Bizagi Healthcare Intelligence

Healthcare industry overview 1

Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
Appendix 5
Healthcare Trends, Challenges, & Opportunities

Patient
1
Quality of care improvement with empowered, better-informed
patients measuring, monitoring, and reporting their own health. This
improves healthcare care delivery. BPM allows for measurable
process metrics that can track patients and measure their outcomes.
Key Pillar: Engaged

2
Payments transition to outcomes-based (value-based) payments from
episodic-based payments. Managing enrollment process and new
Payer
3
reimbursement payment models (e.g. Medicare)
Key Pillar: Agile

Bridge Ensuring/adhering/monitoring/reporting regulatory compliance.

Increase innovation and efficiency while reducing costs. Harnessing
new technology, like analytics, instead of outdated/ineffective IT
Provider infrastructure.
Key Pillar: Connected

5
 Top Healthcare Provider Initiatives
Population Health Management
Cerner 35%, Epic 31%, Allscripts 21%
Data Analytics
Epic 33%, IBM 25%, Cerner 21%, Meditech 21%
Information Security
Cisco 61%, VMware 34%, McAfee 32%
Telemedicine
EVISIT 17%, Secure Telehealth 17%, Advanced
Telehealth Solutions 17%, Intouch Health 17%
EHR (both INPATIENT AND OUTPATIENT)
Epic 40%, Cerner 39%, Meditech 34%
Patient Engagement
Epic 37%, Press Ganey 29%, Cerner 24%
MACRA Implementation
Premier 22%, Advisory Board (CRIMSON) 19%
Optum 16%

Other notes: Revenue Cycle Management

In addition, ICD-10 Migration was huge in 2015.
Top Healthcare Payer Initiatives
Verification of Benefits/Collecting co-payments
Use a practice management system. Vendors include Allscripts, athenahealth,
– Cerner, Epic, GE Healthcare, Greenway Medical, MEDITECH, McKesson Corporation, NextGen
Healthcare Information System LLC
iVerify, eEligibility
Pre-Authorization- Should be 100%
Coding review/claim scrubbing
Clean claim submission rate
Claims Denial
Adjusted Collection Rate
Reimbursement ratio: Closed vs overall claims
Negotiation fee
Average Paid Percent, Medicare allowable, compensation for top procedures, average reductions percent

• Embracing new business models and care delivery

• Making better use of IT and Data
• Enhancing care coordination
Increase communication between patients and providers across the spectrum, insurers can drive costs
down even further.
• Reducing administrative costs
Through automating existing manual business processes (85% of respondents) with the need to
reduce rates of human error associated with manual processes (57%) as key to reigning in expenses.

Homegrown IT built-on 40 year old technology is using a Band-Aid approach. However, it does not make
sense to upgrade the complete IT system, only targeted enhancements.

Net-net: Bizagi BPM will make payers more profitable

Worldwide Healthcare IT 2017 Predictions
● Prediction 1: Ransomware is part of a larger regulatory
and compliance initiative so that hospitals are not under
attack.
● Predictions 3 & 4: Data and analytics will become the
cornerstone of healthcare, and patients will be playing a
more active role in the collection of data. Can also be
called the unification of patient data.
● Predictions 6, 8, 9: Patient engagement and IoT-enabled
biosensors translate into patients acting like consumers
and willingness to give data. Patients will have their health
plans calibrate according to their current health state.
● Predictions 2 & 5: Process automation, even robotic, will
increase efficiency and lower costs of non-user value-
added functions.
BPM + RPA are complementary
RPA for efficiency, BPM for effectiveness

Routine tasks Complex tasks

Bizagi Healthcare Framework
Bizagi Healthcare Community

Security Bizagi 11 DBP Orchestration Layer Bizagi

Consulting for
Identity ELECTRONIC HEALTH RECORD (EHR) Integrations Healthcare
management
Legacy BPM
Wrapper Clinical

