PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)

Intramuros, Manila

GRADUATE SCHOOL OF BUSINESS

MASTER IN BUSINESS ADMINISTRATION

Operations Management
Case Study

Intellicare (Asalus Corporation)

Submitted to:
DR. CARLOS C. SISON

Submitted by:
Nemelyn Joy Laguitan
 INTRODUCTION:

Intellicare (Asalus Corporation), is one of the top leading health maintenance organization

(HMO) provider in the Philippines. The company began its operations in 1995 and has made

a commitment to consistently provide its members with high-quality, easily accessible health

care services which leads them to stay in the top of competition among others HMO

providers. The key success of this company is the high quality of services it is giving to the

members and maintaining a good relationship with the medical providers such as doctors and

facilities. Members of Intellicare can avail themselves of a wide variety of health care

services at more than two thousand accredited hospitals, clinics, diagnostic centers and other

medical facilities nationwide. Among their options are the annual physical, a range of out-

patient services such as emergency room care, medical consultation, minor surgery not

requiring confinement and in-patient confinement services such as room and board benefits,

laboratory tests and administered medicines. The company also offers a 24/7 call center

which enables members to inquire their cases and a patient relationship is always the top

priority of the company; there are employees who are readily available to assist the intellicare

members inside the hospital. Also, the intellicare have three head offices in Makati and

regional offices at Calamba, Cebu, Davao, Bacolod, and Cagayan De Oro which enables

regional offices to access easily to intellicare offices. The goal of Intellicare is to reach

across the archipelago and expand its network, that’s why with the help of recently

acquisition of Fullerton group (leading vertically integrated healthcare platform in the Asia

Pacific region), It will enable Intellicare to tap into Fullerton expansive network and wealth

of experience across Asia Pacific to ensure that Intellicare are delivering the most

sophisticated care possible to corporates and patients throughout the Philippines.

 1. PRODUCT:

Intellicare, a health maintenance organisation (HMO) engaged in the delivery of managed

healthcare services via comprehensive, systematic and prevention-oriented health

maintenance programmes.

B. Intellicare is a service company; the flowchart below is process flow of using an Intellicare

HMO card to the Intellicare’s accredited facilities

The account/company The member use the The facility coordinator

Start chose Intellicare as Intellicare HMO card will check the health
their HMO provider to the Hospital / coverage of the
Facilities members

The member will show
an approved form to
the doctors or facilities
Approved
The facility coordinator
Approved or
will process the claims
disapproved?
of Intellicare members

The member can enjoy

the accessibility and Disapproved
privilege with
Intellicare HMO card The facility coordinator
will call the 24/7
intellicare’s call center
and ask for clarification

End
The facility coordinator
or the Intellicare call
centers will explain the
criteria why the claims is
disapproved to the
Intellicare members

End
C. The trends in a workforce are already changing, so as the preference of every employees.

Employees nowadays include in their benefit a good HMO. That’s why companies now are

engaging in including HMO as part of their benefits and marketing to workforce. As an HMO

provider, this trend becomes an opportunity to us since companies acquire us as their HMO.

Also, having a strength of being a well-known HMO which provides a high quality services,

and becomes a leading HMO, the companies chooses Intellicare.

D. Intellicare is a service company. All medical packages were customized according to the

contract of companies. It means that Intellicare produce the packages as well as the HMO

cards internally. The processes of contracts are made by underwriting departments while the

processing of HMO cards are produced inside the company by Accounts Processing

Department. In this manner, the confidentiality of all members is secured since it is an in-

house production. Also, a better control is implemented inside the company to secure an

accurate benefits and packages to the members. Lead time is also monitored, to commit to the

agreed time of submitting the contracts to the accounts/companies.

E. I considered that physical and digital design of our product design is one of the issues.

Intellicare has not yet engage in some technologies that can help in processing claims

efficiently. If this issue will be solved, it will create an opportunities and new technological

advancement to intellicare among other medical providers.

F. Intellicare is in a growth stage now. As discussed form the previous question regarding the

opportunities, the workforce trend becomes the opportunity of Intellicare. There is rapid

expansion in sales as the impact of the trend. The product or HMO becomes well-known and

accepted in the market. Also, Intellicare has a reputation as a top HMO provider so the

companies choose Intellicare among other HMO providers.

 3. LOCATION

Being on the right location can create an opportunities to the company because of this

accessibility, affordability and some other factors that can make the companies process

efficiently. Intellicare choses the three offices in Makati as their head-office, namely; AXA

building and Feliza Building, these buildings are all operational, clean and accessible to

different companies. The workers are comfortable in working inside the facilities.

Meanwhile, when it comes to community it is well-secured which can be seen as a good

implication for a long term location. As we all know, Makati is the business area in the

Philippines since Intellicare’s clients are companies, the accessibility to market the product to

other companies is easy. The infrastructure as well were determined by the company, since

Makati have a high signal when it comes to technology it is an opportunities for

telecommunications services. There is also lot of transportation available; employees can

easily go to work and to their houses.

