Bizagi Healthcare Messaging

Healthcare industry overview 1

Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
Appendix
Integrated campaign plan 5
Healthcare industry overview 1
Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
Appendix 5
Healthcare Trends, Challenges, & Opportunities

Patient
1
Quality of care improvement with empowered, better-informed
patients measuring, monitoring, and reporting their own health. This
improves healthcare care delivery. BPM allows for measurable
process metrics that can track patients and measure their outcomes.
Key Pillar: Engaged

2
Payments transition to outcomes-based (value-based) payments from
episodic-based payments. Managing enrollment process and new
Payer reimbursement payment models (e.g. Medicare)
Key Pillar: Agile
3
Bridge Ensuring/adhering/monitoring/reporting regulatory compliance.
Increase innovation and efficiency while reducing costs. Harnessing
new technology, like analytics, instead of outdated/ineffective IT
Provider infrastructure.
Key Pillar: Connected

5
 Top Healthcare Provider Initiatives
Population Health Management
Cerner 35%, Epic 31%, Allscripts 21%
Data Analytics
Epic 33%, IBM 25%, Cerner 21%, Meditech 21%
Information Security
Cisco 61%, VMware 34%, McAfee 32%
Telemedicine
EVISIT 17%, Secure Telehealth 17%, Advanced
Telehealth Solutions 17%, Intouch Health 17%
EHR (both INPATIENT AND OUTPATIENT)
Epic 40%, Cerner 39%, Meditech 34%
Patient Engagement
Epic 37%, Press Ganey 29%, Cerner 24%
MACRA Implementation
Premier 22%, Advisory Board (CRIMSON) 19%
Optum 16%

Other notes: Revenue Cycle Management

In addition, ICD-10 Migration was huge in 2015.
Top Healthcare Payer Initiatives
Verification of Benefits/Collecting co-payments
Use a practice management system. Vendors include Allscripts, athenahealth,
– Cerner, Epic, GE Healthcare, Greenway Medical, MEDITECH, McKesson Corporation, NextGen
Healthcare Information System LLC
iVerify, eEligibility
Pre-Authorization- Should be 100%
Coding review/claim scrubbing
Clean claim submission rate
Claims Denial
Adjusted Collection Rate
Reimbursement ratio: Closed vs overall claims
Negotiation fee
Average Paid Percent, Medicare allowable, compensation for top procedures, average reductions percent

• Embracing new business models and care delivery

• Making better use of IT and Data
• Enhancing care coordination
Increase communication between patients and providers across the spectrum, insurers can drive costs
down even further.
• Reducing administrative costs
Through automating existing manual business processes (85% of respondents) with the need to
reduce rates of human error associated with manual processes (57%) as key to reigning in expenses.

Homegrown IT built-on 40 year old technology is using a Band-Aid approach. However, it does not make
sense to upgrade the complete IT system, only targeted enhancements.

Net-net: Bizagi BPM will make payers more profitable

Worldwide Healthcare IT 2017 Predictions
● Prediction 1: Ransomware is part of a larger regulatory
and compliance initiative so that hospitals are not under
attack.
● Predictions 3 & 4: Data and analytics will become the
cornerstone of healthcare, and patients will be playing a
more active role in the collection of data. Can also be
called the unification of patient data.
● Predictions 6, 8, 9: Patient engagement and IoT-enabled
biosensors translate into patients acting like consumers
and willingness to give data. Patients will have their health
plans calibrate according to their current health state.
● Predictions 2 & 5: Process automation, even robotic, will
increase efficiency and lower costs of non-user value-
added functions.
BPM + RPA are complementary
RPA for efficiency, BPM for effectiveness

Routine tasks Complex tasks

Bizagi Healthcare Framework
Bizagi Healthcare Community

Security Bizagi 11 DBP Orchestration Layer Bizagi

Consulting for
Identity ELECTRONIC HEALTH RECORD (EHR) Integrations Healthcare
management
Legacy BPM
Clinical

