The pace of change for Healthcare has never been faster or more demanding - from ongoing regulatory and policy changes to increasing pressure to deliver superior care and coverage with the utmost of transparency while reducing costs. Find out how the role technologies such as Business Rule Management Systems (BRMS) and Optimization software will play in helping Healthcare organizations of all types and sizes build smarter processes that allow you to adapt to change faster, overcome process silos and improve patient care and safety.
Smarter Healthcare Processes in 2010
Imagine if
Healthcare Revitalized Reduce Costs, Increase Productivity, Deliver Best Outcomes
with IBM ILOG Business Rule Management System (BRMS)
and Optimization SoftwareAccording to a recent McKinsey Global Survey (May, Smarter healthcare processes are resilient processes that 2009) of 367 health care executives, 14% of payers, 2% of can help you avoid costly human error, deliver optimal providers and 6% of pharmaceutical companies said they outcomes, increase revenue and improve productivity as were prepared for ongoing reform and the new economic you better adapt and respond dynamically to the changes environment. Those who feel prepared are focusing around you. They can help you accomplish critical tasks on customer service, IT, product design and medical that many healthcare organizations find nearly impossible management as innovation areas most likely to yield the today, such as creating customized health insurance plans majority of benefits in the next one to three years. at the optimal price or remote patient monitoring systems that can quickly validate critical lab results, changing data from Smarter is . multiple sources sending alerts to hospital staffers. Smarter healthcare processes go beyond basic automation by adding intelligent decisioning capabilities for greater agility, speed and transparency. This automation not only cuts costs by reducing manual tasks and human errors-it also delivers the right answer to the right person at the right time. Smarter healthcare processes also provide for faster change, allowing you to adapt to regulatory and market changes in real-time or days, instead of weeks or months. With smarter healthcare processes, operational risks and costs are significantly lowered, clients and staff are more satisfied, and higher revenue is supported with tools for growth through better information and change management.
Imagine if you could work smarter. Imagine if you were better prepared for anything.
CASE STUDY
Optimizing processes for greater efficiencyStreamlined claims processing, rating and lab assignment.Vision Service Plan. Imagine processing one million claims achieved consistent and accurate validation and processing per month with a pass-through rate of 80+% with productivity of claims, pricing of products and enforcement of regulations gains of 30%. Imagine obtaining comprehensive audit that vary from state to state. trails of rules and decisions rendered; ensuring consistent enforcement of regulatory and corporate guidelines across "ILOG's BRMS provides the level of flexibility we need in processes and channels. order to quickly address changing business conditions and continue delivering the most effective customer service. Prior to adopting a Business Rule Management System, ILOG's software will allow us to continue generating value VSP was hard-coding rules. As a result, implementing rule from our legacy system, which is a critical factor in helping changes took months, having an adverse impact on speed make business rules a core technology throughout our to market, productivity and efficiency objectives. enterprise architecture." Kyle Kent, Director of Information Technology Architecture, Now VSP has externalized business rules using IBM ILOG Vision Service Plan (VSP)®WebSphere JRules; using rules across processes in a service oriented architecture (SOA). By doing so, VSP has
2Why do you need to invest in smarter processes now? . High operational costs and decreasing revenue from a semi-automated member enrollment process and lack of HEALTHCARE CODE BLUE upsell and cross-sell functionalities The over-riding driver facing the healthcare industry now is escalating costs which are having an adverse effect on the . Lack of customized, individualized healthcare offerings industry and nation at large. Impending healthcare reform (group plans) and regulatory changes will require that payers, providers and pharmaceutical companies streamline their processes . Elevated compliance risk - to changing regulations to ensure competitiveness, resilience and superior care (JCHAO, HIPAA, ICD-10 codes, etc. - and more on the while reducing operational risks and costs. It will require an way) requiring greater transparency across processes, unprecedented degree of operational flexibility to respond systems and channelsand adapt to these changes. . Risk of ... [download for more]
