By Mala Ramakrishnan on Jul 03, 2013
The U.S. health care industry is in a period of rapid transition as both public and private organizations respond to the far-reaching implications of the 2010 Patient Protection and Affordable Care Act (PPACA). This progressive legislation brings sweeping changes to payers and providers at the federal, state, and municipal levels, with a consequent impact on the fundamental business processes that these organizations depend on to provide services to patients. Among other things, the legislation requires each state in the U.S. to build or adopt a health insurance exchange (HIX) to broker and manage insurance plans, measure eligibility, automate enrollment, and transfer health care information electronically among participating organizations. Each HIX must integrate with a number of existing social services systems and handle myriad details related to billing, collections, reconciliation, taxation, reporting, and customer service.
Coordinating all of these processes and information is an ongoing challenge—and there are significant monetary incentives associated with doing it properly. For example, health plans can reduce costs by simplifying the claims approval process by automating the workflow.
Figure: Automating Claims Approval Process
BPM for Big Data Management in Health Care: BPM technology helps health care organizations to synchronize and improve their big data processes. For example, public health officials can study trends in flu vaccinations by monitoring citizen compliance on a national scale, and combine that insight with aggregate claims data to monitor the impact of various vaccines on that years most troublesome strains of influenza. This knowledge can help officials predict future needs for additional vaccines based on population health statistics. Big data analytics can also help individual patients who have agreed to let disease management companies closely monitor their chronic conditions on a constant,real time basis.
BPM for Apps in Health Care: One of the key values of BPM is to forge links among critical information systems, fill process white spaces and make the entire business more efficient. The idea is not to replace existing systems or applications but to leverage those systems to define end to end processes that fill the gaps between applications.Any activity that is performed in a BPM application is auditable, efficient and enhances visibility across the continuum of care. In health care this becomes particularly valuable as several applications emerge and are accepted to fasten the process of complying with the new health care imperatives. Filling in the white spaces with BPM can save costs, improve operational efficiency and provide visibility.
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