Transforming Provider Engagement with a Cutting-Edge Provider Portal for Global 1
Empowering Healthcare Providers through Technology: A Seamless Integration of Service and Support
This case study explores the creation of a provider portal for Global 1, a subsidiary of Optum and as a
leader in Third-Party Administrator (TPA) bundled payment structures. This project showcases the
development of a provider portal designed to enhance the efficiency of both the Global 1 provider
support team and their provider network.
PROJECT OVERVIEW
PROJECT DETAILS
Project Type
Custom Software Development
Technologies
Cake PHP, Salesforce, Google Maps etc
PROJECT SUMMARY
The primary goal of the project was to develop a user-friendly portal that would allow healthcare
providers to self-serve various operational needs such as referring cases, checking claim statuses,
and viewing payment information. This initiative aimed to streamline operations and reduce the
administrative burden on Global 1's staff, with a rigorous deadline set for completion within 10
weeks.
"I have yet to encounter a vendor as committed to the success of a project as this one. Their
exceptional ability to grasp our business objectives and seamlessly integrate this understanding
into a user-friendly final product truly sets them apart." - Sandra Souter, Director of Payer and
Provider Operations, Global 1.
THE CLIENT
Client
Global 1, managing over 20,000 surgical cases, specializes in innovative, cost-effective surgical solutions that improve transparency, reduce costs, and enhance medical outcomes in outpatient settings.
Healthcare-Third Party Administrator
Carlsbad, CA
Situational Overview
They required a solution that could simplify and accelerate the claims and referral processes for their providers and reduce the overwhelming volume of inbound inquiries faced by their support team.
CHALLENGES
Overview
The lack of automated systems led to delays in processing claims and referrals resulting in frustrated providers and patients.
The provider support team was inundated with inbound provider phone calls and emails related to questions around claims and referrals.
As their client base grew, Global 1 realized that they were unable to scale without adding headcount.
The lack of automated systems led to delays in processing claims and referrals resulting in frustrated providers and patients.
The provider support team was inundated with inbound provider phone calls and emails related to questions around claims and referrals.
As their client base grew, Global 1 realized that they were unable to scale without adding headcount.
DETAILS
There was a pressing need for a system that could handle increased demand and facilitate easier and faster service delivery.
Streamlined Provider Onboarding
THE SOLUTION
A user-friendly provider portal was developed using Agile methodology, with the project broken down into 2-week sprints.
The final solution is a custom web-based provider portal, designed to serve two primary user groups:
healthcare providers and the Global 1 support staff. Healthcare providers benefit from robust self-service
features that enable them to submit, track, and manage referrals, claims, and payments efficiently. A
user-friendly physician lookup module streamlines the referral process, enhancing patient satisfaction by
expediting approvals. Integrated real-time chat allows providers to quickly resolve queries with Global 1
support staff, boosting efficiency.
For the Global 1 support staff, the portal significantly reduces routine administrative tasks through
seamless integration with EHR and Salesforce CRM. This efficiency gain frees the team to focus on building
stronger relationships with providers, leading to improved partnerships and increased business. Overall, the
portal has tripled the efficiency of processing claims and referrals, greatly enhancing operational
effectiveness and satisfaction for both user groups.
Providers are now able to submit case referrals and claims much easier AND view their
status.
The G1 claims team now has a user-friendly dashboard where claims and referrals that are
questionable, may be reviewed by the G1 team.
New providers who want to join the Global 1 network, can easily be onboarded, saving the
G1 team hours of what used to be back and forth emails and phone calls.
Claims and referral are automatically checked against strictly defined parameters and
then automatically inputted into Global 1’s EHR saving time and speeding up submissions.
A chat feature that allows providers and G1 staff to answer questions, make requests and
more is integrated in key areas of the app. Furthermore, the chat is contextual where
depending where the provider is in the app, the chat goes to the correct department
within G1. Furthermore, chats are saved allowing for chats to be picked up on where they
may have left off.
Global 1 needed a way for their providers to easily find specialists within the Global 1
network that were geographically close and within the G1 network. A user friendly
physician look up module was later added saving both G1 and provider staff time.
Results
The new provider portal significantly enhanced operational efficiency and provider satisfaction:
- Operational Efficiency: Processing time for claims and referrals was reduced by 3X.
- Inbound Queries: A dramatic 95% reduction in inbound phone calls and emails was observed, significantly freeing up resources for Global 1's provider support team.
- Communication Efficiency: The ability to use real-time chat improved responsiveness and provider satisfaction.
"I have yet to encounter a vendor as committed to the success of a project as this one. Their exceptional
ability to grasp our business objectives and seamlessly integrate this understanding into a user-friendly
final product truly sets them apart."
Quality
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