USI Health Provider Process Optimization Using DMAIC Methodology at Triple S-Salud

Abstract

Triple S Management Corporation, founded in 1959, is Puerto Rico's leading managed care company. Its success is built on integrity, with the USI (Unidad de Servicios Integrados) department playing a crucial role in managing complaints and petitions related to contracts and payments. Recently, the USI department has undergone evaluation for potential modifications. This project aims to define the issues within the process of managing requests via the SASS platform, using the DMAIC methodology. The team, composed of three Industrial Engineering Capstone students, focused initially on defining the problem and identifying key stakeholders. The Voice of the Customer revealed that 56% of employees consider themselves experts in the process, providing valuable insights for developing an improved process. Key tools like Process Mapping, Stakeholder Analysis, and CTQ (Critical to Quality) were utilized to clarify the petition management process. In the Measure phase, a data collection plan was implemented, identifying KPIs such as the percentage of requests closed within 30 days, with a target of 99%. Statistical analysis revealed significant delays, especially for complex requests. The Fishbone Diagram analysis pinpointed system configuration and contract adjustments as major causes for delays. Solutions were proposed, including the creation of a Standard Operating Procedure (SOP) to standardize processes, implementing a Petition Tracking System (Service Now), and introducing a Single Contact Method and Direct Communication Line for better control and faster resolution. In the Control phase, the team recommended maintaining the current KPIs to sustain improvements, expecting a 10% reduction in errors and significant cost savings.