EMR/continuity of care

Clinical data repository

Wrapper

Radiology Information
Business Intelligence
transformation

Patient scheduling
Access

Medical billing
Patient portal

Systems (RIS)
E-prescribing

Back-office
management (SSO) Productivity Apps

PACS
Lab
via
ConnectorXchange
Managed Services
Clinical data access
assurance (PHI/PII) Enterprise Contenet
Management (ECM)
via
Open Systems Architecture ConnectorXchange
HIEs
HIPAA compliance Vendor-neutral archive and repository for patient information
ERP Apps (SAP/R3)
via
Virtualized Infrastructure ConnectorExchange
Risk management
and GRC
Business continuity, disaster recovery, and data protection Drag-and-drop via
WidgetExchange
Maturity Model to Adopting “Big BPM”
Other solutions:
• Systems (i.e., information technology) ● Workflow-oriented
● Simplistic, task-oriented
● Short-term
● Function-specific
• People (change management) ● Departmental/workgroup
• Process (workflows)
Above the line

Below the line

BPM & digital process automation
• Intent (AI/machine learning) ● Advanced workflows
●
• Data (analytics) ●
Complex tasks
Ongoing, (e.g., RAC)
● Industry specific (e.g., healthcare)
● Across departments

Use cases for Bizagi healthcare combining machine learning and analytics:
● Predicting hospital bed rotation
● Assessing patient readmittance risk; leads to healthcare provider penalties
 The Evolving Provider

Analog Digital

Email & Conversations Custom code Off-the-shelf Workflow Enterprise DBP

Traditional Epic
Application KiSSFLOW Bizagi
Allscripts Process Maker Appian
Development
Cerner Pega
CloverLeaf K2
In-house Third-Party
Manual intensive Automated

Light, process flow BPM/DPA

 The Evolving Payer

Analog Digital

Email & Conversations Custom code Off-the-shelf Workflow Enterprise DBP

Epic KiSSFLOW Bizagi
Allscripts Process Maker Appian
Cerner Pega
CloverLeaf K2
In-house Third-Party
Manual intensive Automated

Light, process flow BPM/DPA

Healthcare industry overview 1
Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
5
Patient-first, but not patient only
Option: Patient-centered healthcare
Self identified, diagnosed, and
reported

Commercial, Blues,
Medicare Part B
PAYER
Drivers: Spending & All the patient observes. Is it good or bad.
Government

PATIENT
KPI: CSAT and WOM
Drivers: Science, Technology, and
Innovation
PROVIDER
Doctors, Hospitals,
ACO, Alternative
Healthcare Providers

Driver: Cost, Quality, and Access

EXTERNAL
From Workflows to Complete, Integrated Healthcare
Use Case: Provider
Emergency Room Visit Using Bizagi’s
Easy-to-Use Advanced Workflows
• Patient registration, check-in, accessing
medical records, assessment, & risk
• Identification of conditions based on
patient data
• Automated determination of drug
interactions
• Test results notification
• Hospital bed rotation
• Discharge readiness planning:
communications, care planning, remote
Pictured: Emergency Room Visit
End-to-End Workflow via Bizagi Modeler
monitoring, and readmission avoidance
• Scheduling and prescription
management
• Financial clearance – proof of medical
insurance
• Patient transfer between providers

Net-Net: Reduce admission time from patient drop-off to discharge while alleviating readmittance
Use Case: Payer *
Member Enrollment and Claims Eligibility
● Claims eligibility, pre-authorization, routing and processing, and status
● Case management required to handle applications
● Medicaid application, appeal, and re-certification process
● Medicare application process
● Member enrollment and plan management
● Enrollee/insured case/record management
● Claims adjucation/payment
● Membership/provider/plan sponsor services
● Evidence-based actuarial analysis
● Waste, fraud, and abuse prevention & detection
● Agent portal for quotes and contracts
● Member/enrollee portal for wellness management, benefits selection, and coverage status

