My Foreword and Chapter in Business Process Management in Healthcare, Second Edition

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Foreword

I am delighted to write the foreword to BPM in Healthcare. Forewords traditionally deal with genesis and scope. I’ll tell you why I, an emissary from the medical informatics and health IT community, traveled to another land, that of Business Process Management (BPM). I hope to convince you that the sky is the limit when it comes to the potential scope of BPM in healthcare. And, finally, I assure you this is the right book to start you on your own exciting path to healthcare workflow technology self-discovery .

I first wrote about “Business Process Management” (BPM) in a 2004 health IT conference proceedings paper entitled EHR Workflow Management Systems: Essentials, History, Healthcare. But I’d been writing about workflow systems in healthcare since 1995. From the Journal of Subacute Care:

subacute

In 2004 I applied the Workflow Management Coalition’s (WfMC.org) Workflow Reference Model terminology to an Electronic Health Record (EHR) ambulatory patient encounter. (The Workflow Reference Model itself dates from 1994.)

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I attended my first BPM conference in 2010 (BPM in Government, which had a healthcare track). At that and many subsequent BPM (and Case Management) conferences I met many of the BPM experts and workflow professionals who co-authored many of the Future Strategies’ publications currently sitting on my own bookshelf. In particular, I’d like to thank Keith Swenson, (My Sandbox, Your Sandbox, in this volume) for answering my incessant questions and welcoming health IT colleagues to BPM venues over the years. Eventually I even became a judge in the annual BPM and Case Management excellence awards.

That’s where BPM in Healthcare comes from in my personal journey. But where is BPM in Healthcare going? The biggest big picture within which to appraise the potential for BPM to transform healthcare is The Fourth Industrial Revolution2. The Fourth Industrial Revolution (also known as Industry 4.0) is not about any individual technology, such as steam power, electrification, or computing (the first three industrial revolutions). The Fourth Industrial Revolution is not even about the Internet of Things (IoT), 3D printing, self-driving cars, artificial intelligence, or big data. It is about the interaction among all these technologies. In other words, The Fourth Industrial Revolution is not about innovative technologies, but innovative systems of technologies. It is about multiple, different, complementary, interlocking, and rapidly evolving technology sub-systems becoming part of an even larger, and way more complex, super-system, a system of systems. Wearing my systems engineering hat, I will argue that the Fourth Industrial Revolution is therefore about processes and workflows.

How do systems engineers manage system complexity? With models. Systems engineers gather data and optimize these models. These optimized models then drive system behavior. Then more data is used to optimize, and so on. In the old days, systems engineers sometimes gathered data with stopwatches and clipboards. I did exactly this, when I built simulation models of patient flow. Today, the Internet of Things and Machine Learning are reducing time scales to collect and process data down to mere seconds. And today, process-aware systems, such as BPM suites, orchestrate and choreograph system processes and workflows, potentially in seconds.

What are “process-aware” systems? These are information systems that explicitly represent, in database format, models of processes and workflows. The models are continually informed by data. The models are continually consulted when deciding what to do, say, or steer next. While process-aware systems “introspect,” they are not “aware” in a conscious sense, but rather in the sense that they can reason with these models; in real-time, in response to their environment and to exhibit intelligent behaviors that would not otherwise be possible.

Currently the industry most adept at representing work, workflow, and process explicitly, in a database, and using this data to drive, monitor, and improve process and workflow is called the Business Process Management industry. Why is BPM so relevant to creating and managing effective, efficient, flexible, and satisfying systems or systems? Because, as Wil van der Aalst, a leading BPM researcher writes, “WFM/BPM systems are often the ’spider in the web’ connecting different technologies” (and therefore different technology systems).

BPM, while not a direct descendent of early artificial intelligence research, inherits important similar characteristics. First, both distinguish between domain knowledge that is acted upon and various kinds of engines that act on, and are driven by, changing domain knowledge. Workflow engines are like expert systems specializing in workflow (warning, a very loose analogy!). Just as expert systems have reasoning engines, workflow systems have workflow engines.

