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Top 25 Wikipedia Health Topics

The IMS Institute for Healthcare Informatics published a report in January called “Engaging Patients Through Social Media“.

One of the things it highlighted is the incredible use of Wikipedia for healthcare information.  People are typically going to Google and looking for a disease.  Based on Wikipedia’s page rankings, this often leads them there.



Now, what makes this more interesting is the article in the BBC News which says that 90% of wikipedia articles on health contain errors.

Of course, the trick in reading the article closely is that it says they found that “90% of the entries made statements that contradicted latest medical research”.  What’s the difference?  Well, we know that it takes years for evidence-based medicine to become adopted within healthcare.  So, how long does it take the latest medical research to get updated on all the sites?  What I would love to see is a comparison of Wikipedia to WebMD, Ebix, and Healthwise.  That would be telling.

The 15 Year Old Technology Missing From

I talked about my experience trying to use the site day one. I honestly hoped it was an anomaly but it doesn’t seem to be.

But, as I think about and the general benefits selection process, I see two huge gaps.

Back in 1999, I was working with a company called Firepond. The had what was called a product configurator. At the time, I was at E&Y and Empire BCBS and several other Blues hired them to build a tool for brokers. The tool sat behind a really slick web interface which allowed the broker to ask a consumer less than 10 questions. They would move a sliding bar across the screen and it would dynamically rank their plan options to tell them what was the best option for them to buy. It seems like that wold be great for and

What we were missing then which Big Data might actually help us solve now is individual claims data. This is what drives me crazy when you have to pick your benefits at work. Why can’t I upload my benefits information and have a tool actually tell me what to buy? If I had my claims history plus a predictive model, I could make smarter decisions about how to select my benefits.

Do You Have A Communications Waterfall?

For those of us that have ever worked in IT, the idea of a waterfall based design always implies a less than optimal strategy.  But, I’m beginning to see an applicability of this framework for communications.

Let’s look at a scenario for a prescription refill where you’re trying to optimize for the lowest cost intervention.

  • Identify targets for an intervention
  • First push a message to all those that have downloaded your mobile application (~10%)
  • Second push a message to all those that have opted into your SMS reminder system (~6% with some overlap)
  • Third push a reminder to those that you have an e-mail address on file
  • Fourth send a reminder using an automated outbound call with the option to refill during the call
  • Fifth (maybe) use agents to reach out to the patient
As you go through this “communications waterfall”, there are several things to think about:
  1. How do you leverage permission-based or preference-based marketing here?
  2. How do you integrate your channels so that if you send an e-mail which isn’t opened after 48 hours (and the message is important) that it automatically escalates to the next channel?
  3. How do you cross-promote across channels to drive greater use of the self-service channel?
  4. What permissions do you need to use each channel?
  5. What are the HIPAA / PHI limitations within each channel?
  6. What is the correlation between preferences and behavior?
  7. If you know that certain segmentation and messaging increase the likelihood of action, how do those insights manifest themselves in each channel and does that change your interest in using a particular channel?
  8. What data do you want and can you get from each channel to understand the response curves?

Handling A Mistake: Chevy’s Versus Jilly’s Cupcakes

I think in healthcare we are finally all realizing that the customer experience matters (#CEM).  The question is how to standardize and optimize that experience in scale and on a personal level when the people delivering that experience are call center agents, receptionists, physicians, pharmacists, pharmacy technicians, etc.  It’s the people in the field not those sitting in the corner office.

And, since exchanges will make healthcare a more individual buying experience and satisfaction is tied to loyalty, this is something we all need to figure out sooner rather than later.

As a family, we recently had a few experiences that show the two extremes here:

  1. Chevy’s.  This is a Mexican restaurant we frequent.  We go there probably once a week to the point where we have a preferred waiter (who knows our order before we sit down) and know the server and the manager.  Service has been great for years, but it’s begun to go down.  One night, it took 3x as long to get our food with no explanation, and we had to leave without eating.  The next time, the hot plate of food had some oil jump off and burn my wife (to the point of them getting her burn spray and ice).

    This seems like a great opportunity for an intervention by the manager.  But no.  They didn’t do anything.  They still charged us for the meal including my wife who’s leaving with an ice bag.  Oh well…time to find a new restaurant.

  2.  Jilly’s Cupcakes.  Here’s a cupcake store and restaurant that we’ve never been to, but we saw that they recently won on Cupcake Wars.  We decided to book a small birthday party there to decorate custom cupcakes.  When we show up, they are surprised.  Apparently, their reservations person wasn’t very good and got fired so they’re dealing with us and another party of 25 that have showed up unexpectedly.  A key opportunity for success or failure.

