The first time that they attempted to build this system they did not follow the life cycle plan and the system ended up failing. Developing a new claims payment system that will talk to and be user friendly with the customer service management system would help to speed up efficiency and enhance quality of all departments within the organization. This streamlining would help the company as a whole to reduce costs and ultimately become more competitive and successful within the insurance market.
Being able to answer the following question is vital to any business. How would your organization continue to deliver mission-critical services if normal business operations were interrupted? Being able to quickly resume functioning enough to continue delivering the services that are critical to a company's mission are very important. When normal business operations are interrupted, an organization should use its business continuity plan to prevent disruption in the delivery of services to its customers. Regardless of the type or severity of business interruption, the delivery of services to customers should not be interrupted. An organization should be able to continue to service its customers while continuing to meet its mission and organizational goals (Module List, n.d.).
A Business Continuity Plan is a collection of policies, procedure, protocols and information that is developed, compiled and maintained in preparation for use in the event of a business interruption. The BCP should outline all steps an organization will need to take in order to quickly resume business. Having a BCP in place before anything happens is critical. If there is no plan in place, the organization may not be able to respond quickly enough to prevent an interruption in services. Business continuity planning is different from disaster recovery and crisis management in that the focus is not on rebuilding or lessening the effects of a disaster, emergency or catastrophe, but on sustaining the delivery of services essential to the organization's survival. If an organization has a sound business continuity plan, it can continue to provide mission-critical services, no matter what happens (Module List, n.d.).
The first step in assuring the continued delivery of mission-critical services in the event of a business interruption is to identify what services your business delivers, to whom these services are delivered, and to rank each in terms of priority. The next step is to do a business impact analysis which essentially is a means of systematically assessing the potential consequences or effects from a various number of business interruptions. When conducting a BIA, an organization gathers and breaks down information about its essential functions and processes. This information is used to determine how the organization would be affected if these functions and processes were disrupted. The final step is to determine which policies and procedures are needed. The importance of each policy and procedure is tied to the importance of the function that is dependent upon it (Module List, n.d.).
When talking about the IT functions of a business the business continuity plans should include the following key concepts:
Periodic back up of all computer files and a safe off-site storage place for those backup files is necessary
Frequent routine testing should be done on all computer backup files
Restoration of computer backup should be done
Telecommuting functions and computer security should be in place
Facilitating the ability of key personnel to work from home should be outlined and set up
A software and hardware inventory should be performed
Power-outage and surge protection should be evaluated
User and application password development and access should be initiated
Vendor agreements for software and hardware replacement and/or repair should be in place (Module List, n.d.).
Humana has a very extensive business continuity plan in place. Computer are files are regularly backed up and stored at an off site location. Information that is needed to service customers is kept on a shared drive that is accessible by anyone in the company no matter what service location they are at. In the even that there is a service interruption that affects one call center, the flow of calls are immediately diverted to the remaining call centers to be handled. Because the necessary information is available to anyone these calls can be handled in a seemless nature to the customer. The customer that calls in has no idea in what call center their call is being handled as it should not make any difference to them as long as they are receiving exemplary customer service.
There are many emerging technology trends that are prevalent in business today. There are a few of these that Humana could use in order to improve their efficiency in order to be more competitive in the marketplace. Having supervisor carry cell phones at all times would make them very accessible to handle problems that might occur throughout the day. One of the major areas of concern in Humana's call center has to do with service delivery guarantees that are in place for several of the major employer groups. They have a contract with Humana that determines within how many seconds incoming phone calls will be answered. Because of these the efficiency of the calls centers fall under very close scrutiny. Equipping essential personnel with cell phones would enable these service levels to be monitored more closely.
Another area that would help Humana to be more competitive would be to utilize the technology that is available to allow more of their associates to work from home. This would help to cut overall costs along with boosting employee morale. Both of these things put together would allow the company to remain competitive within the insurance market and ultimately increase their bottom line.
With all of the talk now days about security this is another area in which Humana must be aware of. Especially with the business that they are in and the enforcement of the Health Insurance Portability and Accountability Act it is very important that security measures be as tight as possible. The HIPAA privacy rule provides federal protections for personal health information held by covered entities and gives patients an assortment of rights with respect to that information. The privacy rule is balanced so that it allows for the disclosure of personal health information when needed for patient care and other important purposes. Health information is protected in the following ways:
Covered entities must put in place safeguards to protect all personal health information
Covered entities must practically limit uses and disclosure of protected health information to a few people as possible in order to accomplish their intended purpose
Covered entities must have contracts in place with their contractors and others ensuring that they use and disclose health information properly and safeguard it appropriately
Covered entities must have procedures in place to limit who can view and access health information as well as implement training programs for employees about how to protect health information (Health Information Privacy, 2009).
Humana has several security measures in place to avoid violating the HIPAA rule. They have an extensive employee training program that everyone is required to attend. All systems are pass word protected and pass words are required to be changed every ninety days. All email is encrypted and all outgoing communication has a legal disclaimer on it. Humana takes information security very seriously and does everything that is possible to protect their customer's information. Not abiding by these rules would not only get them into trouble with the government but it would not bode well with their customers. And like has been previously stated with out customers, Humana has not business. They must do whatever possible to protect their customers and instill confidence and trust in them. Good security measures go a long way in accomplishing this.
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