EMR/continuity of care

Clinical data repository

Radiology Information
Business Intelligence
transformation

Patient scheduling
Access

Medical billing
Patient portal

Systems (RIS)
E-prescribing

Back-office
management (SSO) Productivity Apps

PACS
Lab
via
ConnectorXchange
Managed Services
Clinical data access
assurance (PHI/PII) Enterprise Contenet
Management (ECM)
via
Open Systems Architecture ConnectorXchange
HIEs
HIPAA compliance Vendor-neutral archive and repository for patient information
ERP Apps (SAP/R3)
via
Virtualized Infrastructure ConnectorExchange
Risk management
and GRC
Business continuity, disaster recovery, and data protection Drag-and-drop via
WidgetExchange
Maturity Model to Adopting “Big BPM”
Other solutions:
• Systems (i.e., information technology) ● Workflow-oriented
● Simplistic, task-oriented
● Short-term
● Function-specific
• People (change management) ● Departmental/workgroup
• Process (workflows)
Above the line

Below the line

BPM & digital process automation
• Intent (AI/machine learning) ● Advanced workflows
● Complex tasks
• Data (analytics) ● Ongoing, (e.g., RAC)
● Industry specific (e.g., healthcare)
● Across departments

Use cases for Bizagi healthcare combining machine learning and analytics:
● Predicting hospital bed rotation
● Assessing patient readmittance risk; leads to healthcare provider penalties
 The Evolving Provider

Analog Digital

Email & Conversations Custom code Off-the-shelf Workflow Enterprise DBP

Traditional Epic
Application KiSSFLOW Bizagi
Allscripts Process Maker Appian
Development
Cerner Pega
CloverLeaf K2
In-house Third-Party
Manual intensive Automated

Light, process flow BPM/DPA

 The Evolving Payer

Analog Digital

Email & Conversations Custom code Off-the-shelf Workflow Enterprise DBP

Epic KiSSFLOW Bizagi
Allscripts Process Maker Appian
Cerner Pega
CloverLeaf K2
In-house Third-Party
Manual intensive Automated

Light, process flow BPM/DPA

Healthcare industry overview 1
Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
5
Patient-first, but not patient only
Option: Patient-centered healthcare
Self identified, diagnosed, and
reported

Commercial, Blues,
Medicare Part B
PAYER
Drivers: Spending & All the patient observes. Is it good or bad.
Government

PATIENT
KPI: CSAT and WOM
Drivers: Science, Technology, and
Innovation
PROVIDER
Doctors, Hospitals,
ACO, Alternative
Healthcare Providers

Driver: Cost, Quality, and Access

EXTERNAL
From Workflows to Complete, Integrated Healthcare
Use Case: Provider
Emergency Room Visit Using Bizagi’s
Easy-to-Use Advanced Workflows
• Patient registration, check-in, accessing
medical records, assessment, & risk
• Identification of conditions based on
patient data
• Automated determination of drug
interactions
• Test results notification
• Hospital bed rotation
• Discharge readiness planning:
communications, care planning, remote
Pictured: Emergency Room Visit
End-to-End Workflow via Bizagi Modeler
monitoring, and readmission avoidance
• Scheduling and prescription
management
• Financial clearance – proof of medical
insurance
• Patient transfer between providers

Net-Net: Reduce admission time from patient drop-off to discharge while alleviating readmittance
Use Case: Payer *
Member Enrollment and Claims Eligibility
● Claims eligibility, pre-authorization, routing and processing, and status
● Case management required to handle applications
● Medicaid application, appeal, and re-certification process
● Medicare application process
● Member enrollment and plan management
● Enrollee/insured case/record management
● Claims adjucation/payment
● Membership/provider/plan sponsor services
● Evidence-based actuarial analysis
● Waste, fraud, and abuse prevention & detection
● Agent portal for quotes and contracts
● Member/enrollee portal for wellness management, benefits selection, and coverage status

● Ensure the right information gets to the right people in real-time

● Collaboration cross departmental collaboration
● Common operating vision for all stakeholders

● Reducing processing time for standard claims by x%

● Generating an average ROI of x % of each internal process improvement project
● Increases customer and provider satisfaction by freeing claims process to focus on more complex
claims

Net-Net: Bizagi makes payer more profitable and simplifies the processing of applications.
Use Case: Patient
The unification of data and patient reported outcomes furthers self-healing
Alternative title: “Healthcare as a team sport”

● Chronic disease management

● Monitoring health levels
● Patient reported outcomes
● IoT for healthcare workflow
optimization

Net-Net: Can reduce hospital readmission and

Net-Net: Self-service leads to an empowered patient
optimizing care can avoid non-urgent use or ER
Use Case: Patient
Why is patient empowerment vital

Medi-Cal ER visits
up 75% over the
last five years
Bizagi – Healthcare’s DBP Choice
Why Change?
Inefficiencies in healthcare lead to lost revenue and additional costs incurred. DBP mediates any
such efficiencies by automating tasks. BPM reduces the time-to-value as compared to
installing a new application.

