Business of BPM

Online Bill Pay Needs BPM

I was talking with a friend who complained about getting his cable cut off. He pays all his bills online and never checks his paper bills. I have heard this from several people now.

As companies increase their rates, consumers have set up either fixed payments or payments within certain rules. Over time, those escalating prices exceed the pre-approved payment ranges and the consumers go into default.

This seems like an easy BPM fix. First, when a company raises their rates, there should be some trigger to the consumer. Second, when the consumer approves online bill payment, they should get a printout of what was paid, when, how much, deviation from standard, and ideally this would be directly inputed into Quicken or Money. All of this process along with the payment approval rules could be implemented using a business process management solution.

As we deal less with paper and more with virtual solutions, companies need to make sure that how they implement pricing changes and other changes don't mess up these systems.

Credit card companies could play in this space too. When you lose your credit card, you have to remember to go to all these sites and re-register your new card. This would be a great service for Mastercard, Visa, AMEX, Discover, or any other vendor to provide to their consumers. If they could track where your card is on file and automatically update it, it would make the card replacement process much easier and be a great value add. I believe consumers would pay a small fee for this rather than getting notices that their payments weren't processed.

Healthcare Appeal Process

Healthcare is such an easy target for BPM opportunities.  I am living one right now. 

In December, we had to refill a prescription for my son.  It happened to be 2 days before Christmas.  Since I had switched insurance carriers, Aetna now required a PA (Prior Authorization) for the drug (although my son had been on it for a year).  By the time, I got the message and tried to call the physician, he (a specialist) was gone until the new year. 

I had to fill the prescription and pay cash since I needed my son to stay on the drug.  So, in January, I downloaded the appeal form; completed it; had the pharmacist complete it; and mailed it in.  In March, I heard back from Aetna that it was rejected.  Fortunately, after working in the industry, I know that you can appeal it multiple times, and I understand the coding and reject process.  After talking with a call center agent, I had them change some of the notes on the claim to reflect the situation with my physician and appealed it a second time.

It is now May, and I got a letter telling me they haven't finalized the review process but have received my appeal.  I should know something in 60 days. 

This has to be easier.  All parties have to be frustrated.  The Aetna PBM has to spend expensive pharmacist time reviewing these multiple appeals; answering multiple calls by me; and sending me multiple letters.  My employer and Aetna will eventually have to pay a claim from 2006.  I am out the cash and spending valuable time trying to work the process.  And, none of us have much if any visibility into the number of appeals, the average cycle time, the status, and how to change this process.

BPM could help with this in many ways including simply streamlining the process. 

eRx with BPM?

From a pharmacy perspective in healthcare, one of the more elusive solutions has been e-prescribing (or eRx).  There are numerous companies (e.g., Allscripts, Prematics, Purkinje, RxNT, Zixcorp, iScribe) that have solutions and many more that have died over the years.  When I was at Express Scripts, we funded RxHub which was an industry solution by the PBMs (Pharmacy Benefit Management companies) to facilitate eligibility checks and other electronic transactions.

The goal of e-prescribing is to eliminate safety errors associated with wrong prescriptions, drug-drug interactions, non-compliance, and many other issues.  Anyone who has ever seen a doctor's hand written prescription can understand.  Here is an example from the Prematics site:

Some of the managed care companies have spent millions rolling out these solutions.  In general, most of them are adopted as interesting tools and then disgarded by MDs at the first sign of trouble.  Honestly, there is very little in it for them unless they have a quality bonus. 

Physicians are one step removed from the filling of the Rx.  They care about patient safety, but it is hard to change their working habits. 

So, I wondered the other day whether BPM could solve the problem.  Doctors all use some type of system for managing their office.  This ranges from simple systems that just capture data to much more involved PPMS (Physician Practice Management Systems) or EMR (Electronic Medical Record) systems. 

Could a BPMS use a process to:

1. Push data from the physician's desktop using messaging queues;
2. Run the data through some eligibility and adjudication logic;
3. Identify issues real-time; and
4. Then either route it back to the MD for questions or send it to the patient's pharmacy of choice.

An interesting spin on this would be to do an auction at the end where pharmacies could bid on the prescription (e.g., BidForRx).  Patients could create customized rules in the BPMS solution that processes the claims and managed the auction based on their interests.

Just a thought.  This seems to make adoption easier (no change in process); deployment cheaper (no ongoing support); integration cheaper and easier; and add additional value (patient involvement). 

