Bring Modern BPM’s Unique Value to Member, Provider, Medical, Benefits, and Claims Management

Modern BPM application platforms are highly relevant to every traditional area of health insurance payer IT. In fact, as a refresher, and to highlight every instance of payer IT process-aware opportunity with a yellow marker, I just took both courses AHIP Education offers on payer IT. Every category…

  • Membership Management
  • Provider Network Management
  • Claims Processing
  • Benefit Plan Management
  • Medical Management
  • Fraud, Waste, & Abuse

… evidenced effects of diffusion of the kind to workflow tech I’ve been advocating generally in healthcare for years (technically, decades, though just barely). Here I will just focus on one area: Claims processing.

I hope you’ll watch this 20-minute video of how Serco stood up a claims operation in a remarkable short of time, and then processed daily claims volume that literally caused exclamations in the audience around me.

The Agility Imperative An Affordable Care Act Case Study

  • 695,000 running processes (workflows)
  • 2000 concurrent users
  • 125,000 tasks in single day
  • over two million documents stored
  • 27 releases in 18 months (27 times system improved)

Impressive, but the following, in the context of the former, is what made the collective audience jaw drop…

The Federal Government awarded the contact July 1, 2013, with a go-live date of October 1st, 2013 (no, not 2014).

Keep in mind, Serco is NOT an IT services organization. It’s a business services organization. Serco used BPM consultants, but ultimately only needed one FTE to run the BPM system making this remarkable claims-processing throughput figures possible.

The following isn’t claims processing, it was said in the context of provider network management, but it’s certainly worth including here. This is what a Vice President of IS Strategy and Shared Services had to say:

(compressed a bit, because I had to get it to fit into a tweet)

A modern BPM application platform will

  • aid provider transformation and
  • change care management to
  • achieve network excellence

Look for more examples, on this blog, of the dramatically positive implications of modern BPM application platforms for every aspect of health plan and payer IT.


10 Reasons Health Plans Should Double-Down on Modern Business Process Management

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