Why Now?
Changing business models, increased volume transactions of visits, and payment penalties make
this the proper time to implement a DBP.

Why Bizagi?
Can bring process into the tools that users are familiar with today. Interoperability: The average
shadow IT healthcare worker uses 26 applications. Integrations with everyday, common
applications via ConnectorXchange connectors.
An Agile platform, Bizagi represents the “Lowest-code” enterprise DBP allows for ease-of-use via
drag-and-drop forms and widgets. Simplicity: Performance: Fastest speed to implementation
Scalability: Capture, retain, reuse, and improve on documented processes (e.g.,
templates/widgets)
Allows for repeatable, managed, and optimized processes. Can start with a simple departmental
level workflow, and expand to the entire enterprise healthcare organization.
Healthcare industry overview 1
Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
Appendix 5
 Resources
• http://www.performancedesignlab.com
• Fierce IT Health
• https://decisions.com/company/
• http://healthcare.mckinsey.com/sites/default/files/the-trillion-dollar-prize.pdf
• PwC Healthcare Study
• OECD
• https://hbr.org/2015/02/the-biggest-u-s-health-care-challenges-are-
management-challenges
• American Hospital Association http://www.aha.org/research/index.shtml
• HIMMS 17
• http://www.mckinsey.com/business-functions/digital-mckinsey/our-
insights/disruptive-technologies
• BPMNext 2017 conference
– BPM 2017 – 201: Outlook for the Next Five Years, Nathanial Palmer, BPMNEXT CoChair
– The Top 10 Technologies That will Impact BPM in the next Five Years (or Don’t Get Caught with
your technologies down), Jim Sinur, Aragon Research
– The new wave of automation, MWD Advisors
– The Great Migration: How to Survive the leap from BPM as we knew it to the era of the digital
workforce, Clay Richardson, Digital Fastforward
– The Recipe for Successful Digital Transformation: Derek Miers, Structure Talent
Bizagi Healthcare Landscape
Bizagi Offerings and Markets Market Size and Growth
• Bizagi 11 BPM Digital platform–Suite • BPM market size projected to reach $23 billion by 2024.
of Bizagi Modeler, Bizagi Studio, and 14.2% CAGR from 2016 to 2021 –Markets&Markets. NA
Bizagi Engine. dominates 30%+ share in 2015
• Both on-premise and SaaS options • BPM for hospital management systems, including bed
management and patient monitoring, are anticipated to be
key factors fostering growth in healthcare.
• Appian and Pega are the leaders, followed by IBM.
Appian has 280 customers with 37 of Fortune 500
companies and recently has an IPO.

