Do you see the recession as an opportunity or are you panicking?

The Dow was down about 200 points earlier this week – is that bad or good? The Dow has been picking up fairly consistently over the past 6 weeks or so and this is probably just an “adjustment” rather than another freefall. Is the glass half empty or is it half full? Many people see the down economy as a time to hunker down, sell off their assets and bury the money in Mason jars or hide it inside their mainframe. But for those with the stomach for it, this down economy brings a lot of opportunities; a lot of bargains.

Any insurance organization looking to improve IT services can find a lot of good deals on hardware, services, and especially back office systems. However, most insurance organizations, because they are intrinsically risk averse, don’t want to spend the money now, but instead wait and see what happens. When things do turn around, they could find themselves behind the curve, rather than leading the way. A lot of companies are looking for band-aids for their IT problems, quick fixes to get them through the storm. Rather than just repairing the mast and patching the hull on your ship, wouldn’t it be better to have a new, stronger, and more stable ship ready for sea when the storm subsides. Or, even better, fully prepared to weather the storm if it continues, and head out for the deadliest catch.

Another benefit to purchasing during a down economy is that as a mid-market carrier, you are likely to get a lot more attention from technology vendors and a better team now because you become a big fish in a little pond, and every customer is extremely important. Because you’re in more of a command position, you can negotiate better services and even more free upgrades because it also becomes an opportunity for the vendor to improve their product.

We’re all confident that the economy will turn around, it’s just a question of when. There are those “economic experts” that say September; those that say next Spring; and more that say Summer 2010. If any of them are right, its really not that long a period of time – about the same amount of time it takes to implement a system.

When it does, your agents, your customers, and most importantly, your prospects, will be there to move forward with you. So talk to technology vendors now, because just like the car companies, prices have come down and there are deals to be had.

The Magic of Mash-ups: Co-browsing

What is co-browsing?

Co-browsing lets multiple users work together in their respective browsers through what look like shared screens and communicate via telepresence including video and audio.  The impact of this technology is enormous as companies become more virtual and the need for serious collaboration increases to be competitive in tough times.  To be able to share, interact and see the body language of your collaborator in real-time without extraordinary downloads to your PC or expensive third party solutions could simply change the way we work.  This innovation comes from not Google, or Yahoo but from IBM in a proof of concept project called Blue Spruce, a Web browser application platform that IBM is working on to allow simultaneous multiuser interactions enabled by AJAX and other standard technologies through the Web browser.

The Blue Spruce project is IBM’s solution to the classic one-window, one-user limitation of current Web browsers.  The application is a mash-up that combines Web conferencing with voice and video and other data forms to let people share content including existing Web widgets – at the same time.  Two different users, possibly anywhere, are able to move their respective mouse pointers around the screen in the browser to click and make changes on the shared application, with the platform enabling concurrent interactions through the browser without disruptions.  Despite the appearance, the co-browsers aren’t actually sharing content. Both collaborators obtained a Web page through the Blue Spruce client, but the “events” enabled by the mouse are what is being sent to the Blue Spruce Co-Web Server.  The idea is that no matter where the two users are in the Internet world, they pick up the general data caches on both personal computers and react to the events.

The applications for co-browsing collaboration are numerous, especially for knowledge workers. In healthcare, IBM has used Blue Spruce to create an online “radiology theatre” product, currently at the prototype stage, which allows teams of medical experts to “simultaneously discuss and review patients’ medical test data using a Web browser.” The project is being run in collaboration with the Brigham and Women’s Hospital of Boston.  According to IBM, it has created a secure Web site that allows select medical experts at Brigham and Women’s Hospital to access and collaborate on data such as CT scans, MRIs, EKGs and other medical tests. Each medical expert can “talk and be seen through live streaming audio/video through their standard web connection, and have the ability to whiteboard over the Web page as well as input information to the patient’s record.” Basically it is a secure multimedia experience running inside a single browser window, using Blue Spruce as the platform.

It is important to note that Blue Spruce is not your typical “fat client” or downloaded application, but it is a fully browser-based application development platform, currently in development, which is being built on open Web standards. The main feature of Blue Spruce is that it allows for a combination of different Web components – data mashups, high-definition video, audio and graphics – to run simultaneously on the same browser page. It’s important to note that the Radiology Theatre app only requires a standard Web browser – so there’s nothing to download for the end user, in this case, doctors.

This is how IBM described how the new online radiology theatre will work:

 ”A group of doctors can log into a secure Web site at the same time to review and analyze a patient’s recent battery of tests. For instance, a radiologist could use her mouse to circle an area on the CT scan of a lung that needs a closer look. Then using the mouse she could zoom into that scan to enlarge the view for all to see. An expert on lung cancer could use his mouse to show how the spot had changed from the last scan. And then, a pathologist could talk about patient treatments based on spots of that size depending on age and prior health history, paging through clinical data accessible on the site.”

