Managed Care (Basic & Advanced)

The field of Managed Care is constantly changing as it responds to market forces and government/regulatory initiatives.

One of our Health Insurance clients wanted to make sure its employees had a sound grasp of Managed Care concepts. They asked us to put together some training that would upgrade the skills of all of their employees.

They also wanted us to link the results of the training to their Performance Management and Planning system.

We started by defining the specific knowledge and skill levels required for each job function in the organization.

Based on our analysis, we defined a blended solution featuring two different courses:

• Basic course, for every employee. This online course provided a general overview of Managed Care, explained the latest trends, and explained how Managed Care products were affected by those trends. We used case studies to bring the material to life, so learners could see how these trends played out in the lives of their Plan Members. There was plenty of interactivity, both in the form of Case Study questions and in a Mastery Test.
• Advanced course, for employees with customer contact. This classroom course focused on how ongoing developments in Managed Care were affecting current products. Games were used to review and reinforce basic concepts from the online course. Slides were used to present concepts and pose challenge questions. Here we put material that was more job-specific, as well as material that reflected very recent changes in Managed Care products. The Instructor Guide was designed to encourage instructors to add in the latest developments on-the-fly, and to customize the focus slightly depending on the needs of the class. Interactive Case Study exercises were designed to encourage discussion and group problem-solving. Worksheets were used to help employees see how to apply complex process flows on the job. A Mastery Test was used to ensure understanding.

For both courses, we linked the results of the Mastery Test to Key Indicators in the Performance Management and Planning System.

Special Skills/Software

• Front End Analysis: We conducted a needs analysis and competency assessment for all job categories. Our findings drove the course design and development.
• E-Learning software design and development: Articulate software was a good choice for the Basic course. It allowed us to make the content lively and interesting, yet provided plenty of tools for testing and tracking. Because the Basic course was a prerequisite course, we set up Articulate so it would report not only whether learners completed the prerequisite course, but any areas of the course where they had problems. That way, the instructor could use the information to tailor his/her classroom presentation to address special problems.
• Learning Transfer: We knew that Learners in the Advanced Course were going to be coming from different areas of the organization, and would need to apply what they learned to different work processes. We designed worksheets that helped learners take the generic course content and work through exactly how it would impact them in their job-specific work process.
• Performance Management and Planning System: We built the Mastery Tests so they integrated with the organization’s Key Performance Indicators. Supervisors and Department Managers were able to access the Mastery Test results, and even drill down to look at mastery of specific topic areas, as they were writing quarterly and annual Employee Performance Plans.

All staff had a deeper, and more consistent, understanding of basic Managed Care concepts.

Staff who had customer contact had an updated skill set that allowed them to resolve customer problems quickly and appropriately, in keeping with current organizational work processes.

Managers were reassured that their staff understood how Managed Care worked, how it was changing, and how those changes needed to be applied in the context of their own jobs. They felt more confident that their customer service staff was able to answer Managed Care-related questions more reliably and consistently. And they were pleased to have easy-to-use tools to use during Performance Management and Planning season.

HR was pleased to offer managers and supervisors a practical, easy-to-use method for integrating Training Results with the Performance Management and Planning system.

For more information about this project, please contact us.