Second, artificial intelligence (AI) and machine learning (ML) are critically about knowledge representation. Early AI used logic; current ML uses neural network connection strengths.

Finally, many AI systems, especially in the areas of natural language processing and computational linguistics, communicate with human users. When I say “communicate” I don’t just mean data goes in and comes out. I mean they communicate in a psychological and cognitive sense. Just as humans use language to achieve goals, so do some AI systems. Communication between humans and workflow systems is rudimentary, but real. Workflow systems represent the same kinds of things human leverage during communication: goals, intentions, plans, workflows, tasks and actions. These representations are, essentially, the user interface in many workflow systems.

To sum up, The Fourth Industrial Revolution is not about any one product, technology, or even system. It is about innovation in how multiple systems of technology come together. Process-aware technology, such as business process management, will play a key role in gluing together these systems, so they can be fast, accurate, and flexible, at scale.

You could go off and read a bunch of books about BPM. There are many excellent tomes. Then figure out how BPM and healthcare fit together. Or just keep reading this Second Edition of BPM in Healthcare.

If you are a healthcare or health IT professional interesting in healthcare workflow and BPM/workflow technology, you could start here:

References

Aalst, W. Business Process Management: A Comprehensive Survey, ISRN Software Engineering, Volume 2013 (2013), Article ID 507984, 37 pages.

Webster, C. Prepare for a Computer-Based Patient Record That Makes a Difference, Journal of Subacute Care, Vol. 1(3), 12-15, 1995. (http://ehr.bz/subacute1995)

Webster, C. EHR Workflow Management Systems: Essentials, History, Healthcare, TEPR Conference, May 19, 2004, Fort Lauderdale. (http://ehr.bz/tepr2004)

Terminology and Glossary. Winchester (UK): Workflow Management Coalition; 1994 Feb. Document No. WFMC-TC- 1011. BPM in Healthcare (2012) Future Strategies Inc., Lighthouse Point, FL. http://bpm-books.com/products/ebook-series-bpm-in-healthcare

Case Management in Industry 4.0: ACM and IoT – see chapter by Nathaniel Palmer” “http://bpm-books.com/products/best-practices-to-support-knowledge-workers-print


Free! My Book Chapter:

Marketing Intelligent BPM to Healthcare Intelligently!


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BPM & Healthcare Q&A with Scott Polansky, Appian Practice Lead for Healthcare Payers

Welcome to one heck of a freewheeling discussion with Scott Polansky, of Appian (Booth 238 at AHIP Institute), about the wide variety of ways to use BPM software to obtain 360-degree comprehensive and integrated views of member patient data, and then do really cool things in real-time contributing to member experience. What stood out to me, after rereading the transcript, is the intriguing fit between Scott’s experience designing management health plan products and his job, since Appian BPM can be used to so quickly create and deploy mobile software necessary to support new health plan products.

BPM stands for Business Process Management. It is rapidly diffusing into health insurance IT infrastructure. I’ve long been a fan and proponent for more use of workflow technology, AKA BPM, in healthcare, so I am delighted to have this conversation with Scott Polansky, Appian Practice Lead for Healthcare Payers.

CW: Scott, tell us about yourself!

Ha! Where do you want to start? I started in this business back when HSA stood for Health Systems Agency, not Health Savings Account.

CW: That was late 70s under Nixon, right? My graduate advisor headed the Health Systems Agency in central Illinois.

Right. I started as a premed major and then got a Masters of Public Health from UCLA. I did product development for health plans, leveraging my quantitative background and what is now called predictive analytics. I sold cost accounting software. Consulted for some boutique consulting firms helping providers get into the health insurance business. I came to Appian because I realized health plans must become more efficient and effective and Appian provides that kind of smart work platform.

CW: I want to drill down on Appian’s special work and workflow secret sauce in a moment. But first, I’d like to follow up on our conversation at Appian World.

CW: You emphasize something you call “relentless incrementalism.” What’s that?