“The theatre allows all these experts to discuss, tag and share information simultaneously, rather than paging through stacks of papers, calling physicians to discuss scan results and then charting the results. This collaborative consultation brings together the personal data, the experts and the clinical data in one physical, visual theatre.” 

The impact on rural medicine and the need for telemedicine for key healthcare experts is significantly advanced with this technology.
Perhaps the biggest potential benefit of the online radiology theatre is that it will enable experts from all over the world to consult on cases. The ability for multiple users to “co-browse” means they can interact in the browser in real-time and see each other’s changes.  Of course, since this is medical data, there are significant privacy implications involved in using the Internet to collaborate.  The time and cost savings from collaboration is important, but better and faster decision making is the key.

The need for inexpensive and minimally invasive techniques for real collaboration over the Internet is real and the backlog of potential applications is fun to consider.  Imagine reviewing your health care or insurance claims with a live person (and their reactions) at the insurance company to reduce cycle time, or collaborating on new product engineering drawings from the U.S. with your Chinese manufacturer.  Imagine the potential for teaching or training with key experts and a worldwide audience using a live whiteboard. Finally, imagine not paying big monthly fees for basic meeting collaboration needs on a daily basis.  Blue Spruce is really a technology to keep an eye on.

Claims Outsourcing Strategy – Managing a Smooth and Seamless Transition

Part 3

The focus of this three part series is to provide insight into managing a smooth and seamless transition for outsourcing claims business processes.  Part 1 concentrates on the upfront gathering of current and future requirements, the Request For Information (“RFI”) and Request For Proposal (“RFP”) process, the selection of the “right” vendor, and a brief on contract negotiation.  Part 2  focuses on  the development, testing, and conversion that takes place between both organizations, and some of the pitfalls to avoid.  Part 3 will focus on maintaining a productive,  long term partnership with your vendor.

One of the biggest pitfalls seen in an outsourcing arrangement is the absence of a true partnership between the client and the vendor.  In the absence of a partnership, the replacement is a customer-vendor relationship.  In this type of relationship the customer is looking for one deal while the vendor is looking for another.  This arrangement creates a lack of trust between both parties involved, that will eventually make the relationship sour because it becomes disconnected from the true business needs and requirements.

Secondary to the partnership but equally as important is the communication between parties.  Communication ensures business interests are aligned and understood. Lack of communication throughout the life of the relationship creates tensions that will definitely hinder future value creation.  Effective and continuous communication ensures both companies are responsive, deal with the facts and not assumptions, keep all stakeholders in the loop, and make decisions in the spirit of a partnership.  Successful outsourcing arrangements, those that last for years, put in place a joint planning process between the client and vendor.  Regularly scheduled joint planning meetings every six (6) to nine (9) months assure that both the client and vendor monitor the health of their relationship.  By continuously reviewing the strengths, weaknesses and opportunities of the relationship, agreeing upon recommendations and placing those recommendations into action continually improves the relationship.  

Most often seen in healthy outsourcing relationships is an effective governance methodology or framework.  Both parties must agree early on to operate in a collaborative environment, as noted above.  In the absence of a governance structure, the resulting implications could be devastating.  This could lead to unclear roles and responsibilities between the client and vendor, challenges encountered that are not overcome and linger, problems not resolved in a timely fashion, and unmet expectations . 

Conclusion

The worth of an outsourcing agreement is generated when both companies strike a mutual agreement that forms the foundation for a long term partnership.  When both parties buy into these steps as well as avoid the pitfalls noted, the framework and foundation has been set for a long term successful partnership.  By doing so, both parties have put in place the tools, design, contracts, and methodologies that will ensure success. Failure comes when anyone of the steps are short-changed, missed or are misunderstood by either or both parties involved.  When your company makes that strategic decision to outsource, make sure you make the same decision to be successful by employing these  best practices.

The Patient Centered Medical Home (PCMH)

In a recent article released by IBM, an argument is made for a transition in the U.S. healthcare system to a team-based approach based on the Patient Centered Medical Home (PCMH) model. A strong case is made from a description of the model, its’ players, technology, and benefits. The critical change that must be established first, though, is the healthcare systems’ evolution to a data-driven system. The access to, higher quality and integration of data, across disparate silos of information, will provide the foundation for this change. Only then can the position of Dr. Douglas Henley, EVP and CEO of the American Academy of Family Physicians, “ A smarter health system is one based in comprehensive patient centered primary care which improves patient/physician communication, the coordination and integration of care, and the quality and cost efficiency of care” be achieved.