● Ensure the right information gets to the right people in real-time

● Collaboration cross departmental collaboration
● Common operating vision for all stakeholders

● Reducing processing time for standard claims by x%

● Generating an average ROI of x % of each internal process improvement project
● Increases customer and provider satisfaction by freeing claims process to focus on more complex
claims

Net-Net: Bizagi makes payer more profitable and simplifies the processing of applications.
Use Case: Patient
The unification of data and patient reported outcomes furthers self-healing
Alternative title: “Healthcare as a team sport”

● Chronic disease management

● Monitoring health levels
● Patient reported outcomes
● IoT for healthcare workflow
optimization

Net-Net: Can reduce hospital readmission and

Net-Net: Self-service leads to an empowered patient
optimizing care can avoid non-urgent use or ER
Use Case: Patient
Why is patient empowerment vital

Medi-Cal ER visits
up 75% over the
last five years
Bizagi – Healthcare’s DBP Choice
Why Change?
Inefficiencies in healthcare lead to lost revenue and additional costs incurred. DBP mediates any
such efficiencies by automating tasks. BPM reduces the time-to-value as compared to
installing a new application.

Why Now?
Changing business models, increased volume transactions of visits, and payment penalties make
this the proper time to implement a DBP.

Why Bizagi?
Can bring process into the tools that users are familiar with today. Interoperability: The average
shadow IT healthcare worker uses 26 applications. Integrations with everyday, common
applications via ConnectorXchange connectors.
An Agile platform, Bizagi represents the “Lowest-code” enterprise DBP allows for ease-of-use via
drag-and-drop forms and widgets. Simplicity: Performance: Fastest speed to implementation
Scalability: Capture, retain, reuse, and improve on documented processes (e.g.,
templates/widgets)
Allows for repeatable, managed, and optimized processes. Can start with a simple departmental
level workflow, and expand to the entire enterprise healthcare organization.
Healthcare industry overview 1
Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
Appendix 5
 Personas Spanning Healthcare
STRATEGIC

Payer Provider

Process Paula Strategic Steve

“Strategic” Personas

NOW FUTURE
Payer Provider

Ambitious Amy Nurturing Nancy

“Bridge” Personas

Diligent Deepak
“Technical” Personas
Payer
TECHNICAL
* Combines both user and buyer personas for payer and provider. Patient is always the center of the universe, even without a dedicated
 DILIGENT DEEPAK
Java Developer
Functional Role: IT Developer