Key Competitors Market Position and Momentum

• Appian • Bizagi appears on both Gartner’s MQ and Forrester WAVE.
• Pegasystems • It’s the only solution that appear on the ‘Challengers’ portion
• IBM of the MQ, a testament to Bizagi’s strength in execution and
price/value ratio.
• Oracle
• Bizagi’s “freemium” model was introduced long before the
• Software AG term was coined and popularized.
• TIBCO • The oldest kid on the block, with a strong track record
• K2 • Both Appian and Pega have identified healthcare as a
• Lexmark vertical with dedicated real estate:
– www.pega.com/industries/healthcare, and
– www.appian.com/industries/healthcare
Healthcare Terminology
Healthcare Healthcare IT Bizagi’s Three Pillars
Mandate/Security ● Business Intelligence 1. Agile
● ACA/PPACA – Affordable ● CIS (Clinical Information 2. Connected
Care Act System) 3. Engaged
● CHIP DICOM
● EPCS - e-Prescribing of
● EHR/EMR
controlled substances
● E-prescribing Value propositions
● Fraud
● HIPAA ● HIE ● Citizen developers
● HITECH ● HIS ● Cloud-first, but not
● ICD-10 ● HL7/FHIR cloud only
● MACRA ● KLAS Research ● Lowest code
● Meaningful Use ● Lab Integration
● MIPS – Merit Base Incentive
● Medical Billing
Program
● Protected Health Information ● mHealth/mobile health
(PHI) ● PACS (Picture Archive
● Smart card/patient card Com. Sys.)
● Patient Portal
● Patient Scheduling
● RIS – Radiology Information
System
Extended Healthcare Use Cases
Accessing EMR/EHR systems Medical Card Exchange
Admission notification via patient administration system Medical bill processing/triggered email
Alternative health and services Medical device tracking
Automated determination of drug interactions - EHR *** Member enrollment for payment and provider ***
Call center for healthcare provider Optimizing care and avoiding non-urgent use of ER
Care manager Patient access to medical records
Care planning and discharge readiness *** Patient assessment/risk stratification ***
Casement management to handle applications *** Patient on-boarding ***
Chronic disease management with patient reported outcomes Patient data migration and processing
Claims pre-auth./eligibility, consultant selection, and status *** Patient record storage
Clinical trial program Patient registration and check-in
Commercial claims testing audit Patient transfer between providers
Compensation processing and automated disputes Personal health record (PHR) portal
Credentialing of temporary health workers Physician referral, directory, and second opinion
Discharge communications and readmission avoidance Physician access to patient clinical data anywhere
ER Visit – triage via ER consult Policies and procedures application
Employee adherence of policies and procedures Preferred drug prescription audit – EHR
Expediting Medicaid application approval Pre-visit/patient intake via PAS
Financial clearance – proof of medical insurance Printing application workflow
Financial tasks management Recruiting, job placement, licensing, credentialing, travel and
Healthcare providers regulatory and compliance accommodation of temp. workers ***
Health care claims processing *** Medicaid application, appeal, and recertification process*
Health insurance exchange Remote monitoring
Hospital bed rotation *** (example of machine learning) Remote nursing work management
Hospital administration for back-office processes Remote and secure express care for patient communication
Identification of conditions based on patient data Reporting by doctors
IoT for healthcare workflow optimization (wrist ID) Resource scheduling of employer shifts
IoT for inventory management (pharmacy) Scheduling and prescription management
IoT for medical device integration Test results notification
Insurance data automation and claims processing Training/certification programs for employees
Intelligent referral letter triage Wayfinding apps - Patient centric
Knowledgebase system
Trends in BPM and Digital
Process Automation
“Many organizations are either beginning, or in the midst of, digital business transformation
initiatives. We expect that only 30 percent of these efforts will succeed. To be part of that 30
percent, business and IT leaders must be ready and willing to innovate rapidly from a business
model, business process, and technology perspective.”
Julie Short, Research Director, Gartner

“Through 2017, insufficient business process management (BPM) maturity will prevent 80
percent of organizations from achieving the desired business outcomes from their digital
business strategies.”
Julie Short, Research Director,
Gartner

“The primary driver for the rise in DBP is the need to make businesses more responsive with
faster and more effective processes or applications while dealing with frequent change and
increasing demands for customer-driven approaches.”
Jim Sinur, VP of Research and
Research Fellow, Aragon Research