Relentless incrementalism is all about taking a series of small steps toward a goal and being persistent. Even daunting tasks, from eating an elephant (a bite at a time, not that I recommend doing so, I love elephants) to cooking a frog (while doing so, up the temperature a degree at a time, and I like frogs too!) can be accomplished through small but persistent steps. Think of Agile Development, which in my mind is a form of relentless incrementalism.

CW: “Relentless incrementalism.” I like that. How does it relate to health plans and the software they use to achieve their goals?

Good question! Consider different, ultimately flawed approaches, to transforming health plans with information technology. On one hand there are those who are accused of automating “cow paths.” What’s the point if you going to accomplish the same bad workflow faster and more consistently? On the other hand some recommend “big bang” re-engineering: fix all the workflows at once, because you won’t get another opportunity after you’ve automated them. Appian BPM is third way to use IT to transform health data and process management.

CW: Huh! Now you’ve got my attention (though I must admit I do suspect where you are going with this…).

The key to transforming health plan data and process management is through relentlessly changing and improving data and process management strategies, all the way from, perhaps, cow paths, to eight lane super highways, one bite, one degree, one lane at a time. Entire sophisticated health plan software applications can be built in just week, sometimes days. And then, even after they have been deployed, you can gather data (the software gathers it for you) and then use that data to change the software (both data views and process activities) gradually and systematically until you get your desired intended level of efficiency and effectiveness. Figuratively, Appian BPM allows you to automate and then still change, subject to human users’ tolerance for change, until you eat the entire elephant.

CW: I love it! BPM software, and Appian is consistently top ranked in that category by Forrester and Gartner, is so cool.

CW: OK, let’s talk about another couple areas near and dear to my heart. First, let me note, some parallels between your background and my background. I was a premed accounting major. I took a wide variety of operations research and management science courses. I ended up incredibly excited by Business Process Management in healthcare. You were premed. You’re foray into actuarial science and predictive analytics reminds me of some of the topics in those courses. And here we both are, just before the 2016 AHIP Institute and Expo, enthusiastic about what Business Process Management can do for health plans.

CW: So, here’s a question for you. I think it may have been Einstein who said if you can’t explain something simply, you don’t understand it. What is actuarial science and why do we need it?

I am not an actuary. I don’t have that degree or initials after my name. But I am a recovering underwriter.

Actuarial science is using historical data and trends to predict future costs or incidents. Why do we need it? When you are building new products or managing existing products, actuary science allows you to look at historical costs and utilization, and when you put those together you can calculate an overall premium. Note well, actuarial science tells you what the rates should be based on historical data but actuarial science does not necessarily look at market or competitive forces. (BTW, actuaries don’t always appreciate this comment…). Basically, premium pricing is an art form and actuarial is a key input. Folks sometimes joke that actuaries drive down the highway looking in rearview mirror. To drive we need to look both backward and forward. What we seen in the mirror can predict a lot. But sometimes we need to incorporate other information.

CW: You mentioned cost. Do healthcare organizations and health plans know their true costs?

I can definitely say, as someone who used to sell cost accounting software to hospitals and health plans, that the answer is typically no. Hospitals have a much greater sense of their cost and do use sophisticated cost accounting systems, whereas most health plans do not. They typically measure medical loss ratio as an approximation. Ultimately, both health plans and their healthcare organization partners need a better and more comprehensive view into the costs associated with a patient member episode. In fact, I suspect that part of the reason we see such remarkable disparities in pricing, say $4K for vaginal delivery at a good community hospital versus $13K at the downtown medical center, is lack of accurate internal cost information (along with the fact that the patient isn’t paying that difference, rather the insurer is).

In general, providers have better overall cost information that health plans. But even there when you are a member facing a specific diagnosis or procedure, that cost/price doesn’t always add up to the overall cost/price.

To health plans, they may know cost of product lines at the level of commercial vs Medicare. But when you start drilling down toward specific products and benefit packages within product lines, they start losing accuracy, since they don’t have a good way to allocate administrative costs. Also, many companies offer both PPO and HMO products and it is important to price the PPOs higher even though the experience at a specific employer might show the HMO to have a worse claims experience.

Admin costs are maybe 10% so they have pretty good idea of overall costs, but when margins are 1-2% this is still a problem.