The quality and cost of care is what we hear the most about in news headlines. However, the success of each piece of Dr. Henley’s statement is based on the ability of a team of providers to access accurate and updated patient data across care settings and over time in order to proactively suggest lifestyle improvements and reactively diagnose and recommend appropriate treatments.  Fundamentally, each decision maker and operating entity needs a data strategy for how it will achieve the ambitious and often ambiguous goals it likes to claim.

I’ll recite a popular management mantra I’ve heard numerous times, “you can’t manage what you can’t measure.” The healthcare system is a data rich environment. Cleaning, manipulating, and leveraging  the huge volume of data available will become the critical success factors that will enable the linkage between education, research, the delivery of care and its outcomes, to benchmark and monitor the performance of the continuous improvements necessary to bring costs down and quality up.  

Players in the healthcare world will soon find out (if they haven’t already) a principle all those in the data world already know:

• Good data, appropriately aggregated and manipulated, drives accurate information;
• Accurate information is not a luxury that most decision makers have;
• The executives, managers, physicians, nurses, nurse practitioners, educators, pharmacists, researchers, and other stakeholders that do have access to accurate information are in a position to leverage and evolve this data and information from satisfying compliance and regulatory requirements to enabling an organizational knowledge-based asset.

Actionable data will drive the improvements that you see scattered across headlines and mentioned in political speeches in the past and no doubt, in the future.

Image courtesy of Texas Family Physician

Claims Outsourcing Strategy – Managing a Smooth and Seamless Transition

Part 2

In Part 1, we focused on creating the core structural foundation of a Claims Outsourcing Strategy:

• gathering the business and technical requirements
• creating a detailed Request For Proposal (“RFP”)
• selecting the correct claims outsourcing vendor
• contract negotiations

In Part 2, we will concentrate on the development, testing and conversion that take place between both companies, identifying some of the pitfalls that can be avoided during this stage.  In Part 3, we will wrap up with a focus on maintaining a strong, healthy partnership.

Development Phase

 Prior to the development phase you should ask yourself as well as your staff the following question:

“What is the best strategic approach that both companies should utilize to obtain optimal success during the development phase?”

Without a key strategy agreed upon by you and your vendor, many unforeseen obstacles will soon be on your door step, obstacles that you’ll need to juggle and resolve. 

One pitfall many organizations fail to identify prior to the start of the development phase is the common “siloed development approach”. Your company works against a set of functional and process requirements specific to your own system to support the outsourcing project.  Your vendor works against another set of functional and process requirements specific to their system.  There is no known intersection of the functional or process requirements between the two companies. By no means is this ever considered the correct strategic approach to take.

 

By strategically working together prior to the development phase, both organizations will find the intersection or “Joint Functional and Process Requirements”, so all three pieces of the puzzle can come together and be managed accordingly.  If you skip these requirements, the puzzle is not complete and managing this process will become a nightmare.

Testing Phase

As with the development phase, a joint strategic approach for testing should be developed and agreed upon prior to testing beginning.  Many organizations fall into one of the biggest known pitfalls – unclear definition of the different phases of testing.  Ask your IT and Business staff as well as your vendor this question:

“What is considered unit testing, system testing, User Acceptance Testing (“UAT”) and Integration testing?”

I promise you this, you will not receive a unified answer from your staff or vendor as to what each phase represents.  Clearly identify in a Testing Strategy Plan what each phase’s primary purpose is, who is responsible for executing the phase within and between both companies, and what is the measurement of success for each phase.

Without a doubt you can utilize the integration concept from the development phase in the testing phase.  Developing test plans to support this process should include resources from both organizations.  Agreement on what is to be tested and who should test will lead to the optimal testing results.  This joint planning should take place early on so that both companies know what is expected of them during this joint testing effort, and have their resources allocated when it come time to start.

Conversion Planning/Execution

Conversion is one area we consistently see that both companies have not spent the quality of time or effort needed to succeed in their conversion efforts.  Conversion of data and files to and from both companies is equally as important as the development and testing efforts.  Yet most companies will spend less time understanding the data and files needed in order to make the transition and outsourcing arrangement successful.

Time and effort must be allocated to analyze and enhance the data to support the outsourcing initiative.  This includes putting a team in place to focus on:

1. Identifying and measuring the data in your systems(s) today — determine the quality of the data or the lack thereof.
2. Identifying a set of data quality rules and targets that must be met prior to the conversion of the data.
3. Designing and implementing data quality improvements processes where needed, that make the data ready for the conversion.

If the correct analysis and time is not spent upfront to understand the data, files, and conversion planning, the project will come to a screeching halt. Prevent this by investing in a detailed Data and Data Quality Assessment.  Figure 1 below depicts at a high level the data process life cycle that companies must take in order to understand, scrub and enhance their data in preparation for a successful conversion to the vendor system(s).

Figure 1