2013 GRC Value Award: Investigations Management

GRC 20/20 Research awarded SAI Global and HealthPlus its 2013 GRC Value award in the Investigations Management category. With the help of the SAI Global solution called Compliance 360®, HealthPlus, a Michigan health and wellness organization, reduced its average days to complete investigations cases by 56 percent. Average days to complete cases has been reduced from nine days to four days. In spite of ever-rising caseload numbers, the SAI Global team was able to complete the implementation two months ahead of schedule.

Compliance 360 is a comprehensive software solution that streamlines the GRC process for organizations of all sizes and geographic diversity.  SAI Global’s Compliance 360 solution is designed to make compliance, risk and audit management easier, less costly, and much more manageable – even for organizations in highly regulated industries.  Compliance 360 is a highly configurable set of modules that help identify gaps and risks, eliminate duplicate efforts and easily maintain the records needed to demonstrate full control of compliance, risk and audit programs.

HealthPlus of Michigan (HealthPlus) provides customized, nationally recognized health plans that meet the needs of large and small employers, and families and individuals, through a variety of programs including Medicare Advantage and Medicaid. Organizations including HealthPlus that participate in Medicare and Medicaid programs face significant and unique compliance challenges. In this environment, the regulating entity is also the payer, providing funding for the services provided to health plan members. Because of this unique situation compared to other regulated industries, compliance gaps and breaches can not only result in fines and sanctions, but also in withholding of payments and termination of participation in the program.

A manual, inefficient system stymies a growing organization

Prior to 2011, HealthPlus was managing their cases using manual tools including an MS Access database and e-mail. With over 4,000 cases in the system, they were challenged with difficulty in managing and tracking case status and visibility when needed for escalation. They also needed to improve efficiency.

These objectives were very important in order to ensure rapid response and resolution of cases including allegations of fraud, waste, abuse, privacy, security and other compliance requirements. Failure to do so can result in increased scrutiny and potential fines for health plan organizations.

The Compliance 360 GRC System

The Compliance 360 GRC system from SAI Global was chosen to facilitate regulatory change management and incident management. In spite of an 8 percent increase in case volume in 2011, the implementation of Compliance 360, including the conversion of all cases and all user training, was completed two months ahead of schedule. The implementation at HealthPlus reduced the average days to complete cases by 56 percent. Average days to complete cases has been reduced from, from nine days to four days.

Overall, the system provides improved visibility and flexibility in the form of:

  • Support for establishing standard and consistent processes through workflow automation
  • Ability to ensure security of access to potentially sensitive information — very important in healthcare
  • Monitor and report on trends based on incident types and utilize information to proactively initiate corrective actions for recurring issues
  • Ensure a continual audit-ready state with all incidents, investigations and outcomes in a central system of record

To learn more about the GRC 20/20 2013 GRC Value Awards and other recipients, please visit this post: GRC 20/20 Announces 2013 GRC Value Award Recipients

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