CW: How can BPM software, such as Appian’s, help better manage costs?

Whether about costs or care management or market intelligence, most of the software at health plans tends to be fairly siloed. Even when users can get at all the information they need, they’re using swivel chair interoperability, they’re sitting there with three screens on their task and they are looking back and forth trying to connect them.

Plus, a lot of health plans have outsourced a lot care management components. One company is doing disease management and another company is doing DME (Durable Medical Equipment) and then you have the pharmacy benefit management…. the point is you have all these disparate systems. So health plans have a difficult time integrating all this data to obtain a single 360-degree view the member and/or patient. And! Even if they can get this information, the information is so old it is not actionable.

BPM can pull data from different systems and make that data actionable by allowing the user to drill down. Appian also incorporates powerful workflow management capabilities so that tasks can be assigned when data falls outside a prescribed expected value range . As a result providers interacting with health plan get a much better impression of care managers because the care management really do have a more comprehensive and integrated real-time actionable view of patient member data.

By eliminating manual spreadsheets, care management improves and cost overhead drops.

CW: How does Appian’s BPM software help accomplish this comprehensive, integrated, real-time, actionable view patient and member data?

We’re a platform. We don’t have pre-canned applications. We come in to our customers and help them with workflow management and business processes, by using our very flexible platform application to connect and automate data and workflow silos. This platform application is low-code/no-code to it is the actual users who create their applications. At the core of our platform is the concept of a “record” which can be defined by the user. Think of Products, Providers, Members, That is how flexible the Appian software is. Or course IT is still involved, because they provide access to data in existing systems.

We’re not trying to conquer world hunger. We aim for quick solutions and then build off of those. Back to our discussion about “relentless incrementalism”… We see a lot of competitors with large inflexible applications that can take years and millions of dollars to get to a solution. We’re able come in with quick fixes, sometimes in just weeks, that then flexibly scale. Their rebuilt applications can’t be customized anywhere near as much as Appian’s BPM software, in which entire workflows can be reworked without involving traditional programmers.

Another problem with traditional approaches is that companies buy and collect a bunch of company applications that don’t talk to each other easily. With Appian all of our workflow applications automatically already talks to each other because they are on the same workflow platform.

CW What are some other advantages of the Appian BPM platform?

Well, we are the leading provider of cloud-based platform as a service. We give our customers the options of hosting their own applications or host in the cloud. Second, when you deploy a workflow application in Appian, it is automatically available across a wide variety of platforms natively, desktop, iOS, Android, etc. Both of those advantage, cloud and native mobile, is totally where the world is moving. Everyone wants to manage everything from anywhere whenever they want.

CW: I’m reminded of a recent conversation with several consultants aiming to build a practice applying BPM in healthcare (and looking at Appian for the enabling tech). We noted that Appian’s draw-workflow-once, deploy native-everywhere and especially to mobile, would be fantastic for health plan member mobile self-service apps. Any thoughts on that?

Scott: For example, how about providing health plan members with real-time update about their physicians’ schedules? I thought about this the other day, when I was comparing real-time emergency room wait times on billboards as I drove past. Why can’t we do this for physician offices too? Think about the incredible loss of productivity in this world because people show up at the doctor’s office and have to wait for an hour and a half, when the physician knew they are running later. There are plenty of valid reasons for running late. Someone shows up for a routine physical and it turns out they have some significant symptoms that need to be dealt with. Imagine a native mobile BPM app receiving a notification the physician is running late. IT provides access to internal systems, such as scheduling, and mobile, cloud BPM provides the smart workflow and mobile experience necessary to improve health plan customer/user experience.

CW: I love your idea, especially since medical office scheduling systems both drive, and are driven by workflow design and real time workflow state. A schedule is a set of timed tasks kickoffs, with additional downstream tasks, because each schedule appointment is really a collection of tasks. For example, chronic asthma versus camp physical, and so on. If providers and health plans could make task and workflow state more transparent, in real-time, and then feed that out to the folks who need to know that real-time info, it could be a big win-win, for the health plan member and health plan provider.