    I thought the General Manager did great.  She stepped right up and came up with a plan for us.  We got to go behind the scenes and meet the cupcake making team.  We got to customize our own cupcakes and really enjoyed it.  It was probably more memorable that the original party would have been.  In this case, I’m willing to drive people to her store and will send her a personal note to thank her.

One of the big points here is that it’s easy to either lose a lot of credibility or build up some credibility.  But, customers are fickle.  Much like companies strive for Six Sigma from a process perspective we need to keep that in mind from a customer experience perspective.  It won’t always go perfect, but how do you enable your staff and train them to respond quickly to keep the consumer happy and engaged.

Your Refill Logic Has To Be Dynamic

I signed up for an auto-refill program recently.  It quickly made me realize how stockpiling happens.  (Stockpiling is where a patient ends up with a large supply of their medication over time…typically due to refilling too soon.)

Imagine the following:

  • I get a 90-day supply of a medication.
  • At day 75, I get a refill of the medication.  (I have 105 days left at this point.)
  • 75 days later, I get my next refill.  (I now have 120 days left at this point.)
  • 75 days later, I get my next refill.  (I now have 135 days left at this point.)
The problem here is what I would call “static refill logic”.  The auto-refill program is triggered to fill the drug 75 days after it was last filled.
What is needed is “dynamic refill logic” which calculated days supply on hand.  This isn’t easy, but it makes a lot of sense.  The risk (if I’m a mail pharmacy) is that without this, I get gaps-in-care and/or create a short-term retention issue.
Imagine the following:
  • You ask me to refill, but I have 30 days on hand so I say no.
  • Now I forget to refill on time and I have a choice – (a) skip my medication for a few days or (b) go back to retail.  Neither is ideal for the mail pharmacy.
BUT, all of this could have been fixed if the logic was dynamic and they called to confirm my refill when I had just a few weeks left (i.e., enough to be thinking about refilling but also enough to have time to get it shipped to me).

Are You Using A Mystery Shopper / Caller Progam?

One of the programs we used very effectively at Express Scripts to test our call center was a “mystery shopper” program.  Much like the name implies and has been used in retail for years, this process had a person calling into the call center and asking a series of questions about plan design or other aspects.  This was a great way to see if training had worked and understand the experience that our members had. 

I honestly don’t remember exactly how we set this up to pass the authentication process, but I believe we probably created “dummy” members in the eligibility file with a name and member ID that could be used by the mystery shopper. 

Those calls were then ranked based on quality of response, consistency of response, first call resolution, and other aspects.  This testing process was continued until the quality scorecard passed a certain level. 

With the increasing complexity of plan design, this is something that everyone should look at.

Why Integrated Communications Are Better?

This morning is a perfect example of why integrated communications are better.  What do I mean by this?  I mean where a communication campaign is designed using rules to coordinate events across multiple channels.  Still too mumbo-jumbo…Where companies can interact with consumers across channels (e-mail, voice, print, web, call center) and create a seamless experience.

Here’s an example…

This morning, my kid’s school is closed due to snow.  [Although the snow has passed and they’ve already plowed the side streets.]  When I checked the Internet at 5:15, it wasn’t closed.  At 5:40, I got the call that it was closed.  BUT, the call comes on my home line, our home business line, and both our mobile phones.  Somehow it didn’t wake the kids, but it could have.

I don’t really care about the over-communication in this example, but in a professional setting, this would seem like overkill and potentially a waste of money.  In an integrated communications example, it might work like this:

  • An update was put on the Internet and everyone was sent an e-mail
  • At 5:50, the system would identify anyone who had either not opened their e-mail or had not visited the website (assuming they had cookies on their PC for tracking website visitors)
  • At 5:50, the system would call the primary number to play the recorded message by the principal
  • If there was no answer by a live person or the entire message was not listened to, the system would move on to additional numbers

This is always one of the big discussions we [Silverlink Communications] get in with clients in healthcare.  What are the rules for escalation of communications?  How do I track data in an integrated data set?  What is the right timing between communications?

This is critical.  Sending people a letter and a call or a letter or a call (for example) is pretty easy.  Determining the next action based on their final disposition in the initial outreach is not.

Of course, the other question this begs is how many companies actually track return mail.  I know a lot of companies don’t.  If it keeps getting returned, they’re not processing this return mail and taking the bad addresses out of their member database.

