Summary of Main Points
Heritage Health company had been experiencing challenges relating to limited cash. Ann Igbo was responsible for making decisions for her company, paying bills, and making payroll. She had doubts about whether to hire another employee, outsource, or automate the insurance claims. The challenge with the insurance claim process is that it would be a burden to her stretched workforce. Ann was a licensed therapist offering services to individuals, couples, and families. She organized multiple training programs and workshops to help individuals with mental health problems (Shindledecker, Grissom, & Jones, 2015).
During the early stages of her company, 90 percent of the clients used medical insurance to pay for services. Heritage would submit insurance claims to patients’ providers after each visit. Ann realized that the process of completing each HCFA 1500 claim form was time-consuming since it was conducted manually. Automation was one of the main alternatives, but it resulted in delayed payments as some insurance companies were slow to pay deteriorating cash flow.
In the end, Ann and Kim (office manager) selected Therapist Helper that allowed automation of the claims preparation process as well as the electronic mailing of claims to insurance companies. Therapist Helper had some concerns relating to training time and costs, maintenance fees, and compatibility with existing operating systems and computer hardware. Hence, Heritage Health faced many challenges relating to the automation of the company’s systems, such as submitting insurance claims to clients’ providers.
Core Business Problems
Heritage Health faced several business problems; for example, the company experienced a deteriorating cash flow due to delayed payments by some insurance companies. Ann was also concerned about automation due to the costs of training the workshops and maintenance costs. The primary problems revolved around cash flow due to increased costs; the company relied on payments from clients’ insurance companies that were mostly delayed (Shindledecker et al., 2015). As a result, many business operations would stop due to limited cash flow. Therefore, Heritage Health Resources required alternative options for conducting business to identify and eliminate bottlenecks and delays.
Alternatives Available to the Decision Maker
As the owner of the company, Ann was the sole decision-maker. She had several options in regards to addressing the problems the company was facing. First, she should have automated her entire system to ensure the electronic processing of claims and submission to insurance providers. Ann could also hire more employees to help other workers to decrease their workload. Another alternative to consider was outsourcing which allows to share responsibility and reduce the burden on the office manager Kim. Each of the proposed alternatives had its merits and disadvantages that were of concern to the company.
Analysis of the Alternatives
Professionals apply different analytical concepts to analyze and understand the events in the past and forecast the future of their performance. Applying analytic concepts enables a business to predict future outcomes and optimize business resources (Baum, Laroque, Oeser, Skoogh, Subramaniyan, 2018). Berenskoetter (2017) outlines predictive, descriptive, and prescriptive as the main analytic concepts. Ann can use automation as an alternative; using the descriptive concept, she can analyze the historical trends of automation. For example, companies’ performance tends to improve when they integrate automation systems.
However, this approach requires capital investments to train workers and buy the necessary equipment. Using the predictive analytics model, Ann can examine the available alternatives to determine the probability of a future outcome. Through this model, Ann can analyze the risks of hiring a new workforce. The model can also help her assess the risks of outsourcing its insurance claims processing system. Based on the above analysis, automation is the best alternative; however, it presents some challenges relating to additional costs in training.
Recommended Decisions for Heritage Health
I would recommend that Heritage Health should focus on automation. Business process automation enhances organizational efficiency by eliminating redundancy and decreasing human efforts. Automation would enhance the insurance claim process for Heritage Health. However, the company will have to invest in training programs to equip employees with the necessary skills. It will be required to purchase new equipment to integrate with new automated systems. This approach will present many benefits to the company, such as the elimination of bottlenecks and delays in payment by insurance companies for services offered to patients.
Concerns with the Ability of the Decision Maker
Ann’s capacity to make rational decisions is questionable. The rational decision-making process pertains to a single actor reasoning to maximize the purposes depending on the means at his or her disposal. Ann fails to utilize resources at her disposal when making company decisions. For example, important decisions are based on her opinion. She fails to consult employees regarding how to improve company performance and selects options based on what she thinks is suitable. Different scholars have developed various models of rational and strategic decision-making (Halabi, 2019). Rational decision-making models outline different stages decision-makers should follow.
Decision-making should always start with the setting of goals by analyzing internal and external environments (Uzonwanne, 2016). Ann has goals or objectives that guide her decision-making procedure; however, her objectives are not explicitly defined. She does not have full or perfect information regarding her options. Critiques of the rational decision-making model argue that the model makes unrealistic assumptions by oversimplifying them.
For the case of Ann, her rationality is limited by her capacity to perform analysis and think through competing alternatives. She could not make completely rational choices due to the complexity of the options. For example, the financial challenges facing Heritage Health relate to patients and their insurance providers; therefore, the company had to contact clients’ insurance providers for payment after services have been delivered. The process of claiming payment and receiving the actual payment was long and cumbersome creating challenges to the corporation. Hence, Ann’s capacity to make decisions through a rational decision-making process raised concerns and undermined overall organizational performance.
Risks to Heritage Health of Hiring additional Billing Personnel
Heritage Health planned to hire additional billing personnel without changing its current business model. Recruiting new employees presents multiple risks; for example, the company may struggle to get the right fit for the right role (billing).
Heritage Health created the risks of no coverage to protect against employment practices by hiring billing personnel. Many companies lack employment practices liability insurance that can protect them if employment practices risks arise (DeVaro, 2016). Employment practices liability insurance protects the business from unplanned situations. Therefore, it is important to evaluate potential risks in hiring and recruitment processes. Heritage Health should consider the best recruitment, such as internal hiring to limit the capacity of these risks to delay billing procedures and other organizational operations.
Baum, J., Laroque, C., Oeser, B., Skoogh, A., & Subramaniyan, M. (2018). Applications of big data analytics and related technologies in maintenance—literature-based research. Machines, 6(4), 1-12. Web.
Berenskoetter, F. (2017). Approaches to concept analysis. Millennium, 45(2), 151-173. Web.
DeVaro, J. (2016). Internal hiring or external recruitment? IZA World of Labor. 1-10. Web.
Halabi, A. (2019). The factors that affect rational decision making. International Journal of Applied Research, 5(5), 365-369. Web.
Shindledecker, S., Grissom, D., & Jones, E. H. (2015). Heritage Health Resources. Journal of Critical Incidents, 8(87), 1-3.
Uzonwanne, F. C. (2016). The rational model of decision making. In A. Arazmand (Ed), Global Encyclopedia of Public Administration, Public Policy, and Governance. Cham, Switzerland: Springer.