CW: Let’s see, premed, cost accounting, actuarial science, product development, health insurance… I’m always fascinated by how folks reflect the evolution of an industry. I know we opened talking about how you got to Appian, but let’s drill down a bit more.

Scott: Well, after my MPH from UCLA I did marketing for an HMO, then finance, accounting, underwriting, sales, business development, product management, I really like to move around, learning new things all the time. I think my favorite area is product management, because it bring a lot of disciplines together when your building and launching and managing health plan products you really have to be aware of almost everything going on in the organization, to be able to price these products accurately, you need to be able to market and sell them appropriately, so you have to provide a lot of training and education to sales and customer service folks, and ultimately you need to make these new products as understandable as possible to health plan members.

You have to understand your customer. That’s one of things thats always driven my career, you always have to take the “outside it” route to product development. One of my favorite saying about health payers is we’re too busy looking in the mirror instead of outside the window.

CW: “Outside In.” I like that. It reminds me of I’ve heard of BPM applications as “outside in” systems. IT manages IT infrastructure (networks, hardware) and supplies access to data. Then BPM applications are crafted by, or at least with direct input from users, using low-code approaches, to build from the “outside” (closest to the customer) toward the “inside,” the traditional enterprise transactions systems.

CW: Your background in product management… it seems like a lot of the folks you are interacting with now are probably trying to figure out how to create new products and services for their members.

Scott: What drew me to Appian when I first heard of it is I do not have a software background. I am more of a business and applications guy. What really intrigued me about Appian was this opportunity and ability to start with a blank slate and to connect all of these data sources together and incorporate workflow management plus the sophisticated reporting. Ultimately, it all comes down to providing timely actionable information.

CW: That word “actionable”… how does Appian BPM make health plan data actionable?

Scott: In a couple of different ways. First the data is presented in an appealing and easy-to-use reporting output with a user interface in which you can easily drill down into any and all of the data. You start out at the top of the funnel and then in just a couple clicks you can get down the level of an individual claim. You can start out looking at a specific product line and then in a matter of minutes you can look an entire class of claims, such as how much are we spending on pharmacy for HMO products that have $5000 or more deductibles. That’s just a quick example.

Second, the data is timely and coming from multiple sources. Here is one example from my product background. One of the things we struggled with was that we’d launch a new product, and, unlike manufacturing, we have a large lag between claim information being meaningful and when we could act on that info. When someone has a claim it can be two to three months before it comes into system because maybe the provider sat on it, maybe the claim wasn’t clean, so it has to go back to the provider, the point is there is a significant built-in lag in trying to observe the performance of product form a claims standpoint.

For example, Appian could link drug data (which can impact product performance), for which there is less lag, to product performance. The point I’m making is that with Appian we have the opportunity to link customer service data and product data. In the past I did not have this linked data so I had no idea whether a product was getting an inordinate number of claims kicked back or a large volume of customer inquiries. If we are able link the systems together, I could have had early warning data, in the “canary-in-a-coal mine” sense, whether a health saving account product we launched was a disaster or not. If I had that call volume data upfront we could have made adjustments to the product in a matter of weeks instead of instead of waiting nine months to start seeing some of the financial data. We could have seen the problem sooner in the customer service data.

CW: You’re getting better data sooner and then you are more easily changing your workflows and processes via BPM’s low-code to improve the data.

Scott: Right, it’s Relentless Incrementalism. It comes back to that. We’re able to keep tweaking the products workflows without have to go back to the software vendor for customization. You have much more flexibility with Appian software. Here is a quote from our CEO Matt Calkins who said, “Software in the first 30 years was about efficiency. We see the next thirty years as using modern BPM software to empower.”

CW: Fantastic. I so agree. Well, Scott, I know you have to go soon, so just one more short question. I just want five words from you. You’ve been to AHIP, the America’s Health Insurance Plan conference many times before. Now you are with the Appian business process management company. In five words, what on people’s minds at this years AHIP Institute? What will be in the air, almost symbolizing a moment in time in the history and evolution of health insurance?

