Cambia Health

Cambia is a family of more than 20 companies that creates simple and personalized health care experiences for people and their families. Known for the first employer-based health plan in the country 100 years ago, they continue to put people at the heart of everything they do. Today, Cambia serves more than 70 million Americans with simple and personalized health experiences, including 3.3 million people served by our regional health plans. 

With so many complex processes, systems, data, people, and regulatory requirements at play, Scott McNamara, Senior Operational Excellence Manager at Cambia, and the OPEX team have a big job on their hands — they work in all areas of the company, from product development to core IT initiatives and pre-authorization insurance approvals. There is a need to understand, map out, and then optimize process flows. 

Mapping processes allows Scott and the Operational Excellence team at Cambia to identify guardrails and inefficiencies, but it also allows for visibility at all levels of the company into what they do and how every team member functions. After analyzing the process maps, they present the solutions to Cambia’s executive team and project stakeholders in a way that’s both easy to understand and visually interesting—a tall order, Scott says, when it comes to process maps, which he calls, “well...boring,” and like “trying to figure out a foreign language,” especially for stakeholders who need to make decisions based on these process maps. That’s where Lucidchart and its flexibility, intuitiveness, and ability to provide a bird’s eye view come in, allowing people at all levels of Cambia Health to see their processes, areas of improvement, and the subsequent solutions. 

Solving problems creatively

While waiting for the Portland MAX and looking at a metro map one day, it dawned on Scott that “the parallels between big city transportation networks and the fog of process work could not be any more exact.” So instead of “reinventing the wheel in trying to design an easy-to-understand process journey,” he decided to “leverage the existing, intelligent design of a metro map” and its universal readability to create process maps using a custom metro map shape library he created in Lucidchart. He was confident these maps would be something stakeholders would not only “actually want to look at and later reference, but also innately understand right off the bat,” allowing them to visualize complex issues and their solutions.

“Everybody knows how to read a metro map, right? Most people have ridden a subway at one point or another, and it makes looking at it much less intimidating and approachable. More human,” Scott says.

Visualizing phases of a complex, defined process

When mapping out anything from complex API’s to Cambia Health’s prior authorization process, the Cambia’s OPEX team uses their custom Lucidchart metro map shape library to illustrate each phase or step of complex processes or systems—assigning different phases or teams involved, depending on the project, a different colored metro line. 

In mapping out a process, each metro line represents a phase, and smaller metro stations along each colored phase represent key tasks, approvals, or milestones that must be completed before that phase transitions to its next phase at a larger station marker, where the metro line changes colors.

For example, this Lucidchart metro map outlines a typical health insurance pre-authorization (PA) process in an easy-to-understand way. Dotted lines represent iterative steps, and the metro track splits to denote where a PA enters the approval or denial process, showing essential steps that go into the final decision before the tracks end at a case determination. Each phase’s label, such as “review,” “setup,” etc., also links to a deeper, more complex set of maps for those wishing to understand each individual step of the process on a more granular level. The master metro map, however, gives stakeholders a high-level, contextual bird’s-eye view. Everyone from executives to quality assurance to providers can reference the metro map to easily understand the company’s processes and systems at the level of detail they need. 

To demonstrate a process that involves hand-offs between teams, each team is represented as a unique metro line on the map, and the individual tasks each team must complete are the stations. The metro line ends and changes colors to symbolize the transition from their piece of the project to the next team’s.

Identifying guardrails and opportunities for improvement

Because the operational excellence team is constantly working in different areas of the company, they’re often looking to improve processes with which they have no prior familiarity or expertise. By mapping out the process in Lucidchart using their metro map shape library, not only can the team, stakeholders, and executives see the processes from a bird’s-eye view, but they can also identify guardrails and areas of opportunity where a step can be streamlined or automated. Scope is also clearly defined, as only the section of process that is represented on the map.

Increasing transparency, collaboration, and sharing

Thanks to Lucidchart’s Microsoft Teams integration, Scott and the operational excellence team, as well as the stakeholders in the department they’re working with can easily access, check the status of, or even make suggestions, notes, and edits to the process flows they’re working on at any time. The team knows they can find the most up-to-date Lucidchart diagrams in their Teams workspace. With the integration in Teams, all process work is easily found in a single, one-stop shop location.  There is no need to log into Lucidcharts via the browser.

Spurring innovation 

Scott says that thanks to Lucidchart’s collaborative tools, shape libraries, and over 1000 templates, the operational excellence team has been able to go far beyond standard swimlanes and process flows. Their creative visuals have increased understanding and spurred innovation and creativity at all levels of the company. For example, in mapping out Cambia Health’s product development life cycle, Scott and the team used airport symbols to represent product sunsets and launches. They even incorporated a river in their Product Delivery Life Cycle (PDLC) map which they named the “River of Hope,” showing all the efforts leading up to a product launch, and how to bridge this critical phase. 

Because these maps are so easy to understand and even incorporate some symbolic playfulness and encouragement to innovate, these maps are often made into hard copy placemats that live at stakeholder’s desks. According to Scott, “adoption of process information has increased significantly.” 

“I’m also a big believer that the sexier something is, the more it will be adopted and interpreted, versus just throwing up another slide deck while the meeting room falls asleep,” Scott adds. “Using time-proven means to visualize processes and journeys will not only delight your readers and better tell your story but also be more fun for you to analyze and create. Everyone wins.”