Taking Control of the Healthcare Business Process Flow

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January 08, 2021

Anna works in the busy claims processing department at an insurance company, where a hundred thousand claims are disbursed each day. A central claims processing engine allows the firm to handle the high workload. But, though the technology does its work efficiently, Anna still faces problems with tracking the claims through to completion. The reason – complex offline factors that arise from a combination of multiple technologies, manual processes, and a network of beneficiaries, which combine together to make it difficult for Anna to individually track the process from claim filing to disbursal.

For example, conducting a credit check is undertaken in a separate department, which Anna does not have any visibility into their process. Without clear visibility, Anna can’t control her own work schedule efficiently. She finds herself going back and forth between departments and their specific applications to complete each of the claims processing tasks. The complex chain of interactions is a result of multiple variables, much of which are beyond her control. Such dependencies affect Anna’s productivity, the department’s key indicators, and above all result in pain-points that impact the end customer.

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Anna’s situation represents the same challenges that thousands of healthcare payers and providers face every day as they struggle to balance rising dependencies with efficient operations and costs. As a consequence of the tremendous influx of technological upgrades in the past few years, organizations are now scrambling to manage the interdepartmental silos. This challenge calls for a re-evaluation of the interdependencies within the wider healthcare ecosystem of people, processes, and technology, to optimize the processes and streamline operational productivity.

Reimagining Healthcare Business Process Optimization

Smooth business processes are key to driving better patient outcomes, this is the greatest priority for the healthcare industry today. New technologies will continue to speed up processing times. But, without aligning these technologies across the critical chain of processes and measuring the process efficiency, these improvements can cost more than the perceived benefits.

A major reason is that most organizations are quick to adopt process solutions in the form of Software-as-a-Service (SaaS) models and cloud without understanding the full process dependency chain. While these solutions indeed lower technology costs and provided scalability, their reliance on external systems adds to the complexities of the enterprise value chain. When things go wrong, Healthcare providers and payers have to sift through data from multiple systems and stakeholders, which increases the risk of duplicate records.

Understanding an end-to-end connection/integration of the disparate points is crucial for any firm that wants to get back control and ensure complete accountability of the critical process chain. This is an intrinsic step towards achieving stable and sustainable operations. After all, when something goes wrong, the end-customer will only look to the end provider for answers, with little tolerance for deflecting excuses that blame a vendor or a SaaS glitch.

Real-time process observability and measurement of the workflow performance is necessary to assess potential risks. Regular observations enable businesses to foresee critical gaps and proactively respond to ensure customer trust. In Anna’s case, real-time updates on the credit check would have given her ample time to reorganize the timelines and notify the client earlier. As a result, the relationship between the payer, provider, and end-customer would remain strong and rooted in trust while maintaining operational efficiency.

Within the healthcare business, there is a need for a system that enables it to predict potential deviations and ensure timely alerts from across the value chain. An effective business process observability solution that can extend beyond typical organizational processes. Such a system needs to integrate critical processes from all stakeholders using intelligent data from every link in the value chain and, in turn, generate better oversight and actionable business insights. This is what HCL’s DRYiCE iControl is designed to do, creating the right level of observability solution for this challenge.

The DRYiCE™ iControl Advantage

DRYiCE iControl (iControl) is part of the DRYiCE Software suite of platforms and products. It delivers real-time observability across the whole process on a 24x7 basis that not only improves the execution of critical business workflows but also creates operational intelligence that helps stakeholders make customer-centric business decisions. The key purpose of this solution is to empower healthcare business owners to avoid negative consequences.

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With iControl, HCL has converged business and IT to empower organizations and make them better prepared to offer effective patient care. By having a set of key controls spanning multiple data ecosystems that have clear dependencies, iControl offers key support to business problems and helps solve issues in real-time within the system. It also enables leaders to control business outcomes with greater agility through the integration of key controls across departments and projection of process function by using the ‘people, process, and technology’ approach.

As a watchdog, iControl provides more than just performance metrics for critical business flows. It offers an accurate prediction of systemic alerts, process failures, and analyzes the business impact of modifications made to the entire business process. iControl can also send warning notifications/alerts of impending healthcare IT system failures.

iControl provides a layer over the top of your systems that integrate into all the different technology tools, including automation, machine learning, and cloud. All leveraging your existing investment in technology. This enables healthcare intermediaries and providers to manage issues upstream and downstream with clear visibility of individual flow performance.

Taking Control of the Future

Once you understand the performance of the business process, you can then spend your money wisely on further automation or process reengineering efforts. iControl’s flexible architecture allows multiple tool integration. As a result, payers and providers can have a granular view of all process segments and benchmark them against set key performance indicators (KPIs) against defined SLAs. With all the right observational controls in place, it becomes simpler to identify potential fall points as real-time notifications enable proactive issues remediation and ultimately deliver the promised product on or even before time.

The result is a significant improvement in service level, and member and provider satisfaction owing to the high process efficiencies. Higher claims disbursement efficiency simply means better performance from Anna and her colleagues, and higher customer retention for the company. In the mass chaos of the world, control may seem farfetched, but within structured systems, HCL’s DRYiCE iControl can make all the difference as healthcare businesses take control of their business flow performance.

Ian Philips

Ian Philips, Global Presales Lead, DRYiCE iControl

Ian is the Business Development lead for DRYiCE iControl. Ian’s role is to further develop business flow observability in the global market and continue to create a consulting differentiator for the customers. He plays an additional role of managing the Splunk CoE globally.

With a corporate background, Ian has an extensive 19 years of experience in various disciplines of IT including application development, production management, and program consulting. He is skilled in managing challenging clients while focusing on business operational management. Ian is passionate about ensuring e2e business outcomes and efficiencies through transparency between IT and business operations. He has been a guest speaker at various industry events such as:

  • AI Summit London 2018
  • AI Summit New York 2018
  • Splunk.Conf Orlando 2018
  • Splunk.Conf Las Vegas 2019