Scott: …… [long pause] Can I have seven words?

Chuck: Sure!

Scott:

  • Consumer Engagement
  • Interoperability
  • Actionable Reporting
  • Efficiency & Effectiveness

Chuck: OK! I suspect you have accurately captured this year’s Zeitgeist at the AHIP Institute and Expo. And I look forward to seeing you there! What’s Appian’s booth number?

Scott: Booth #238 in Las Vega, June 15 and 16 at AHIP. Thank you very much! I enjoyed this.

Chuck: Me too. See you there.


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

The following is a special series of related blog posts about the virtues of modern Business Process Management for solving current pressing health plan and payer IT problems.

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

I’ve just completed a project. I looked at every AHIP Institute exhibitor website. I searched for a wide variety of synonyms for workflow technology (BPM, workflow engines, process orchestration, that sort of thing). Guess what? I found it. Health insurance is relatively advanced in adopting process-aware technologies. But the funny thing is that you really don’t hear about it much. I think there are a couple reasons.

First of all, BPM is often the secret sauce that makes health plan processes and workflows agile, integrated, transparent, and engaging. Second of all, because BPM is still a technically ‘geeky’ IT topic, it’s not often trotted out for marketing purposes. As a healthcare workflow geek, I’m trying to change this. Hence my series of blog posts.

For the rest of this series, I’ll list benefits of applying modern BPM technology to traditional health plan and payer IT. To put it most succinctly (but to be unpacked in later posts):

“Orchestrating information and business processes across critical back-end systems to ensure both health plan providers and members have smooth, seamless experiences in their dealings with their insurer is the key to success in today’s customer-driven health insurance market.” (@cfisherappian)


Health Insurance Is About Risk Management: Health Plans Need to Manage Process Risk Too

It’s ironic. Health insurance is the contractual transfer of risk from the insured to the insurer. This risk is transformed and managed by the insurer through a variety of technical, administrative. and financial means. But if you take a course in insurance underwriting, one area that’s not often addressed is process risk: Probability of loss inherent in business processes. Process risk is sometimes called operational risk, “resulting from breakdowns in internal procedures, people and systems.”

I think this is highly ironic! Insurance is in the business of concentrating and managing risk. But it does not always use the kind of information technology that can dramatically reduce the risk of internal procedures, people, and systems breaking down. What kind of tech am I speaking of? Modern Business Process Management.

A colleague of mine, Mike Ingrisano, wrote a great blog post titled An Application Platform Approach for Compliance and Risk Management in which he said:

“Organizations must align strategies in order to meet regulatory guidelines to reduce operational risk. Businesses of all different types cannot afford process error and data breaches, which has led to large investments to secure data and assets.

Now, combine the fast-paced world of digital business and access to new sources of data, and organizations find themselves investing even more in compliance management.

Forward looking companies are using the best of enterprise IT software to adopt applications that use defined workflows, fixed business rules and process automation to establish solutions that enable the most accurate and safe compliance monitoring to mitigate risk.”

I couldn’t put it any better. But, in the rest of this series of reasons for health plans to “double-down” on Business Process Management, I will try!


P.S. By the way, back when I was a pre-med Accountancy major (more on that in a later post in this series) we did cover insurance accounting and actuarial approaches to insurance underwriting. Plus, during my masters in Industrial engineering, we covered optimization of stochastic systems, some of which are used today to estimate future healthcare and derive necessary premiums! A great book, if you’re interested in this sort of geeky health insurance topic, is Health Insurance: Basic Actuarial Models

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

Accelerate Development of Innovative Customer-Centric Mobile Health Plan Products

In every industry, and especially in health insurance, there’s enormous pressure to more rapidly create innovative customer-centric mobile access to reengineered enterprise workflows. This, to reduce costs and increase customer engagement and health plan revenue.

Health plans have long be stuck between a rock and a hard place, when it comes to products and services based on information technology. Either you buy prepackaged software from someone who promises to solve your problems, or you hire programmers to create new applications from scratch. In the former instance, you’re stuck with whatever rate of innovation and compatibility your vendor allows you. In the later case, you can create exactly what you need, but only at great expense. And then, when requirements change, it costs an arm and a leg, to modify, if it can even be substantially modified at all.

