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3 Big Ways BPM is Being Used in the Healthcare Industry


By University Alliance
3 Big Ways BPM is Being Used in the Healthcare Industry

With the passing of the Affordable Care Act (ACA), the healthcare industry has undergone rapid change. From the Patient’s Bill of Rights and electronic health records, to health insurance and Medicaid, the ACA’s reforms mean that the business of healthcare is becoming more complex and competitive.

With numerous new regulations, plus additional data to gather, analyze and share, healthcare organizations can face tremendous challenges in not only integrating new processes, but also continuing their mission of delivering quality patient care. Failure to meet these demands can result in serious financial losses, as well as patient dissatisfaction. However, there is a way to meet the challenges and avoid the pitfalls of change by using business process management (BPM). BPM can help healthcare organizations better manage new requirements, regulations and processes required in the ACA era, while improving the quality of care patients receive.

Why is BPM Suitable for Healthcare?

Process-driven healthcare organizations can better take advantage of data, respond to developments in the industry, reduce errors, improve the bottom line and provide a higher level of patient care.

In addition, they may be more likely to remain in compliance with federal and state regulations and requirements, such as specific data formats and real-time integration. Through BPM, health insurers and healthcare providers can help structure how information, systems and people interact. BPM can also help providers meet important deadlines, earn incentive payments and work toward continuously improving efficiency.

Healthcare’s History of Inefficiency

Healthcare has historically been a manually intensive business, with patient admissions, charts, billing, and care performed in a hands-on manner. In addition, a shift away from primary care toward an increasing number of options for delivering patient care has resulted in more referrals, research, forms and diagnoses. Healthcare spending increased, while efficiencies decreased. Waste was also prevalent, with billions wasted annually worldwide.

Healthcare providers have been under pressure to transform their business models toward a patient-centric, data-driven approach, and to reduce inefficiencies and eliminate waste to keep the cost of healthcare from spiraling out of control. Investing in more robust information systems paved the way for optimizing processes and coordinating the exchange of information required to deliver the end product of quality patient care.

Three Ways BPM Can Help Improve Healthcare

As healthcare rapidly evolves, the industry requires tools that can keep up. Here are three areas in which BPM can improve vital processes:

  1. Claims Processing - Claims processing is a complex task that also encompasses compliance and reporting activities, and requires a smooth flow of information. BPM technology can simplify these processes by streamlining each associated activity. Claims and patient appeals can be handled more quickly and monitored at every step, to make it easier to track and prioritize claims.  
  2. Big Data - Big data refers to the massive amount of data now available to businesses through the proliferation of the Internet. It is defined in terms of volume, velocity and variety. Thanks to electronic health records, a rapidly growing amount of healthcare information is now available and shareable. BPM technology allows organizations to manage their data and improve the way it is utilized. For example, monitoring regional disease trends can help gauge the effectiveness of certain vaccines, as well as predict future needs. BPM offers opportunities to leverage big data to improve healthcare for individuals and the general population, through preventive care and proactive responses.   
  3. Software Applications - BPM can help fill in the gaps that occur when multiple software applications are used in performing routine healthcare processes. It forges links that capture information not covered by existing applications, and provides information more quickly to expedite patient care. BPM also bridges gaps from manual functions, such as face-to-face or email patient interactions that can raise costs and place an organization at risk of non-compliance.

BMP Can Make Healthcare More Consistent

The healthcare industry has not historically been recognized for its consistency, which has led to tremendous waste and lower levels of patient care. When BPM is at the core of a healthcare organization’s approach to business, it allows people, systems and information to interact with greater consistency. BPM can fundamentally change the way the business of healthcare is accomplished, with less waste, cost savings, streamlined processes, increased compliance and better patient care.

Category: Business Process Management