The regional offices of Intellicare are at Calamba, Cebu, Davao, Bacolod, Cagayan De Oro.

The company choses these provinces since one of the goals of intellicare is expanding its

service in archipelago and these regions gain a highest numbers of clients of intellicare.

4. LAYOUT

Intellicare layout the offices according to the departments task. Those departments that have

constant links are in the same floor. The diagram below shows the layout of departments

processing the contracts and departments processing the Intellicare cards.

Restroom

Underwriting
Manager Underwriting Department
Office
Door
Franchising
Manager Franchising Department Guard
Office room

Sales
Sales Department
Manager
Office

Restroom

The diagram above is the office layout of department processing the company’s contract. The

sales department will confirm to the franchising department if the company is already

franchised or not. If not, the sales and marketing will began and if the offer is accepted

underwriting contracts will come, they will process the new and renewed contracts submitted

by sales team.

Printing
Supervisor Printing Section

Verification
Supervisor
Door
Verification Section
Encoding
Supervisor Guard
room

EA Encoding Section
Supervisor

APD
Manager Enrolment assessment Section

Restroom
The diagram above shows the layout of Accounts Processing Department which processes the

Intellicare cards. The EA section will assess the benefits and details of member then endorse

to encoding section for encoding to the system and verification section to verify and check to

avoid repetition, waste and errors. Lastly it will endorse to the printing section. This layout

saves time in endorsing papers to other departments involved.

5. HUMAN RESOURCES

A.. Intellicare have different types of workforce, workforce engaging in business decision is

at stable state same with marketing and operations workforce. The issue of the company

when it comes to workforce is the nurses that must be deploy to different companies. Since

Intellicare have a very strict training when it comes to nurses, only 20% of the trainees passed

the level. Intellicare can’t accommodate the demand if a company needs more than the

pooled nurses. High quality training is always observed and cannot bargain the nurses even if

it is needed.

B. Intellicare offers a 24/7 call center for the accessibility of the members. In this department

the work schedule is shifting. Departments engaging in business decision working schedule is

8:30am to 5:30pm.

C. Intellicare composed of 20 departments Strategic Management Dept.

The following departments are stated below:

Human Resource Mgmt. & Devt. Dept. - engage in employees

Corporate Social Responsibility Dept. – engage in the social factors of the company

Accounting Services Dept. – engage in the finance

Internal Audit Dept. – for control and policies

 Sales Dept. – Marketing and account acquisition

Underwriting Contracts Dept. – Benefits and contract

Accounts Mgmt. Dept. – Assisting the accounts

Patients Relations Dept. – Assisting patients

Customer Service Dept. – Serving 24/7 inquiries of members

Franchising Dept. – Checking potential clients

Information Technology Dept. – Helps in technological system

Accounts Processing Dept. – Processing of cards

Claims Dept. – Processing of Patients request

Operation Support Dept. – Overseeing the operations of the company

Medical Group. – Maintaining a good relationship with medical providers

Treasury Department – Processing of checks

Facilities and Property Administration Department – Admin of the company

Billing Department – Involves in billing of claims

Receivables Management Dept. – Involves in collection of billed claims

D. in Job design, a good example is the Reimbursement Section. This section analyses the

reimbursement of members. The Reimbursement Analyst (RA) task is only to analyse if the

reimbursement is covered. As the productivity increase, the task of the RA also evolves and

given a task equivalent to the Senior Reimbursement Analyst as a training if they got

promoted. This serves as motivation for this company to excel more in their Job.

Reimbursement Section
Reimbursement Analyst (RA)

Job Simplification Job Rotation Job Enrichment Job Enrichment

In- Patient RA The one that analyse The RA can approve The RA need to
Out-patient claims reimbursement of process the check of
Out- Patient RA can also Analyze In- 1000 below Reimbursement
patient claims
Also, in this section the specific task is to evaluate reimbursement which means that

employees must know if the medicine or consultation or any medical related reimbursement

is part of their benefits. In line with this, it is preferred that the employee of this section must

be a nurse or medical related graduate

Discuss job design at your company. You should illustrate

with an example. In your example, talk about the core job
characteristics and how they are met by the example job.
a. Discuss job enlargement, rotation, enrichment,
empowerment, and/or teams if applicable.
b. Give an overview of compensation and incentives at your
company. This does not mean to give numbers which are
confidential. It does mean to describe whether employees
are compensated by the hour, piecework, commission,
knowledge, or salary and whether there is an incentive plan
such as profit sharing or gain sharing. Does the
compensation/incentive plan motivate the employees?
Critique the plan.
c. What does your company do to fit the job to the worker
(ergonomics)?
d. Describe your company’s safety program.
e. Discuss working conditions at your company.
f. Does your company use visual signals/aids for
communication as described in the visual workplace section?
If so, describe.