Process…The Key to Success

“We get brilliant results from average people managing brilliant processes. We observe that our competitors often get average (or worse) results from brilliant people managing broken processes.”

Sources: “Decoding the DNA of the Toyota Production System,” Steven Spear and Kent Bowen, Harvard Business Review, September-October 1999

I think this is so important especially in times like this when we are all focused on doing more with less. It is critical to understand how your process works; how to apply automation; and how to learn and improve it over time.

I came across a presentation from a webinar I gave back in 2007 on Business Process Management (BPM) which made me think about this. (Some of the vendors in this space include Pega Systems, Lombardi, and Appian.)  It’s also very relevant given Gartner‘s recent report on Business Process Outsourcing (BPO) in the payor space.

“Healthcare insurers should view business process outsourcing as a means to achieve business transformation while minimizing risk. Therefore, using BPO for nondifferentiating business processes is an essential step toward achieving competitive success and business growth.” Joanne Galimi in Healthcare Insurers Business Process Outsourcing Trends (January 23, 2009).

Finding a business partner that can work with you to understand your processes, understand what measures matter, help you improve your approach, and that is willing to take risk based on your success is important.   I always encourage people to not think of companies as vendors but as partners that bring them innovative ideas and help them iterate to improve.  I don’t believe in the big bang theory that I can do it right the first time and never need to change.  That flies in the face of everything that has been observed in different industries.

Upcoming Webinars

If you missed it last week, I am giving a repeat performance of my webinar on retention.  I am going to talk about driving customer satisfaction and building loyalty to improve retention which is and should be a hot topic for everyone in healthcare. (Sign up here for the 23rd at 1:00 EDT)

Additionally, my peers are giving a webinar on closing the adherence gap which should be another hot topic for many of you.  (Sign up here for their sessions on April 30th and May 22nd)

Convergence: MiCoach

As a runner, I found this interesting new product c/o The Hospital Impact blog.  The video is pretty engaging on the MiCoach.  It blends a GPS technology with an MP3 player with a personal coach with a phone and links it to a website for tracking.  If I wasn’t a runner, I would have some skepticism, but those are all relevant things.

When I run, I have a GPS on my wrist, my iPod, and often (for long distances) a phone in my pack.  I then download my running to my PC which has some great reporting tools but limited analysis tools.  The personal coach response will vary by person as different people respond to different “encouragement”.  I may have to put this on my wish list to try out at some point.

Now, of course it requires specific shoes, which I think is an issue for runners.  I have been using the same brand of shoes for 4 years.  And, I go out of my way to get them.  There is no store in St. Louis that sells them so I have to order them every 3 months or so.

I was also somewhat confused on the website about how to get the products.  There was no buy here function (unless I missed it).

But, I think the key here is the idea of device convergence and the blending of clothes with technology.  Just one sign of the many interesting things to come.

Is Prior Auth Purely For Sentinel Effect?

In talking with a few PBMs, it is clear that they approve 90%+ of all prior authorization (PA) requests that come in. With that, I instinctively think of two questions:

  1. Why do it at all?
  2. If you’re going to do it, why have humans involved?

I haven’t seen the data on prior authorizations and how many people who hit a reject at the point-of-sale (POS) actually get a fill ever, but I imagine it is like step therapy (ST). With step therapy, only 50% of the people who hit the reject get a claim. (As I have mentioned before, 90% of those that don’t get a claim get samples, buy an OTC, pay cash, or find another solution.) But, the huge step therapy savings that plans and employers realize is not really about the movement to generics but about the lack of claims. Reduce your claims by 50% in a category and you save money.

So, I have to assume that PA has a similar role. The people that don’t really need it (or don’t understand the process) will either pay cash or find another solution, but they won’t have their doctor call the PBM for approval. (aka – The Sentinel Effect) Those that really need it (and understand the process) will call in and get approved.

So the next question is why are people doing this. I have heard from some pharmacists that it has to be humans so that physicians can’t figure out the approval algorithm and “game” the system. Somehow, I doubt that is what they are staying up at night trying to figure out. And, the agents taking the calls are following a very tight script anyways. I have argued for years that either a website or an inbound voice IVR that asks questions and based on answers determines the next question until the physician either fails the request or gets approval. Only exceptions would require a live person.

$200K Word Change

I was talking with a friend last week who has spent all his time at small, nimble companies. He was amazed at the challenge of getting something prioritized and completed in a big IT shop where process can often kill flexibility. There are lots of reasons for this – doing all the small projects would use all the time, the big projects have great ROI, the risk of something going wrong is much higher, etc. There are also dozens of reasons why you want to figure out how to be big and nimble.