Molson's BPM Efforts

I came across this and thought it was interesting.  It is a presentation by Molson on their BPM efforts.  I did see the woman running this program present last month in Chicago.  It was interesting as she talked about this as strategic for them and mentioned they were actually building out a BPM career path within the company.  This is a good example of a company that gets it.  They understand the value of process and how to take this from the shop floor to the corporate level. 

http://www.bpminstitute.org/uploads/media/Boykin_4_19.pdf

ITIL and BPM

ITIL (IT Infrastructure Library) is a best practices methodology for many of the core IT processes (see list below).  Traditionally, companies have bought products to handle the different components of ITIL.  One of the processes which was never well addressed was change management.  Most companies struggle with tracking and documenting change to their existing IT infrastructure. 

But, the opportunities for process management in IT are many - tracking software licenses so you can re-use them rather than buy new ones, asset tracking, program management, and now SLA (service level management) is a key one. 

If you don't have these different systems today, using ITIL as a process framework and then building out a custom solution using a BPMS makes a lot of sense.  But, in many cases, your company already has several standalone systems.  Then BPM has a different value proposition which is to connect the white space around your existing environment.  It can either use ITIL as the governing approach or simply connect your multiple processes for efficiency, data quality, and visibility. 

The added benefit of using BPM for IT process is that your IT team can become familiar with the concept, learn the technology, and be a better service provider.  As we learned long ago on the business side, establishing metrics is one thing but capturing them, reporting on them, and meeting our SLAs is a whole other challenge. 

Fortunately, one of the people on our team was a practitioner and subsequently a trainer of ITIL.  He has put together a great example of using ITIL in a BPMS.  If interested, let us know. 

Traveling w/ BPM

For anyone that travels, they know the challenges of dealing with multiple disconnected parts (air, hotel, car).  As I did my million miles years ago, I have experienced many things that I believe a travel service using BPM could address.

• Just recently, I had a car service planned to pick me up.  My flight was delayed so I jumped on a different flight.  I had to scramble to get a hold of them, wait for them to find a different driver, and finally confirm their ability to get me. 
• I can name numerous examples where my flights got delayed, and the hotel was sold out or had given away my room by the time I got there at midnight or 2 in the morning.
• It is often frustrating to get to the airport and have to wait for the car rental bus in the cold or rain.  It is equally frustrating to get to the rental lot and have your car not started or covered with snow.

The challenge of course is linking these disparate companies and using event based triggers or messages to connect the check-in processes.  I would think that a travel company that could create this would offer a much higher service model for their customers.  Imagine the following:

• Your check-in at the airport confirms your hotel and car rental or car service.
• Any delays or changes in flight arrival time (or flight) are automatically sent to update your car service or other time sensitive events.
• Upon arrival, a message is sent to the car rental or rental car bus to get you.  (You could even pre-configure certain rules as to whether you have luggage or not.)
• When you pick up your car or the car service gets you, a message is sent to the hotel to pull your portfolio.  Ideally, the hotel would have a bluetooth device that recognized you and automatically checked you in as you walked in the door.  All you would have to do is grab your key and go to your room.  No waiting in line.  No pulling out your credit card.

The fact of the matter is that service companies or others that look systemically across multiple entities to create STP (straight through processing) for a customer or patient or client have great opportunities.  They aren't easy, but this is where innovation opportunities exist. 

BPM to help OSS

I was reading a recent study from Amdocs about OSS (Operational Support Systems).  The press release was about inadequate OSS affecting time to market.  It identifies several reasons:

1. Lack of visibility to business processes;
2. Legacy system issues; and
3. Data issues.

This seems like a great BPM opportunity. 

The press release says "The survey revealed that service providers currently face significant operational challenges when attempting to roll-out new services such as Virtual Private Networks (VPN), Internet Protocol Television (IPTV) and Voice over Internet Protocol (VoIP). The systems to support these complex new services are struggling to keep up; 77 percent of service providers stated that legacy systems are unsuitable for meeting the needs of today’s customers, and that these systems are not equipped to quickly introduce new services. Additionally, issues such as a lack of visibility into business processes and systems, shortfalls of legacy systems and data management have negative impact on cost, fallout rates and time to market."

Healthcare Examples

Here is a message I pulled together for the HC CIO...

