Apparancy Transforms Health Care BPM

Transcription

1 Apparancy Transforms Health Care BPM The Affordable Care Act (ACA) has irrevocably disrupted the United States' health care landscape and will have a ripple effect for all participants well into the next few decades. Regardless of whether The Affordable Care Act is adopted as is, modified, or entirely repealed, this landmark legislation will impact health care payers, providers and software vendors through "Business as usual," whether for payers, providers, and/or vendors, is already disrupted and new solutions are needed. Therefore, it is paramount that providers and payers address the new requirements needed for their business process workflows, financial reporting, and compliance NOW. Traditional business process management (BPM) solutions will put most of the burden to decipher requirements and build workflows on the buyer community. Most require substantial configuring without legal guidance. An alternative is market newcomer Apparancy, powered by Corefino, which includes pre-built, compliance-ready ACA workflows. Apparancy s previously introduced cloud-based sister company Corefino, has already proven that its 500-plus process framework can save organizations from 25 to 50 percent over their current workflow frameworks. Health care payers and providers especially financial and compliance executives - are already struggling to simultaneously extinguish a myriad of industry, state legislation, and profitability fires. Now, they have the daunting task of preparing for the overwhelming implications of new federal legislation that will touch nearly every facet of their operations. Compounding the situation is the fact that recurring financial/auditing/ compliance issues usually require manual intervention by finance and/or IT department executives. While manual processes have never been an optimal solution, chief financial officers (CFOs) and their direct reports will, with the new ACA, no longer have the luxury of tending manually to recurring tactical problems. Automated compliance-centric solutions will be the only option for continued fiscal, legal and competitively strategic survival. There is a broad range of ways that business process automation can positively impact health care organizations. The automation of redundant repetitive processes, such as parameter-driven approvals, activity exception alerts, real-time scheduling/inventory/ procedure or other updates, provide cost and resource advantages that over the course of a year can total savings in the millions of dollars. Moreover, recent technology improvements now allow these actions to be handled by any device, anywhere, anytime so that issues can be resolved instantaneously not in two or three days or weeks. Cloud deployment also has reached critical mass and there are some providers that offer security levels often not paralleled with on-premise technology deployments. RFG believes payers and providers need to rapidly incorporate best practice BPM capabilities into their processes so that they can optimize their operational costs. Deadlines are looming and noncompliance will mean hefty government-imposed fines. To remain viable, health care organizations will need to aggressively embrace new options, rely on reliable automated workflows and processes, and choose technology solutions that can adapt to change instantaneously. Robert Frances Group, Inc. 11/30/2013 Page 1

2 Deploying a BPM solution that will not only enhance bottom lines, but ensure legal compliance, will be challenge without considering new options outside of the enterprise resource planning (ERP) and BPM tools (i.e. build-it-yourself or pay someone to build it) perspective. In particular payers and providers will require formidable assistance with: Workflow management Financial and regulatory compliance HITECH compliance Risk management Provider-specific processes Payer-specific processes Financial and compliance monitoring and reporting. Health care IT vendors and Business Process Outsourcers (BPOs) are facing the same game-changing challenges as their provider and payer enterprise clients. Both sides must ensure that their offerings reduce risk and eliminate redundancy, ensure compliance and accurate reporting, and provide an audit trail. However, more is needed: they must become transformative. Specifically: Provide customers a fast and sizable return on investment (ROI) Reduce resource expenditures and optimize soft and hard assets Assure penalty avoidance Partner with disruptive technology vendors that can optimize their offerings Assimilate the requirements of new privacy and big data needs Leverage newly available technology access options, such as secure cloud-based software-as-a-service (SaaS). Introducing Apparancy Purpose-Built BPM Workflow Solutions Apparancy is the sister company of Corefino, which has been providing CFOs with a turnkey SaaS BPM solution that automates recurring financial processes since Corefino's SaaS framework frees CFOs and their direct reports from spending inordinate amounts of time on manual process configurations and fixes, enabling these executives to morph into the strategic leadership roles necessary to move their organizations forward in an uncertain economy. Apparancy evolves business process management beyond CFOs to additional stakeholders in new sectors. Health care is a burgeoning industry and one such sector that needs BPM assistance. There are many vendors offering products and services from billing and coding to electronic health and medical records to claims processing and adjudication to both providers and payers. However, these solutions are disjointed and require buyers to spend significant time and resources on hard-coded integration. Robert Frances Group, Inc. 11/30/2013 Page 2

3 Apparancy, powered by Corefino, provides vendors with an automated, compliancecentric, and holistic business process workflow framework (see Figure 1). Apparancy customers get pre-built workflows to solve specific issues, such as compliance to ACA mandates, in a platform that sits on top of existing data systems, and that can then be continuously (and easily) updated and modified. The cloud-based SaaS model is proven (based on the five-year experiences of sister company Corefino) to support legal compliance while delivering substantial measurable ROI. Apparancy's workflow platform minimizes and simplifies state, federal, and industry mandated compliance. The framework vets data and marries systems of record with systems of engagement to make business processes accurate and auditable. In essence, the Apparancy solution enables the any device, anywhere, anytime paradigm to be applied to pre-configured business process workflows an industry first. What s more, with minimum effort, disparate applications and platforms can be linked and accessed by social media and mobile devices through a secure cloud framework. Source: Aberdeen July 2013 The alternatives, extensions of existing ERP and BPM tools, have proven to be anything but turnkey. They are comparably enormously expensive, invite seemingly never-ending project creep, and fall short of expectations after implementation. The Apparancy framework can bring these processes together with reduced cost and risk. Robert Frances Group, Inc. 11/30/2013 Page 3