When I was focused on this technology challenge (see old blog), I used to talk about SOA (service oriented architecture) and BPMS (Business Process Management Systems) where you could create a process abstraction layer that sits above your existing legacy environment. This abstraction layer allows companies to make rapid changes within a controlled environment.

The one example I always use is when we decided to move from the word “member” to “patient”. To do this systemically, you have to change call scripts, job titles, system fields, metadata, contracts, letters, etc. Of course, you also want to change the website. When I put this request into IT, I got back an estimate of $200,000 to make that change (or 2,000 hours at $100 internal cost transfer per hour). How do you justify the business case for this other than strategically and qualitatively? And, given a shortage of resources, why would you focus on this rather than some other web development project?

It was an interesting and frustrating process. We obviously wanted to show clients that we had fully transitioned to focusing on patients. We wanted to show consumers that we were thinking of them differently. But, we were stuck in the project prioritization process for scarce resources.

This ability to drive branding through every interaction and evolve your branding as you learn about your consumers will be an interesting challenge to an industry like healthcare where companies are slow to change and change takes time.


I read an article this morning by Chris Graham on Multichannel Marketing which I thought was a great framework for several marketing related items I have been thinking about.  He talks about the following:

If you don’t know what all these mean, it doesn’t surprise me, but I think MOM is the key.  Chris describes it as MCM in a box.  I think it is the key of how direct marketing processes operate.  You need to understand the customer.  You have to know what channel they respond to.  You have to know how to effect their behavior.  You need to have proven messaging (DAM) that you can pull from.  And, this needs to be part of a process so that it is not simply a one-time ping of that customer. 

From Chris’ article…”So let’s look at an MCM scenario: The customer makes an enquiry through his digital satellite TV remote in response to an advertisement; immediately an email is sent back to them, a personalized MMS confirms the dispatch of a personalized printed document specific to their geographical area, a call center flags a “to do” for seven days time, from which a personalized micro Web site is automatically generated with the latest product literature specifically for the products they want to look at.”

Medical Devices and the 10 Faces of Innovation

Today, I unsuccessfully searched for a smart consumer device that would link process and medical monitoring.  I am sure it is out there, but I couldn’t find it.  The opportunities are numerous.

Imagine having a device that monitored your blood sugar levels and sent off messages based on your current levels.  The messages could be to home to make something different for dinner.  It could be a note to yourself to remember to snack earlier in the day.  It could be a note to your physician keeping them aware of your situation.  I think that the opportunities for consumer centric medical devices that have embedded intelligence and plug into some type of BPM or process centric model are great.

Art_of_innovation This made me think of one of my favorite companies – IDEO.  If you don’t know them, you should.  They have been involved in all types of innovation and product design.  The Art of Innovation by Tom Kelley is a great book about their process.  You should also read the article about the different types of innovators in Fast Company.

This article categorizes them into Learning, Organizing, and Building personas.  Which are you?  I am either a Cross-Pollinator or a Collaborator (in my mind anyways).

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Is Marketing a Process?

Is marketing a process or really a bunch of sub-processes that are part of other end-to-end processes?  I was looking at how to automate the different marketing functions (new product development, product management, pricing, research, marketing communications, and voice of the customer) and realized that most of these are simply part of a bigger process.

The process that consumes most of these is the lifecycle from idea through sales through billing.

Here is a quick picture I came up with to describe the marketing function from a subprocess view.

Marketing_overviewPerhaps you wonder why this matters?  Architecturally, it matters if you are building a system and want to connect processes.

Technology-wise, it matters if you want to focus on a SOA (service oriented architecture) approach where you can re-use components.

Organizationally, it matters to understand how data and tasks flow and how to optimize your investment.

Process-wise, it matters to understand best practices.

As I have talked about several times, the fear with any improvement is sub-optimization which often happens when you focus on a subsection of the entire process.

Here is a article to read on sub-processes (a little technical for some of you)

BPI Example

I often get asked the question of what I mean by BPI or Business Process Innovation.  I often talk about how process can create a competitive differentiator for companies.  There is technical innovation, product innovation, cultural innovation, etc.

Here is a quick example.  I am a die-hard Quicken user.  Every time I get gas, I print my receipt, carry it around for a day, and then enter it in the computer.  To Amoco, Mobil, BP, I am someone what “invisible” as a customer.  They don’t have a relationship with me.