“Aragon expects that the DBP market is poised to grow into a $50-billion market by 2021.”
Jim Sinur, VP of Research and
Research Fellow, Aragon Research
Value Driver Description
Improve Business Effectiveness & Improve business collaboration across organizational boundaries, and enable employees to be more productive by giving them
Productivity (Grow Revenue) greater insights, richer context and a single view of customers.
Manage Risk and Regulatory Compliance Protect high-value information yet at the same time provide greater transparency on data and processes mapped to regulation and
(Mitigate Risk) compliance requirements, automating much of the approach to mitigating risk.
Operational Efficiency and Process Identify areas for process improvement, orchestration between disconnected systems, core processes or supporting processes, all
Improvement (Reduce Costs) with the goal of reducing costs and increasing throughput.
Improve Business Effectiveness & Productivity (Grow Revenue)
Business Situation (Challenges) • Disconnected systems prevent having a single view of a customer
• Organizational silos ensure no cross group collaboration, inability to support across customer lifecycle
• Lack of alignment between executive vision and day-to-day execution across organization
• Existing systems are too complex and take too long to implement or change
• Cultural resistance to change and fear of failure
Consequences • Threat of challenger brands or more innovative firms taking market share
• Poor customer experience will lead to reputational risk and potential negative PR (social media campaigns)
• Cost of doing business escalates and is less responsive to increasing customer demands to be more digital
• Loss of customers and loyalty as they switch to competitor products or services
• Inefficiency in dealing with customer requests, lack of opportunity to cross-sell upsell
• Caught in trap of wanting to change but unable to due to constraints, hits employee morale and increase staff turnover
Bizagi Position (what needs to be done) • Connect legacy systems by creating a ‘wrap around’ integrating systems, data and streamlining processes to derive greater agility
• Executive sponsor responsible for aligning organization to the vision and goals and day-to-day execution (transformation)
• Identify key processes that can be automated and map across the customer lifecycle
• Use Studio to align Business and IT to map common goal and approach to what needs to be fixed
Benefit • Reduce customer waiting times
• Increase customer satisfaction scores
• Create true customer loyalty (retention strategy)
• Drive down the cost of doing business
• Grow revenues as more successful at attracting and retaining customers
• Increase average revenue per customer
Proof Points Customer Onboarding:
• Old Mutual | Challenge: Disconnected systems, silo businesses (loans, cards, mortgages, savings), advisors unable to meet all
customer needs | Solution: Bizagi wrap around silo systems integrating to UX | Result: Net Promoter scores up 15%, Customer
resolution up 30%, branch queue time down 9x, customer onboarding time cut 10x.
• Mentis Neuro Health | Challenge: Patient onboarding taking 2-3 weeks, wait times for patients left in hospital too long, losing out
to other healthcare providers | Solution: Needed to quickly scale to support growth plans, worked with Partner InnoVelocity,
business and IT worked together to map the processes | Result: Up and running in 90 days, worked on 3 week sprint cycles
thereafter based on user feedback, Patient intake dropped from 2-3 weeks to 2-3 days, Mentis have now seen a 21% increase in
Patient demand.
Manage Risk and Regulatory Compliance (Mitigate Risk)
Business Situation (Challenges) • Manual processes for monitoring transactions
• Deep collaboration required between departments to ensure consistency
• Hard to maintain SLAs due to unpredictable nature of processing tasks
• Often lack of transparency leading to unexpected outcomes
• Paper-based processes prevent responsiveness and agility as regulation requirements evolve
Consequences • Inconsistency in how transactions are conducted, leading to breaches of policy
• Misalignment between departments
• No process aligned to regulation requirements, no ‘safety net’ to ensure policy met
• Inability to manage policy and regulation changes proactively, always behind the latest compliance and regulation requirements
Bizagi Position (what needs to be done) • SPARK methodology, identify a core process to map in it’s entirety
• Ensure project leads are trained and involved in process design (Business and IT) using Studio
• Ensure alignment to Exec vision and day-to-day deliverables
• Review and iterate as the project progresses
Benefit • Meeting regulation and compliance requirements
• Seamless and automated processes improve collaboration across the organization
• Greater transparency leads to improved reporting and insights driving better business decision making
