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BPM Working in Healthcare
Your Challenges
Today, healthcare organizations live in an extremely competitive, ever-changing industry. Efficient management of core processes is essential for all healthcare professionals – payers, HMOs, hospitals, provider groups, or pharmaceutical companies. Consumers are more demanding. Regulations are tighter. Costs continue to rise. Government reimbursement is constrained. Gaps exist between people, back-end systems, and critical processes and initiatives.
Healthcare as a whole can benefit from improved process management that goes beyond simply accessing patient data and provides visibility and control across the patient’s health status – including provider details, insurance plans, services, scheduling, and so on. The primary challenge is that a patient lifecycle is not linear. Patients can be involved in multiple concurrent processes and operations must be flexible enough to accommodate these unique requirements and circumstances.
Other process-centric demands include:
- Deploy efficient, cost-effective processes to maintain the highest standards of patient care and grow business to generate more profit
- Provide process-driven access to disparate information from multiple sources to enhance business negotiations with reference labs, drugs suppliers and others
- Make better and faster decisions to keep the hospital financially and operationally healthy
- Speed and simplify insurance claims processing, ensuring that missing information and redundant paperwork are eliminated
- Provide visibility into all necessary, reliable documentation so second- or third-level billings are not overlooked
- Improve administrative processing tasks – such as purchasing approvals for capital, biomedical, or IT related supplies and equipment
- Tighten up procedures and audit trails to ensure regulatory (HIPAA) and legal compliance issues are covered
- Improve the exchange of patient information between physicians and caregivers – no disconnects, no delays, and no lost files - which means faster, less expensive and more accurate patient care
Our Solutions
Metastorm understands the unique needs of healthcare organizations and how they can better succeed with efficient process execution. Metastorm’s proven, enterprise-level BPM platform is the foundation that enables companies to design and deploy processes that increase output and manage resources in an unprecedented manner. Metastorm’s BPM technology and proven expertise is helping organizations around the world achieve regulatory compliance, reduce risks, enhance customer service, retain and acquire customers, tie together silo processes and systems, and do more with less.
The Metastorm BPM platform provides an open, standards-based framework by which designers and implementers can easily integrate external applications or application components. With easy-to-use tools for modeling, designing, managing, and changing processes, business users own, maintain and optimize their processes. And, the platform provides all the components needed to support a continuous process improvement cycle using BPM. Finally, the Metastorm approach offers rapid design and deployment with complete control over continuous improvements based on insight into how the business is running.
Healthcare organizations are gaining real competitive advantage using Metastorm BPM to more efficiently manage business processes, including:
- Eligibility and Enrollment Process Management
- Surgical Scheduling Process
- HIPAA Compliance
- Billing & Claims Management
- Pre-surgery Patient Processing
- Patient Treatment Tracking
- Critical Incident Report Tracking
- Pharmaceutical Review
- Payer Record Management
- Billing and Accounts Receivable
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- Customer Service Request Management
- Hospital Administrative Purchasing
- Materials Management
- Equipment Charge Master Tracking
- Disability Care Services Management
- Utilization Management
- Regulatory Compliance & Auditing
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Proven Results
Increased Revenue
New and improved business processes contribute to company growth. A strong, reliable BPM platform changes how your company manages existing accounts, acquires new customers, interacts with partners, creates and delivers new products, and complies with regulations. Employees spend less time on manual tasks and focus on innovative, value-producing activities. Communication with all audiences is automated and timely, and processes are streamlined and integrated with core systems. The bottom line – you run your business more efficiently and produce faster results.
Decreased Expenses
Healthcare, pharmaceutical and insurance companies have always looked for ways to lower costs while maintaining high customer service and quality levels – and BPM is today’s way of reaching that goal. BPM improves productivity, eliminates costly inefficiencies and reduces errors. With new and improved processes, your people work smarter and better with less risk.
Metastorm BPM delivers a host of benefits that drive down expenses, such as:
- Automating paper-intensive, error-prone tasks
- Enabling more intelligent and faster exception resolution
- Promoting better staff collaboration with process consistency
- Providing real-time insight into inefficient stages of daily business operations
Metastorm BPM helps companies quickly adjust how they run their business and allows them to efficiently respond to changing conditions, new regulations and higher demands for service. It is not just about doing more with less, but rather doing more by working smarter.
Successful Implementations
Metastorm BPM enables healthcare companies to cut costs and grow their business—just ask these customers:
AmerisourceBergen
Aventis Pharmaceuticals
Children’s National Medical Center
(CNMC)
EyeMed Vision Care
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Fairview Medical Center
Gaston Memorial Hospital
Metropolitan Hospital
North Staffs Health Authority
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Health Care 