Why don’t they think about their role in the process.  It wouldn’t be too hard to get me to register my cards with them in return for them sending me an e-mail with a digital receipt.  They could even send me a file that I could launch which would place the transaction in Quicken for me.

This benefits me (simpler, no risk of losing the receipt).  And, it benefits the gas companies because they now have a relationship with me.  They could include a coupon for goods inside the store or a car wash with the receipt.  Next time I go in, they can now cross-sell me.

This is what I mean by BPI.  Thinking about the process differently and looking at how you can impact the process in a novel way to capture more value and add value to the constituents.

Asking a 90-year Old to Use E-mail

You can use business rules in many ways.  I think one of the most important areas is in customer segmentation.  There is initial segmentation around which customers to target with which offering (e.g., cross-selling, multi-variate analysis).  There is secondary segmentation around which message will compel them to act on an offering (e.g., campaign management).  Additionally, there is segmentation around which channel they are likely to respond to (i.e., e-mail, text message, letter, call, web, TV, radio).

My 90-year old grandmother who does Masters swimming called earlier this week because she had a letter asking her to send in some information to them via e-mail.  She can barely use a phone without silver dollar size numbers so asking her to respond using e-mail is ridiculous.

As you design processes that spawn communications or create messaging, thinking through the multiple levels of segmentation and the supporting rules is critical.  Ideally, some type of “artificial intelligence” by which the rules are automatically updated as the system learns is ideal.  Linking success (i.e., outcomes) to the logic used allows you to refine and improve your communications and marketing over time.

Marketing Process

Interestingly, yesterday, I heard from five different companies about using BPM for marketing. So, I have spent the day (and will continue to spend time) flushing out the marketing processes and the value proposition associated with improving marketing processes and managing them using BPM.

For example:
* Reducing the cycle time of product development
* Easing version control of public relations
* Minimizing pricing errors
* Using data triggers to initiate processes (e.g., competitive intelligence initiates change to promotional materials)

Pricing struck me as a good one since yesterday my wife was looking at a golf club (Taylor Made R7 driver). At the store we buy from, it was $300. Online and in the paper at the store down the street, it was $190. Our golf pro called the Taylor Made rep and found out that the other store had jumped the gun. The discount wasn’t supposed to begin until this weekend.

Now, both the store and Taylor Made are going to sacrifice several days of higher prices all because the pricing coordination didn’t happen right. Coordination of releasing information across channels and partners is a big deal but something that a basic rules engine could manage.

I put together a high lever pricing process (see below) that I am going to work up into a demo. Overall, I am going to try to put together the story for automating the entire marketing value chain. I think it has a great story leveraging DFSS (Design for Six Sigma) and Stage-Gate and a few other best practices that are out there. More to come…


Continue reading

Healthcare Appeal Process

Healthcare is such an easy target for BPM opportunities.  I am living one right now.

In December, we had to refill a prescription for my son.  It happened to be 2 days before Christmas.  Since I had switched insurance carriers, Aetna now required a PA (Prior Authorization) for the drug (although my son had been on it for a year).  By the time, I got the message and tried to call the physician, he (a specialist) was gone until the new year.

I had to fill the prescription and pay cash since I needed my son to stay on the drug.  So, in January, I downloaded the appeal form; completed it; had the pharmacist complete it; and mailed it in.  In March, I heard back from Aetna that it was rejected.  Fortunately, after working in the industry, I know that you can appeal it multiple times, and I understand the coding and reject process.  After talking with a call center agent, I had them change some of the notes on the claim to reflect the situation with my physician and appealed it a second time.

It is now May, and I got a letter telling me they haven’t finalized the review process but have received my appeal.  I should know something in 60 days.

This has to be easier.  All parties have to be frustrated.  The Aetna PBM has to spend expensive pharmacist time reviewing these multiple appeals; answering multiple calls by me; and sending me multiple letters.  My employer and Aetna will eventually have to pay a claim from 2006.  I am out the cash and spending valuable time trying to work the process.  And, none of us have much if any visibility into the number of appeals, the average cycle time, the status, and how to change this process.

BPM could help with this in many ways including simply streamlining the process.

eRx with BPM?

From a pharmacy perspective in healthcare, one of the more elusive solutions has been e-prescribing (or eRx).  There are numerous companies (e.g., Allscripts, Prematics, Purkinje, RxNT, Zixcorp, iScribe) that have solutions and many more that have died over the years.  When I was at Express Scripts, we funded RxHub which was an industry solution by the PBMs (Pharmacy Benefit Management companies) to facilitate eligibility checks and other electronic transactions.