• Extend participation and visibility to end clients, boosting quality and customer satisfaction scores
Proof Points Industry Policy & Regulation:
• Stone Coast | Challenge: “Back Office” operations, accounting, and valuation services require deep, daily collaboration between
clients and administrators, Needed to move away from paper-based operations to digital services to boost competitiveness while
cutting operational costs | Solution: Over the course of six weeks, the project team designed and deployed their first solution
covering Cash Movement, worked closely between business and IT to map the cash movement process | Result: With the first
application in production, Stone Coast feels it has already proved ROI. The BPM COE is now working with other teams to tackle new
projects, Cases move from business teams to cash teams without any paper, Greater data accuracy and straight through processing.
Strong data integrity naturally makes the team more efficient and effective, Customer service teams can now extend participation
and visibility to end clients, boosting quality and net promoter scores.
• infoCaja | Challenge: Needed to implement a new system to meet changing regulation (MiFID), Needed to deliver without
impacting profits | Solution: Working with PwC to implement Bizagi Studio | Result: Implemented a new process within 4 months 6
less than expected, infoCaja were able to quickly adapt BPM processes to each banking affiliate, This allowed them to reduce the
projected costs of complying with MiFID by 80%.
Operational Efficiency and Process Improvement (Reduce Costs)
Business Situation (Challenges) • Lack of process visibility due to paper-based processes
• Inconsistencies in the way business is conducted
• Slow, cumbersome and unresponsive to customer requests
• Disconnect between systems, silos of data and no intelligence
Consequences • Rising costs with growing inefficiencies and increasing competition
• Poor experience for customers expecting intelligent, personalized experiences
• Financial penalties due to defaulting on policy and regulation requirements
• Inability to make key decisions based on data
Bizagi Position (what needs to be done) • SPARK methodology, identify a core process to map in it’s entirety
• Ensure project leads are trained and involved in process design (Business and IT) using Studio
• Ensure alignment to Exec vision and day-to-day deliverables
• Review and iterate as the project progresses
Benefit • Speed to deliver new automated processes
• Responsiveness in delivering customer products and services
• Support for delivering more digital experiences with the ability to bring new capabilities such as AI and BOT services
• Greater transparency of processes allows for greater reporting and insights, leading to more effective troubleshooting
• Ability to effectively control costs and evening reducing in places
Proof Points • AgFirst |Challenge: Streamline and standardize loan approval processes | Solution: Replace existing Infopath forms with workflow
engine, mobile BPM solution for staff working remotely | Result: Loan approvals closed 60% faster, 1st process delivered in 16
weeks.
• Generali | Challenge: Renewal time slashed by 50%, Making the leap to automated and efficient processes and workflows has
delivered immediate benefits. Bizagi's system architecture enables reuse, meaning multi-country, multi-language deployments
become more effective with scale. The initial project cost saving was 60% when compared to other systems, expected to rise to
90%.
 IDC Health Insights Main Research Areas
for 2017
• IoT
• How does Healthcare providers progress towards IoT platforms?
• What are the top IoT platforms in healthcare and what are their capabilities?
• What are the top services for IoT: e.g. Integration services and how are they applied in healthcare?
• Integrated care
• Is there a real market for integrated care solutions across countries?
• What are the trend in patient data management?: 360° view of the patient vs. specific clinical pathways
and what are the main drivers?
• What are the best practices in value-based care?
• How does healthcare providers empower patients, so they move from passive recipients to active
participants?
• How do you assess the maturity of integrated care initiatives or organizations?
• DX
• Legacy – how does legacy challenge DX initiatives in healthcare?
• Cognitive
• What are the main use cases and users for cognitive solutions?
• What are the preferred delivery models of cognitive capabilities?
• What defines the different types of cognitive capabilities and how are they adopted?
• Is there a lack of trust in cognitive capabilities and why?
• Digital Hospital
• How are hospitals progressing toward a higher maturity as digital hospitals?
• What is the role and best practices for healthcare providers when engaging with a local system integrator
and implementing an international based platform?
IDC’s ACO Maturity Model