4 Two Options: Leverage Apparancy directly or through BPOs Depending upon the resources (or technology structure of the buyer organization), Apparancy can be purchased directly or through its BPO partners. Either choice is intended to help health care payers and providers to: Optimize workflows by automating redundant manual processes to improve productivity, reduce errors, corrections, and reduce business process time - from weeks and days - to days, hours, and minutes Reduce process costs from 25 to over 50 percent Enable companies to update their systems by compliance-driven deadlines to avoid penalties Enable perpetual conformity to new compliance mandates through on-the-fly process update agility Reduce risk by red-flagging non-conformance before such issues become costly, outsized or major profitability threats Manage risk by helping providers improve the probability of correctly matching patients to their EMRS upon hospital admission Quickly reduce or eliminate unclear and incorrect information thereby reducing the payment cycle (payers) or preventing medical errors/improving outcomes (providers) Streamline claims processing (payers) Improve compliance monitoring/reporting by ensuring systems are audit worthy Improve customer/patient satisfaction Provide immediate response and intervention to avert and diminish both threats and risks to ensure ongoing business viability. Why Target Health Care? Today, health care organizations are struggling to remain viable by improving revenue; reducing costs, risk, and waste; while being legally compliant and audit worthy. 1 For U.S. employers, confusion surrounding compliance costs tied to The Affordable Care Act is even prompting some organizations to transition parts of their workforce from full-time employees to part-time. Worse, there has been some evidence that segments of these U.S. employers are willing to pay penalties rather than implement new systems or update existing ones -- because they do not have the legal knowledge, BPM acumen, or technology capabilities to conform to the ACA cost effectively. Consider the all-encompassing challenge of ACA conformity by all parties. Payers need to streamline their claims processes as well as update them as regulations change. Providers must integrate silos of electronic and paper-based medical records to deliver better patient satisfaction and outcomes, and reduce re-hospitalizations. Organizations that are buying up physician practices with disparate electronic medical records are 1 See Business Process Management (BPM) Market Transparency Market Research Robert Frances Group, Inc. 11/30/2013 Page 4

5 realizing that standardization, integration, and supporting these infrastructures are herculean tasks. They are or will be seeking BPM/BPO solutions as a remedy. There are also hard deadlines: both payers and providers must become ICD-10 compliant by October of 2014, or face stiff penalties. The resulting BPO market for the health care sector is forecasted to grow from $5.3 billion in 2012 to $6.55 billion in However, BPO/BPM techniques vary widely based on industry segments and buyer categories. 3 It therefore behooves BPOs to select vendor partners with pre-configured, compliance-ready solutions. It's Not Big Data; It's Not Small Data. It's the Process! For over 20 years, business and IT executives have grappled with the big data problem of a holistic, single version of the truth, with visibility to actionable data. The phrase commonly used to describe this conundrum was "data rich, information poor." As the quest for the Holy Grail of timely, meaningful, accurate, and actionable information continued, the cost of data storage increased exponentially. Moreover, big data projects tended to fail and many mining engines did not scale. In fact, big data projects can dilute rather than enhance extracted information. Business and IT executives alike knew that more data did not equal better data. In fact, data is not information at all, and the problem perseveres. In health care, the big data problem is magnified because of data silos, unstructured data, paper-based records, and data written on post-it notes. It has been reported that almost 80 percent of health-related data is in the form of unstructured data. During the last several years many vendors have developed solutions to capture and mine unstructured data with the objective of providing actionable proactive information, which can improve patient outcomes, integrate islands of information, and improve the bottom line. Little data may be the new frontier from an insight perspective. But in fact, the challenge for organizations is neither housed in a big or little data wrapper. Rather, it is about understanding end-to end business processes and getting the right information to run organizations more effectively. Through a secure cloud framework Apparancy provides BPOs with the business process workflow to enable their customers to synthesize their business processes and get their workflow needs solved in one place. Using this transparent model, customers can scale their systems on demand, maintain multiple data/process copies for auditing, and achieve quick retrieval and modification capabilities. 2 Source: Eval-Source IBID Robert Frances Group, Inc. 11/30/2013 Page 5

6 Summary The embattled health care sector is continuously inundated by ever-changing regulations. This is compounded by payers and providers maintaining disparate systems that are not interoperable and that contribute exponentially to increases in cost and risk. Health care executives must be able to confidently manage, sustain, and grow their organizations well into the future. They need anytime and as detailed-as-necessary visibility into internal workflows without having to increase talent acquisition. Apparancy, powered by Corefino, provides health care executives an SaaS-deployed, streamlined, and costconscious alternative. Robert Frances Group, Inc. 11/30/2013 Page 6