Productivity in many administrative functions in health plans has increased four- to five-fold over the last 20 years. For example, whereas in the early ‘90s there was approximately one claims examiner for every 4,000 members, today it is not atypical to see one claims examiner for every 20,000 members. Although the increase in productivity has driven administrative expense down, it has limited the ability to shift resources around when organizations are under stress or executing change programs.

Although it isn’t clear exactly how health care reform will impact operations, few disagree that the health care industry will undergo massive change over the next several years. To help minimize the disruption and cost associated with the upcoming change, health care organizations should find ways to maximize the efficiency of their change programs, therefore minimizing the draw on scarce resources to deal with temporary productivity losses and to execute the change programs themselves. To do this, operational areas can borrow a technique that has been employed by IT organizations for many years—developing and maintaining a centralized repository of documentation.

IT organizations generally create “run books” to document individual programs (or applications) and overall application architecture diagrams that define how all applications interact with each other. Operational organizations should do the same thing by developing an overall process architecture that includes process plans and process maps.

To get started, operational organizations should develop standard process architectures that define what will be documented and how it will be documented. It is also important to determine where documentation will be stored and how it will be kept fresh; one technique we’ve used is to link process plans to the capital budgeting process. Once standards are defined, it becomes a matter of actually documenting processes, mapping them, and indexing them into the repository.

A key consideration in adopting a standard process architecture is to make sure that this initiative doesn’t become a major change program within itself. The point of a process architecture is to develop an environment that facilitates efficiency in major change initiatives to minimize organizational disruption; and, if not carefully planned out, could become a drain on the organization— which obviously defeats the original purpose. If an organization has standards that can be leveraged and an experienced team, major process areas can be documented in a matter of a few weeks.

This technique is being used, or is in the process of being implemented, within major health plan organizations. It has proven successful and can reduce the effort associated with change by an estimated 20–30%. Organizations should start now so that the benefits of implementing a process architecture can be realized during the planning, design, and implementation of upcoming reform-related initiatives.