Arun Rangamani & Subha Vaidyanathan
SVP & BU and Head & Senior Director and Senior Director Software Product, SCIO Health Analytics
Based in West Hartford, Connecticut, SCIO Health Analytics is a leading health analytics solution and services company. With domain experience in healthcare payer product experience, AHM certification, Offshore-Onsite Models, Solution Architecture, Business Intelligence and IT Integration Specialist & more, Arun leads the Care Optimization and SCIO Xpert business units, and oversees P&L, solutions, sales support, delivery and client engagement. On the other hand, Subha with over 15 years of expertise in global delivery leads the Technology and Data management divisions from Chennai.
Malcolm Forbes, the renowned American entrepreneur, once said that “failure is success if we learn from it.” The axiom is one that certainly could apply to business process outsourcing (BPO) organizations. Unfortunately, most BPO organizations have not yet paid any heed to Forbes’ advice.
"By using analytics to support dynamic processes, healthcare BPO organizations can not only learn from their failures but also apply these lessons at every turn, making it possible to continually improve performance"
The problem is that BPO organizations typically carry on with business as usual, without taking the time to learn from their failures. The typical BPO operation, for example, will require its staff members to follow much defined, checklist-like standard operating procedures. These proceduresdo not leave any room for discretionary thought or action. A s such, staff members take the same actions in every situation, without regard to how successful or unsuccessful the process may be in each instance.
As such, business processes simply remain static. And, that means even when staff members follow established processes completely, the BPO Company often fails to realize positive outcomes. Indeed, with standard static processes in place, there is no opportunity to emulate best practices, learn from past failures - and, most distressingly, no opportunity to improve.
For example, when conducting audits, the BPO staff might diligently follow the 18 steps in the established process. However, the BPO organization will only achieve a positive outcome in 70% of cases - which begs the question: Why is the BPO Company failing 30% of the time despite following the process thoroughly? And the obvious answer: Because the staff members are rather robotically following the defined and published steps, regardless of outcomes.
The more important question, then, becomes: What can BPO organizations do to leapfrog to the next level of performance? The answer: Adopt dynamic processes - which are the opposite of the standard processes currently used. When a BPO organization employs dynamic processes, staff members continually modify their actions based on lessons learned from previous failures.
In essence, under a dynamic model, processes are continually adjusted based on an analysis of context-specific failures and successes to ensure that each and every step contributes to positive results with the situation at hand. To accomplish this, an analytics system provides feedback every step of the way, making it possible to make real-time process improvements that positively change outcomes. For example, when a staff member comes to “step 3” of a standardized process, he might decide to modify this step based on the knowledge from the analysis that indicates that this step will result in failure in the situation at hand. As a result, the BPO organization is increasing its chances for success by dynamically avoiding context-specific failures and e mulating b est p ractices. B y comparison, improvements in a static business process typically are only implemented periodically -once a year or once a quarter - based on anecdotal feedback from clients.
Case in Point
The following example illustrates how a dynamic process could lead to better outcomes than a static process for a healthcare BPO:
Call center staff members frequently are tasked with patient outreach tasks to encourage specific behaviors such as medication adherence. Under the traditional, static process, the scenario might play out as follows: The call center specialist accesses the patient’s name, background, phone number and a script for the call. The call center representative calls the patient and leaves a voice mail message per the script. The patient either does not get the voicemail or does not act upon the voicemail.
So, the behavior change does not materialize, and the patient does not take his medication. The call center specialist closes the case by saying that it was successfully completed, yet the desired outcome was not achieved.
With a dynamic, analytics-based process in place, though, the call center specialist would be alerted to the fact that the patient is 70-years-old and patients of this age are not likely to answer calls after 8 p.m. So, when the operator goes to make the call, the analytics system could prompt a message that says "Typically, patients of this kind will not be available for you. This call may not be so successful, though you will be able to leave a voicemail, the behavioral change is zero percent, so do not make this call."With such analysis in hand, the call center operator will use discretion to make the call at a more advantageous time - greatly increasing the chances for a positive outcome.
A dynamic process can also help BPO organizations operate more efficiently with limited resources. For example, when a BPO company is working on behalf of a health plan and trying to determine if a patient who had a head injury should be covered by a third party, the analytics system could determine if, based on the codes involved, the case is worth pursuing. The historical analysis might indicate that when diabetic patients older than 60 are involved in these types of situations, health plans never win the cases. As such, staff members would not take the time to pursue the case. Similarly, when health plans are looking to audit providers to ensure they are billing correctly, the system could analyze various attributes – doctor’s specialty, practice location and service offerings - to determine if the audit would be worth the effort.
Indeed, by using analytics to support dynamic processes, healthcare BPO organizations can not only learn from their failures but also apply these lessons at every turn, making it possible to continually improve performance. And, that is an outcome that a business icon such as Forbes would most certainly define as a success.