Ad Hoc Opportunistic Repeatable Managed Optimized

● Analytics, ● Demonstrated
workflow, and IT efficiency
patient ● Mobile
engagement technology for
technologies. patient
engagement
POV: Embracing the Provider’s Employees
Nurse and Administrator
Healthcare Challenges
Industry-Agnostic Challenges Healthcare-Specific Challenges
1. Greater agility and productivity 1. Increase Efficiency ***
2. New Payment Models
2. Increase efficiency
3. Cost Reduction ****
3. Consistent, repeatable, and efficient
4. Quality of care improvement ***
outcomes
5. Controls re: privacy
4. Reduce expenses
6. Pricing revision
5. Drive growth 7. Business model realignment
6. Ability to make better and faster 8. Balancing innovation with cost
decisions 9. Harnessing new technology
7. Navigating the complexity of regulatory 10. Internal mindset (change) – HBR ****
compliance 11. Outdated/ineffective IT infrastructure – HBR
8. Mitigate regulatory compliance risk 12. Cultural resistance ****
9. Minimize redundancies 13. Misalignment with physicians
14. Ensuring regulatory compliance with everchanging
10. More satisfied customers regulations***
11. Lowering costs or reducing costs of 15. Alignment of divergent IT (integrate, not consolidate)
operations 16. Accelerating pharma clinical trails and streamlining FDA
12. Increased revenues/improved revenues approval
17. Managing enrollment process
13. Motivate employees
18. Monitor and improve care delivery
14. Boost/improve visibility 19. Identify and avert resource bottlenecks
15. Accelerated innovation 20. Automate the identification of critical conditions using analytics
16. Increased speed to market 21. Improve methods of gathering and reporting data
17. Penetration and expansion into global 22. Monitor cost, quality, and compliance metrics
markets 23. Automate non-value added tasks and eliminate non-value
added ones
Infused Terminology
BPM Terms BPM Terms
• Composite Process Application
BPM Terms BPM Terms
• Standard Deviation
• Activity • Computer Aided Software • Model
• Standard or Normal Bell-
• Activity Cost Worksheet Engineering (CASE) • Model-Driven Architecture
Shaped Curve
• Ad Hoc Workflow Systems • Continuous Process • Modeling
• Sub-processes
• Administrative Workflow Systems Improvement • .NET
• Subsidiary Business
• AI/machine learning • Core Business Process • Nodes
Processes
• API • COULD Process • Object Oriented
• Super-system Diagram
• Asynchronous Process • CRM • Packaged Applications
• Supplier-oriented eBusiness
• Balanced Scored • Dashboard • Parallel Process
Applications
• Batch Processing • Data Warehouse • Portal
• Supply Chain Council
• Benchmarks • Database • Process
• Supply Chain Management
• BPEL • Decision Point or Diamond • Process Analytics
(SCM)
• BPM Software • Development framework • Process Architecture
• Swimlane
• BPMN • Digital Business Platform • Process Automation/Robotic
• Synchronous Process
• BPSIM • DMAIC • Process Designer
• Tasks
• BPMS/iBPMS • DMN • Process Diagram
• Three levels of organization
• Business Analytics • ebXML • Process Engine
(Performance Framework)
• Business Intelligence • EDI • Process Instance
• Total Quality Management
• Business Activity Framework • Enterprise Application • Process Management
• Transaction or Production
• Business Activity Monitoring (BAM) • EAI • Process Measures/Process
Workflow Systems
• Business Process • ERP-Driven Design Output Measures
• Transitioning to a new process
• Business Process Design/Redesign • Exceptions Processing • Process Modeling
• Transformation
• Business Process Improvement • Gaps and Disconnect Processing • Resource Optimization
• UML
• Business Process Management • IoT/Internet of Medical Things • Rules Engine
• UDDI
• Business Process Modeling • IS Process Diagram • Rummler-Brache Methodology
• Use Case Diagram
• BPM Platform • ISO 9000 • SaaS BPM
• Value Chain
• Business Process Management • Java • Scorecards
• Web Services
Initiative (BPMI) • J2EE • SHOULD Process
• WSFL
• Business Rules/Business Rules • Junction/Junction Bar • Silo thinking
• Work portal
Management • KANO Analysis • Simulation
• Workflow
• Business Process Outsourcing • Key Performance Indications • SIPOC
• Workflow model
• Business Process Rengineering (KPIs) • Six Sigma
• Workflow Reference Model
• Case management/adaptive • Knowledge Management • SOAP
• Workflow System or Engine
• CMMN • Lean Manufacturing • Software Engineering
• XML
• CMS • Measures Hierarchy • Software Requirements
• XML Business Process
• Collaborative BPM • Middleware • Software as a Service (SaaS)
Language
Weighing Bizagi’s Strengths
1. Cost
I think is the biggest strength.
1. Scalability
What does scalable mean? # of users? Number of workflows?
1. Interoperability (Integration)
I like the notion of being able to work with existing BPM solutions.
This should be a part of the architectural diagram.
1. Performance
How do you measure performance in BPM?
1. Availability
In hardware, this is usually the system being up?
1. Management
Which product manages? Can you use a third-part tool?
1. Security
Which modules and/or features allow for adherence?
Elements of BPM
• Analytics embedded in enterprise apps
• Potentially lighter-weight process workflows
• Case management for managing complex and evolving situations (called
cases). Usually requires fixed milestones and. They tends to be long running,
complex, emerging, and involve deep knowledge and skills.
• Goal directed flows, situational flows where the goals or milestones change it
provides a good solutions. With rapid change, goal directed processes win the
day.
• Little process drivers – First mile content management journeys are a popular
use to capture, sign, and manage documents as they hit all of the required
stops
• Cross skill/departmental flows are the life blood of organizations. These are driven by
low or no code and light weight process capabilities.
• Event response where, expected or not, trigger off appropriate actions to deal with the
situation of patters of events. This is where canned process responses can be
inventories and pulled out when needed.
• Harmonizing work, content, and data tend to flow when action is taken in
response to attaining a set of goals or responding to events.
BPM Quotes
• Basic investment in BPM Suite can yield significant returns. Gartner
states that by simply “making the current-state handoffs, timing, and
responsibilities explicit, productivity improvements of more than 12
percent are normally realized.1
• 78% of projects see an IRR of greater than 15%2
•The same repo indicates that these projects were deployed quickly
(67% in less than six months, 50% in less than four months.)
•Advantages: Grow revenues quickly while containing their growth in
headcount. Process more with less effort and higher quality.
 BPM Vectors
Basic efficiencies that a more controlled process brings, the next RPA for efficiency, BPM for effectiveness
step is to make the process more effective. There are variants that
are often less scripted. For example, handling exceptions, or
making better decisions. This could include claims disputes. For
regulated processes, as it in healthcare, this level of control and
consistency provides an added benefit. The avoidance of fines Efficiency
because of incorrect or inconsistent execution of the process. Or Perhaps because of manual effort, poor hand-offs between departments,
the lack of timely execution of a process. and a general inability to monitor overall progress. One healthcare
Effectiveness company realized savings of 21,000 hours (10 FTEs) for their employee
on-boarding process in the first year.