Keep in mind this is a very different style software solution. It’s not buying someone else’s preexisting software and it’s not writing software yourself using a third generation language such as Java, C#, etc. (both of which I love, don’t get me wrong). It’s creating exactly the custom workflow-smart/work-smart workflow application you need, but doing so in what is called a “low-code” approach, so you can create and change quickly.

I have experienced this difference first hand. A couple years ago a BPM vendor and I developed a prototype hospital environmental services task management app. It combined Google Glass with their low-code app creation capability. I described what the app needed to do; they drew it on a white board.

whiteboard-2

A week later they showed the completely functional prototype. Wow! I asked to see its workflow in the process designed and they showed me this.

glass-process-model-2

Now, I’ve designed apps in a variety of workflow management systems and BPM suites, but I was still impressed with how fast they were able to turn round that fully functional prototype. I hope you’ll read about it. It did some pretty cool things.

The very best and most articulate explanation of how important low-code BPM apps are to customer engagement comes from Clay Richardson.


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

Systematically Improve Health Plan Member Customer Engagement With New Products

A major sweet spot for companies today — to both shave costs and increase customer engagement — is to externalize internal enterprise workflows via combination of cloud-based social and mobile workflow tech. When I speak of customers, I’m not just speaking of insured (potential) patients. I include providers, employers, and brokers, and even other stakeholders such as health plan employees and fraud, waste, and abuse investigator. In fact, the entire of notion of customer-facing, self-service portals will expand, eventually, to include everyone who is a customer, which is everyone, even internal health plan customers.

By “portal”, I don’t mean a website. Increasingly portal access is via native mobile apps. Modern Business Process Management applications, built by drawing workflows and customizing forms, without traditional programming in 3rd generation languages such as Java and C# is the key to rapidly creating and testing and improving new mobile health plan products to a wide variety of external and internal customers.

If you can’t find what you want or need out there among prepackaged software offering… If you’re intimidated by the thought of creating your own software solution the old-fashioned way… Really get close to and understand your customers and create new health plan products and services using a new-fashioned, low-code workflow and work platform….

… Such as the Appian BPM Work Platform. Come by to talk shop about healthcare workflow and workflow technology, and see how easy it is to quickly draw and execute native mobile app access to enterprise data and workflow.


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

Integrate Clinical And Financial Health Plan Systems to Provide Unified View Of Data And Workflow

I have an unusual pre-med major. Straight As in the number one ranked Accountancy program in the world (University of Illinois, Champaign-Urbana). I was also working on a masters degree in Industrial Engineering, focusing in usability and workflow.

I can still remember a giant light bulb going off over my head, during my first year of medical school. To maximize quality and minimize cost health IT needs to better integrate clinical and financial information systems.

At the time, in those early days, this was just an idea. There were no such systems. The clinical and the healthcare financial domains were complicated enough, and there wasn’t even the infrastructure across which to communicate. This lightbulb idea seemed like a pipe dream.

Today, of course, many people have had this idea, and there are many products and services aiming to bridge this traditional divide. I’ve been tracking the evolution for decades. There is no better single technology for integrating clinical and financial data and workflow than modern workflow technology.

This integration requires interoperability, for sure, but a special kind of interoperable above and beyond traditional notions of sending and decoding a message. It requires what I call workflow interoperability, also sometimes referred to as pragmatic (term from linguistics) or task interoperability.

Modern BPM has many sterling qualities, including the ability to rapidly prototype and then deploy mature products and then to continue to change and improve those products…. Including more useable user interfaces, because all and only data and options relevant to each step of a workflow are shown to each users… But modern BPM is also used, though mostly outside healthcare so far, to integrate wide varieties of legacy enterprise systems based on disparate technologies. If that doesn’t describe a crying need in health IT, I’ll eat my BPM hat.

“Spider in the web”! Connecting disparate systems and technologies? Need sound familiar? Healthcare IT!