The goal of e-prescribing is to eliminate safety errors associated with wrong prescriptions, drug-drug interactions, non-compliance, and many other issues.  Anyone who has ever seen a doctor’s hand written prescription can understand.  Here is an example from the Prematics site:Vertical_erx

Some of the managed care companies have spent millions rolling out these solutions.  In general, most of them are adopted as interesting tools and then disgarded by MDs at the first sign of trouble.  Honestly, there is very little in it for them unless they have a quality bonus.

Physicians are one step removed from the filling of the Rx.  They care about patient safety, but it is hard to change their working habits.

So, I wondered the other day whether BPM could solve the problem.  Doctors all use some type of system for managing their office.  This ranges from simple systems that just capture data to much more involved PPMS (Physician Practice Management Systems) or EMR (Electronic Medical Record) systems.

Could a BPMS use a process to:

  1. Push data from the physician’s desktop using messaging queues;
  2. Run the data through some eligibility and adjudication logic;
  3. Identify issues real-time; and
  4. Then either route it back to the MD for questions or send it to the patient’s pharmacy of choice.

An interesting spin on this would be to do an auction at the end where pharmacies could bid on the prescription (e.g., BidForRx).  Patients could create customized rules in the BPMS solution that processes the claims and managed the auction based on their interests.

Just a thought.  This seems to make adoption easier (no change in process); deployment cheaper (no ongoing support); integration cheaper and easier; and add additional value (patient involvement).

Pricing Lifecyle

A key part of the 4Ps of marketing (price, promotion, product, and place) is pricing.  One of the complications with pricing is its lifecycle.  The biggest example that we all see around pricing is with airlines.  You can pay all kinds of different prices based on supply and demand, time or day that you buy the ticket, and other factors.

But, clothes, for example, follow a more traditional lifecycle where they initially are listed at the “list” price.  Over time, you see additional markdowns until either the floor price is hit or the clothes are sold off to the secondary market or sent to outlet stores.

Depending on the company, much of this pricing discounts are very rules based.  In some companies, it is more analysis based looking at what is selling and why.  This would be an easy process to automate.  The rules based discounting process could look for triggers (date, inventory level, etc.) to initiate a pricing discount and then launch a subprocess for updating stores and the system of record.  For analysis based processes, the process could link the analysis and the decision making to either automate the steps or potentially automate the decision making as the analysts make their decision making process more transparent.

BPM for Marketing

I have just recently talked with a few clients about using BPM technology in the marketing area.  As one put it, this is the one of the last bastions where companies look at process.

That being said, there are lots of opportunities for process management within marketing:

  1. Most marketing groups are involved with new product development.  One of the most popular product development methodologies is Stage-Gate.  Stage-Gate provides an approach for evaluating products with multiple checkpoints.  This can easily be managed via BPM and the company even licenses the process to BPM vendors.
  2. A lot of marketing groups use internal and external resources to deliver on projects.  This process could use a tool to manage workloads, track status, and share documents.
  3. The advertising process is filled with ongoing dialog and sharing of information.  You can’t always put a process on the creative steps, but you surely can automate and eliminate some of the paper surrounding bidding, creative templates, knowledge sharing, and refinement of the end product.
  4. The entire MRM (Marketing Resource Management) space could be served by BPM.  MRM basically is a project / process management approach for marketing specific tasks.  There are numerous vendors providing COTS (Commercial Off The Shelf Software) for this.

From what I have seen (and my experience in marketing), this has been an area slow to adopt technology and not on the radar for BPM discussions.  So, internally and externally, you may want to engage your CMO (Chief Marketing Officer) and bring them up to speed on BPM.

The E-mail Process

I usually think about applying BPM to paper intensive processes.  I think I need to expand that focus to include e-mail centric processes.  Not that it wasn’t inclusive before, but talking about it in those terms seems to bring out new opportunities.

Just in the past two days, I have met with a Fortune 100 and Fortune 400 company where this [e-mail] is their process management tool.  At the one, their documents are completed and e-mailed around the company for work.  If one person in the chain is gone, the whole process is on hold.  No one has any visibility to the process and where the work is.

At the other, one person told me that they get 600 e-mails a day because everything – HR, procurement, identity management – are all done by paper forms which are e-mailed around.  Again, no visibility to status.  No way to escalate if the person is gone.

These are low-hanging opportunities for business process management.  With simple use of forms, a basic process, and automated workflow, these processes would be more efficient and controllable.  Once you add BAM (business activity monitoring) to the solution, you would reduce cycle time and make staff much more efficient.

