Leading Health Insurer Integrates Regulatory Compliance Efforts, Saves Time and Costs

Improved Control Over Compliance and Issue Management

MetricStream has helped the insurer identify all applicable regulatory requirements along with the “enterprise work effort” for each of them. Enterprise work effort is a project targeted at ensuring that compliance requirements and controls are implemented effectively. For each requirement of the PPACA, as well as MAR and other regulations, the product enables the compliance team to build a control library, and to test these controls on a periodic basis. A distinct “implementation status” feature helps in tracking the progress of all work efforts.

Using the MetricStream Integrated Risk Platform’s data foundation, the insurer has mapped all regulations in a structured, multi-dimensional, and relational compliance data universe that is used as a “single source of truth” for compliance across different departments. Regulatory feed channels have been set up to automatically integrate regulatory updates from multiple external sources. If there are any issues or exceptions that arise, they are managed through the product’s issue management functionality.

Aggregated View of Risks Across the Enterprise

With MetricStream Risk Management, the insurer can swiftly assess the likelihood and impact of compliance risks based on configurable methodologies and algorithms. Users gain visibility into both quantitative and qualitative risk ratings, while graphical dashboards provide an aggregated view of compliance risks and areas of concern. In addition, risk heat maps and color-coded charts present a simplified visualization of complex compliance and risk data, sorted by risk type, department, and other parameters.

Streamlined Policy Management

MetricStream Policy and Document Management has enabled the insurer to streamline policy management processes across business units and divisions, while enhancing consistency in policy related workflows. The tool’s integrated data model makes it easy for the compliance team to understand the impact of regulations, risks, and controls on policies, so that they can then take steps to be audit-ready.

Comprehensive Visibility Into Compliance Cases

Using MetricStream Case and Incident Management, the insurer has simplified its case management process, from case recording to case resolution. Over 10,000 users across the organization can log compliance cases which are then prioritized based on their criticality and priority. Multiple investigators can collaborate on each case, documenting findings and resolving issues. Intuitive reports and dashboards highlight cases that need immediate action and further investigation.

The fully integrated solution with compliance risks, policies, and case data aggregated on a common platform, has allowed the insurer to build a best-in-class compliance program that provides management with timely visibility into risk and compliance initiatives

Centralized Audit Management

MetricStream Internal Audit Management has helped the insurer create and maintain an annual audit plan to accommodate different audits across the organization. Audits can be scheduled periodically or on an ad-hoc basis for internal departments, processes, and projects. Based on the master audit plan, the scheduler can select a team of auditors and assign the audit responsibility with a due date. Auditors, in turn, can define checklists, track tasks, record findings and observations, and confirm the audit assignment as well as the completion of the audit. Thereafter, audit reports can be created and presented to the audit committee and the board.