SOAP, email, JMS (Java Messaging Service), SQL, REST, (and bunch of enterprise systems): sound familiar? It should remind you of what are called interface or integration engines in health IT. However, modern BPM application platforms are different, and in my mind, better, in an important way: they have customizable user interfaces. This is the task interop, pragmatic interop, workflow interop layer that is so, so, immature in much of today’s health IT. Of course, if you want to create your own UI apps, you can, because you can call into BPM platforms and return both data and workflow state (something else that is missing in a lot of health IT today).


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

Maximize Health Plan External and Internal Workflow And Process Transparency

“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!


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

Enable Health Plan Workflow And Process Change Necessary For Accountable Care

Health plan IT systems undergo three kinds of change: information accretion, system tuning, and structure transformation.

Information accretion is simply the addition of new rows of data in databases or XML files in XML based systems. In human terms, it’s like learning new phone number one day or a new joke the next.

System tuning is the gradual increase in performance, such as speed and accuracy that occurs over time. Users tweak settings, create shortcuts, and get faster themselves at use of the system through practice. One of my favorite stories about practice is the psychologist who studied eighty year old cigar makers in Miami, who started when they younger then ten years old. He measured speed and consistency. Guess what. They were still improving! Something like that happens with the “cognitive systems” we create out of combining software and people. In often cases, even badly designed software can gradually become better over time, as folks find tweaks and workarounds and themselves compensate for system design flaws.

What about structural change? That indeed is the hardest. Over time, you learn more and more facts, you get faster and more accurate, but every once in a while, old ways of doing things are no longer sufficient. The world has changes but you have not. At this point you can still in your heels, or you begin the painful job of question fundamental assumptions, in effect, attempting to redefine yourself. IT systems are a lot like this. The “structure” of an IT system is in its database structures (models) and workflow structures. Changing database models is difficult, but it generally well understood in health IT. However, workflow is a very different animal. Many health plan workflows are essentially hardcoded in if-then and case statements in 3rd generation languages such as Java and C#. Have you heard the old joke about how many programmers does it take to change a lightbulb? Only one, but in the morning your toilet and stove are broken. Changing workflow requires changing software and changing software is difficult, expensive, and dangerous.

Unless! Unless workflow is coded using high-level models of workflow, that humans can understand, but which can still be executed by workflow engines. That is modern BPMs give to software development. It is much easier to change software systems after they’ve been designed and deployed, because, essentially, they don’t have to be recompiled, retested, etc.

Take a look at one of my most popular blog posts, A Litmus Test for Detecting Frozen Workflow.


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

Harness Social, Mobile, Analytics, Cloud-Enabled Health Insurance Application Development Platforms

Healthcare is like a very large insular country that’s been closed off from the rest of the world for a long time but now it’s opening up. The same forces that are affecting many other verticals, such as social, mobile, analytics and cloud, particularly, are also affecting healthcare. This is sometimes portrayed as an almost a perfect storm. We need to be come more social. We need to become more mobile. Etc. But how, given limited resources and creaky old legacy enterprise tech, can we possibly do go in all these directions at once?

These technologies and these new industries, if you look under the hood, often the most successful platforms have workflow automation, workflow engines, the ability to draw out a workflow or to systematically improve the workflow with the data, possibly big data.

What if I told you that there was an application platform that dramatically reduces time to market, talks to your back-end systems, and has a much better user experience than traditional health IT? Oh, one more thing. Well, actually, four more things. Applications created on this platform automatically leverage social, mobile, analytics and cloud. That’s a modern Business Process Management application platform.

Those folks you hire who are already used to Facebook/Twitter style activity stream user interfaces? That’s the UI to this BPM application platform. (Plus it can appropriately consume and generate public social media content, while securing sensitive content which much be secured.) Mobile? Design your application by drawing workflows and forms. Then push a button, to generate cross-platform and native mobile apps. Analytics, especially time-stamped analytics, so important to find and eliminating bottlenecks, workarounds, and rework, are build into a wide variety of dashboards and key performance indicators. Finally, cloud. You chose. Public or private.


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