Creating the automated coach

A typical struggle that a large company has is how to deal with mid-market companies or average customers.  Typically national clients or repeat customers get great attention, but it is hard to give this same customized attention to an average customer even if they might be your next big customer.

This challenge is exasperated by the difference between your average customer service or account management professionals and your top performers.  How do you embed the DNA of the top performers in that of the average employee.

When I was at Express Scripts, I used to half-kiddingly suggest creating an “automated pharmacist”.  All of our clients from individual groups of 200 people to the Department of Defense with 9M members all wanted a pharmacist to provide them with personalized recommendations based on their member demographics and triggered by market events – e.g., Prilosec goes OTC (over-the-counter), Zocor loses patent, a new drug comes to market.  There was no easy way to do this.

Additionally, all of us who use the healthcare system want more personalized attention from our physicians, nurses, pharmacists, physical therapists, etc.  But, of course, we don’t want to pay a retainer to have them on call.  We just want them to somehow manage to give us proactive advice.

Any professional services firm (e.g., accountants, lawyers) has this same challenge.  When something changes (e.g., long-distance excise tax), how and when do they communicate this change to all of their clients and help them assess the impact of this change on their business.

Companies with distributors or retail branches have similar challenges from communicating downstream or upstream changes across the different constituents to help them prepare in advance.  For example, if your advertising company calls and tells you the ad copy will be 2 days late which means the collateral will be printed 3 days late which means that the supermarkets installing your new display have to shift schedules to have it set up 4 days later…

Well…it didn’t hit me until this morning, but Business Process Management (BPM) technology could help here.  We could map these processes til the cows come home, but that won’t do any good.  Streamlining these processes, capturing the rules, embedding logic into the process, codifying best practices, and integrating these human and system centric solutions can create this automated intelligence.  It is not artificial intelligence but it can help manage your clients and create real personalized value.

Let’s stick with the pharmacy example:

  • Image that Claritin announces it is going over-the-counter
  • This trigger from the Pink Sheets kicks off an internal process
  • The process queries the claims database to identify the number of patients with Claritin claims
  • The internal process sends an e-mail to all the account teams within your PBM (pharmacy benefit manager – e.g., Express Scripts, Medco, Pharmacare, Caremark, Argus) or MCO (managed care company – e.g., Aetna, Cigna, Wellpoint, BCBS)
  • Based on rules or election by the account teams a subsequent e-mail is sent to each of the clients
  • The client can opt-in to a communication to their members
  • This approval triggers a mail merge of a pre-approved letter which is sent to all the affected members (patients)

This is a service that every client wants.  They want the hand holding, but it is hard for large companies to give this to every client.  There is not time enough to have all these discussions, talk about customizing the letters, wait on customer approvals, or manage things through e-mail when people are busy and unavailable.  A BPM approach to this embeds the logic and creates a personalized flow triggered off key events that can initiate dormant processes that are waiting in the background.

CVS / Pharmacare / MinuteClinic

What a perfect opportunity.  CVS (retail pharmacy chain) owns Pharmacare (pharmacy benefit management company) and owns MinuteClinic (onsite medical clinics).  Right now, if you went to a clinic or physician or hospital, you have created one customer record.  At your retail pharmacy, you have another customer record.  The PBM that processes your pharmacy claims has another customer record of you.  And, the health plan with which you are affiliated has a fourth customer record of you.

There has been talk for years about Personal Health Records (PHR) or Electronic Health Records (EHR).  Although some of the technology exists, the integration and adoption challenges are barriers.  That being said BPM offer some of the core benefits.  The patient can be viewed as having one customer record that follows their path of care.  Each constituent along the way adds information and can view information based on HIPAA guidelines and role based security.

If such a solution made sense, this would create a great opportunity for CVS.  They could capture patients at their clinics and learn about them.  This information could follow the prescription to the retail pharmacy where they could learn more about the patient.  Eventually, they could use the diagnosis data to help inform the treatment suggestions or pharmacy-patient dialog about side-effects.  This data could then be integrated at the PBM level to capture other data from mail pharmacy use and other retailers.

CVS could see where people stop taking therapy.  MinuteClinic could see where people don’t fill prescriptions.  Triggers could be created to generate automatic outbound calls or e-mails or care management calls for follow-up.  But, each event is part of a case management framework so they have history and information to build upon each other.

If you leverage some model like this from a CDHC (Consumer Driven Health Care) perspective, you enable the patient to manage their care by setting reminders for refills, electing to have information pushed to them based on diagnosis codes, seeing reports about costs versus payments, and having the ability to track status of open items – labs, payments, prior authorizations, etc.  In a competitive industry built around complexity, there is a way to simplify it for the patient.

