Maximize Health Plan External and Internal Workflow And Process Transparency

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“Transparency” is the rage these days in healthcare. As well it should be! Transparent prices. Transparent costs. Transparent governance. But I’m going to talk about transparent processes and workflow. I’ll talk about transparency in two senses, at “design time” and at “run time.” Design-time is when you are designing software. In the old days, and still to some extent today, for specialized applications, design-time was when you typed code into the programming code editor. Run-time was when you executed that code and observed its behavior. If it didn’t run, or if it did but behaved badly, you’d go back to design time, find the problem (debug) and then enter run-time again, to see if you improved the situation.

Another phrase that means basically the same as process transparency is workflow visibility. About which I’ve given an entire 45 minute webinar. I cover the topic with respect to clinical tasks, not health plan tasks, but the underlying concepts are the same. (Plus, in terms of the underlying IT infrastructure, clinical and health plans tasks do increasingly overlap these days, especially in the area of the medical management function.)

You can think of a workflow system (an informal phrase I use that include BPM) as a collection of tasks and these tasks having states: pending, started, postponed, reassigned, escalated, cancelled, completed, etc. When a task is completed, other task may be automatically started, assigned to users, or roles (collections of user, anyone which can complete the task). Moment-by-moment all tasks and all task states can be displayed. If you’ve never used a workflow system, you have no idea how valuable such a display is to preventing even the possibility of someone dropping the ball, so to speak, with result of languishing task (and an increasingly pissed customer).

Consider what we’ve covered so far: rapidly creating new products, pulling together legacy data & workflow, and then being able to literally watch all tasks flow through the system. In addition to see what tasks are in what states, just think of the extraordinarily detailed time-stamped analytics, so you can retrospectively find and eliminate bottlenecks and rework (but that’s a design topic, or, should I say, a re-design time topic, I’ll address more later).

Finally, transparent processes and workflows lend themselves to “externalization” by the health plan. Feed these tasks, and ability to check on their status, to mobile apps used by customers is a great way to save money and increase engagement. Done right, of course!


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