Have you seen the improvements and ways that Business Process Management (BPM) is being used in the Healthcare industry?  BPM is one of the latest approaches in continuous improvement that blends technology with process.  Rather than focus on total reengineering, BPM improves the efficiencies of your current or streamlined processes and helps you leverage your existing assets.  Given the staffing constraints across healthcare and other industries, this can give you an opportunity to grow your company without adding staff. 

Some examples:

1. Veteran’s Health Administration is using BPM to improve their benefit eligibility process focusing initially on income verification.

2. Gaston

   Memorial

   Hospital

   is using BPM to reduce the time to post job openings internally and has gotten it from days to seven minutes.  Gaston has also started using BPM for patient incident reporting and approval of new medical forms.
3. Lee Memorial Health System used BPM to cut their recruiting time by 50% and reduce new employee record creation from 9 hours to 10 minutes.
4. A 500-bed hospital is using BPM to manage their dietary management system reducing errors while assuring continued accreditation and improving patient, family, and physician satisfaction. 
5. A payer is using BPM to streamline their appeals and grievance process to improve accuracy, consistency, and timely resolution.
6. Another payer is using BPM to increase the efficiency of their call center allowing them to increase membership by 48% without an increase in staff.
7. Another payer is using BPM to manage their provider credentialing process from application capture through case resolution.

Some other examples of how BPM could be used include creation of a virtual EHR, accounts receivable, coordination of benefits, capturing process level metrics, contracting, procurement, product management, and project management.

BPM can help you increase quality while lowering the cost of care and provide a technical, rules-based solution for managing processes and their exceptions.  Additionally, given your historical investments in disparate systems, BPM serves as an abstraction layer that overrides your existing architecture so that changes can be made on an ongoing basis with massive development efforts and many implementations are made within 90-days from process mapping to production.   

BPM and Event Planning

I was running a ½ marathon this past weekend and began thinking about the whole event management industry.  This includes everything from travel to meetings to weddings to charity events.  The amount of coordination which occurs is amazing, and the risk is always keeping the branding, messaging, and information up to date across the value chain. 

Imagine being responsible for an event like a wedding.  Ideally as the couple, you would like to have a dashboard view of the process which showed you all the following information:

• Open tasks and who they are assigned to (e.g., sister, mother, mother-in-law)
• Ongoing invitee and attendee list
• Proposal management process with vendors (e.g., photographer, video, caterer) allowing you to manage the bid process and contracting process

The advantages of a process management solution to wedding planning would be a personalized portal view for each participant showing them relevant tasks and allowing for collaboration across tasks.  It would keep everyone aware of guest count and any last minute changes (e.g., due to weather things are moved inside 24 hours before the event in which case everyone should be informed via e-mail, text message, etc.).

These same concepts apply to things like corporate events.  One of our big events at Express Scripts was our annual Outcomes conference where we flew in about 750 of our top clients to

St. Louis

to talk about trends in the pharmacy benefit management space.  Internally, there was massive coordination for all of us speakers.  We had to coordinate research with our finance people and statisticians.  We had to pull together slides and do dry runs and incorporate feedback.  Additionally, lots of this was memorialized in a book that was distributed at the conference. 

A BPM tool would have done the following for us:

• Provided a dashboard for marketing to coordinate invites going to clients, status of content, status of dry runs of presentations, and other preparations for the event
• Allowed speakers to own the logistics for their meetings and coordinate with the facility planners around the event to make sure that if we changed to a panel from a presentation that this was updated and the room re-configured
• Provide a process flow for legal, marketing, and client sign-off on presentations and an audit log for what happened

Design Change Notification

When we first started the DCN (Design Change Notification) project with Ameren, I did not realize it was a standard process in the industry (and other industries).  It is a reasonably complex process at companies that makes a lot of sense for BPM.

Change notification is about managing the process of identifying changes, capturing the changes, tracking the signoffs, tracking the change specifications (versions, notes, drawings, calculations), and tracking the status of the changes. 

This was also a typical example of the speed to market that we talk about with clients around BPM.  Within 10 weeks, we were able to take a Visio diagram, finalize requirements, build out a LDAP integration for SSO (single sign-on), build two custom integrations, conduct UAT (user acceptance testing) and go live.

Obviously, at some companies where the changes affect suppliers and subcontractors, the effectiveness of this process, the timeliness of the process, and the control of document versioning is critical.  This makes DCN an even more relevant BPM project.