web site.

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