Agility

The ability to change and quickly adapt or modify processes is essential. Customers change
processes 4-7 times per year. The drivers could be internal or external. New partners supports a
different way of doing business. Regulations can also require you to change processes. Agility
benefits typically support adapting to regulations faster, as to not incur chances of a fine or
penalty. In addition, the ability to change a process to accommodate unforeseen events. Claims
process and approval are very important, especially during certain windows like December.
Benefit Example
Efficiency

Eliminate Manual Data Entry Reduction in time to add a new employee record into HR systems
from 9 hours to 10 minutes.
Reduce Process Cycle Time Reduction in compensation processing timing for 12,000 sales reps
from 33 days to 7.
Reduce Manual Analysis/Routing Elimination of 80% of the manual work previously required to route
invoice exceptions to the appropriate resolution teams.
Effectiveness

Handle Exceptions Faster and Better Evolve process from saving 5% of distressed shipments to saving
70% - yielding $2M per quarter in saved revenues.
Make Better Decisions Better review process results in $3M saved in billing dispute write-
offs that would formerly have just been processed because the
process was poorly controlled.
Consistent Execution CSAT improvement to 92% based on proactive tasks that help
ensure the home loan process executes better and faster.
Agility

Faster Regulatory Compliance Change customs related processes after 9/11, within 90 days to
comply with new federal regulations for better shipping visibility.
Support New Business Models Ability to change shipping partners within 10 minutes in core process
allows manufacturer to change primary shipper every quarter –
based on best bid provided.
Benefit Example
Eligibility Determination of eligibility, Medicaid, HIE

Calculation of premiums, co-payment amounts, and health incentive

payments.
Online advice tool (Basque’s Health’s Self-Assessment Tool)

Interactive guidance for contact center staff to triage patients,

generation of treatment plans, and follow-up steps (KP On-Call)
Top Healthcare Compliance Initiatives (Provident Consulting)

Meaningful Use Requires adoption of EHR systems. However, HER implementations

have failed. Many are not user-friendly or fully compliance. And now
there is also patient use of EHRs.
Privacy, Security, and Technology BPM can help with the audits

MACRA More incentive on value and quality or quantity. Requires changes in

data reporting and records, as well as collaboration with other
departments.
Medicare Investigations Medicare reimbursement frauds involving $900 million. Compliance
leaders will need to improve their Medicare documentation and
justification processes. BPM bolsters compliance. A link can be
made between BPM capabilities and compliance efficiencies