Patient as Process Instance

Anyone who has ever been sick knows that our healthcare process is inefficient.  There is lots of paper.  There are numerous handoffs.  Things get dropped.  Patients spend lots of time resolving things that should be automated.  Well, I am not going to give you the answer since there are millions out there trying with limited success.

But, I do think a BPM framework (strategy, process, and technology) makes sense here.  First, I think you need to abstract the healthcare industry.  Think of each component (MinuteClinic, doctor, hospital, outpatient clinic, home health nurse, pharmacist, insurance company, PBM, case manager, therapist, acupuncturist, personal trainer) as a system within an overall company.  Second, think of the patient experience as a process filled with logical steps and driven by rules.

Conceptually, you have a systemic view of healthcare that parallels a typical process view of a inter-company process.  You have constituents.  You have a process.  You have rules.  You have systems (i.e., companies).  Ideally, each of these systems (e.g., the physician’s office computer) could be accessed by the process using a common language.  (I am speaking to a Services Oriented Architecture (SOA) without going there technically.)

Each time a patient engages the system through a doctor’s appointment or a visit to the ER, a new process instance would be initiated.  The patient could be tracked through the process and know where they were at any time.  All the constituents would have shared data (i.e., a personal medical record) about the history of this patient.  Rules would be codified so hopefully there were less errors or miscommunications.

Now, who pays for this is the question which I am not going to debate.  But, the system is broken and finding some fix is important.  I think this is a lens through which to view the problem.

Outbound IVR Process

Here is another example from a previous life.  As part of my direct marketing program, we used to use automated outbound calls from a company called Silverlink.  They do a great job with the calls and providing management tools to monitor the calls.  But, a BPM solution could have helped us to automate the process around Silverlink.  The following scenario is how it could be:

  • When a new client is enrolled, the set-up form could include a checkbox for participation in the direct marketing program.  The set-up form and process would also capture client approval for co-branding along with a jpg of their logo and other information to personalize the communications.
  • That checkbox could initiate a process which pulled in client data from the set-up form, ran a query of their member data (name, address, phone number), and automatically enrolled them in the direct marketing program.
  • A rule could exist that would check against any stipulations in their contract to determine whether they were active participants in message approval or whether they had already signed off on the general messaging within the program.
  • The existing CRM system could be used to manage the campaigns or a BPM rules-based system could be used.  In either case, the system is looking at each case or process instance and determining which direct marketing path to follow, which letter to use, when to trigger a call, and providing status to the call center agents.
  • Any change to the messaging (client, patient, regulatory, research based) could be made and all notifications and approval requests would be triggered by the system and managed by the system.
  • Coordination with outside vendors such as Silverlink would be automatic and rules could be used to monitor their call volume versus inbound call capacity to determine automatically how to throttle up or down the number of events.
  • Stoplight type triggers could be used by the system to monitor different events and rules written to trigger process changes or initiate problem resolution automatically.

To some people this may seem very basic, but I know I am not alone in managing many of these processes with lots of paper, implicit rules, offline databases, and other tools.  The discipline of BPM as an approach and the technology to automate and manage it can add a lot of value here.

Letter Approval Process

In a previous job, I managed a direct mail program where we mailed several million pieces per year.  It was a complex process which included getting client sign offs, interrogation of data against a customer segmentation model, managing several hundred letter variations, and coordination with a inbound call center for responses.  Although we had a decent Visio diagram for our process and well defined SLAs (Service Level Agreements) and rules, a BPM system would have been ideal.

Let me just focus on the letter approval process.  Several things drove letter changes – regulatory changes, corporate branding changes, lessons learned from our campaign results, client requests, physician requests, and consumer requests.  Each letter change went through my product manager who had to sign off.  It then went to marketing for sign off which often took at least one revision back to product management.  It then went to account management for sign off.  It then went to legal to sign off.  And, many of them then went to clients for sign off with many edits in between.

If someone was out of the office or busy, this could take weeks if not months to complete while the total time of the task was probably about one day from start to finish.  The challenges were the need for discussion and supporting documentation around each change (e.g., why is it better to call someone a patient versus a member); access to the previous versions to understand other changes; and a way to know who had signed off to date.  With a BPM system, this could have been managed very easily taking advantage of the workflow, the business rules for routing and escalating tasks, reporting for understanding the status, document management, and collaboration for a discussion tagged to the process instance.

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