Goal: Enable Deepak to create a library of shared components and data models,
which Amy and can use in her Projects.”
DILIGENT DEEPAK Low Skill Developer IT
Department
GOALS
Eclipse works great. Why What is he trying to achieve? TYPICAL WORKDAY
• Implement BPM and rules-based • 50% Eclipse
get rid of a good thing?
projects himself, using Eclipse. • 12.5% Meetings
• Build out a service repository. • 12.5% Email
• Work with QA and testers to fix bugs.
• Get work done sooner so he can go
home on time. COLLEAGUES
Paula: Process Owner
MOTIVATIONS Amy: Associate Process
What drives his behavior? Manager
• Comfort and familiarity, wants to work
with familiar tools and technologies
when developing.
TECH COMFORT LEVEL
• Staying relevant. Feels threatened by
ever changing technology. Low High
Software Tools
Deepak is an experienced Java PAIN POINTS Low High
developer, working for a global systems What slows him down? BPMN
integrator. • Dealing with unfamiliar technologies,
For the last five years, he’s been working especially if he believes the
as an offshore team member of a technology won’t become mainstream TOP 5 TOOLS USED
healthcare payer’s IT department. or important to his job in the future. Eclipse
• Often fighting fires – business users
Deepak has been programming for 15 cannot figure out things themselves, Java
years, but he does not have a formal so they constantly call him or his team
software engineering background. He or help. Subversion
uses Eclipse every day. He is not
obsessed with technology and learning SQL
new tools, but he does work long, hard
hours to do his job. Deepak has a wife Email
and two children. Daily
Rarely
 AMBITIOUS AMY
ASSOCIATE PROCESS
MANAGER
Functional Role: Analyst
Goals: Enable Amy to easily find, choose, and connect shared components and
services inside a Process; provide an easy way for Amy to make Tasks inside
Processes functional; this means the ability to specify Actors, Data Models and I/O
for any Task node; “Enable Amy to define Decision Point logic without code.”
AMBITIOUS AMY Associate Process Manager Line of
Business
GOALS
I’m the glue between What is she trying to achieve? TYPICAL WORKDAY
process owners and • Work with Paula (the Process Owner)
• 50% BPM Tools
developers. to analyze and design processes.
• Work with lead developers to • 25% Meetings
implement process improvements. • 12.5% Web Tools
• String together functional workflows • 12.5% Emaill
as much as possible.
COLLEAGUES
MOTIVATIONS
What drives her behavior? Paula: Process Owner
• To be the glue between LOB and Deepak: Integration
development, translating complex Developer
business flows.
• To learn a lot and keep on top of the
TECH COMFORT LEVEL
latest process management tools and
methods. Low High
PAIN POINTS Software Tools
Aimee is an Associate Process Manager What slows her down? Low High
at a large healthcare payer (e.g., United, • She is pretty tech-savvy, but when BPMN
Cigna, Kaiser, Aetna). She’s only worked she sees code and tech jargon, it
there for a year, but feels like she has turns her away .
already learned so much. • Needs to do a lot of back and forth TOP 5 TOOLS USED
communication with development. It’s Visio
Her main roles are transcribing Visio’s like a game of telephone, and there’s
process diagrams into an automation tool, a lot of delay. Email
exporting process images, and working • Doesn’t want to install or set up
with Deepak to get processes working complex tools and environments. Google
properly and released. Things should just work. Docs
Slack
Aimee is 25 years old. Aimee grew up with
computers, and is pretty computer-savvy.
Rarely Daily
 NURTURING NANCY
Urgent Care Nurse
Functional Role: Knowledge Worker

Goal: Enable Nancy to have the simplest EHR workflow possible and limited the
amount of screens she needs to see access so she can back to what’s the most
important: the patient.
Nurturing Nancy Urgent Care Nurse
Knowledge Worker
GOALS: What is she trying to achieve?
Give the best care I can to • Working with Doctor Derek to give the AVERAGE WORKDAY
my patients. Technology best care to patients and making sure
can undermine rapport. accurate data is entered/validated. • 50% Patient interaction
• Standardizing the process “routine” • 25% EHR
tasks, which improves patient load • 25% Email
and keeps things flowing smoothly.
• Not be affected by “nurse burnout” COLLEAGUES
and give patients a human touch .
Derek: Doctor
EHR systems have taken away much
of that.
• To make healthcare about people and
less about billing and technology.
MOTIVATIONS: What drives her TECH COMFORT LEVEL
behavior?
• Set patients at ease during times of Low High
Nurturing Nancy is a service-oriented stress or discomfort. Software Tools
registered nurse working at a health • Streamline patient/provider interaction Low High
system-owned urgent care center. by acting as intermediary. BPMN
• Simplify routine task (vitals, samples,
Nancy has been formally trained to be a referrals) with EHR
nurse and is well versed in EHR systems TOP 5 TOOLS USED
PAIN POINTS: What slows her down?
using the “day in and day out.” Patients EHR
• EHR workflow is too rigid (switching
are the center of her universes, but
patients, deferring tasks) and difficult
realized that insurance, referrals, and Email
to annotate or add emphasis to EHR
other paperwork are necessary and
forms.
important. Facebook
• Data from faxes must be re-entered to
be searchable.
Nancy is 29 years old and recently
• Can’t see everything on one screen, Web
engaged. She has a BS degree in nursing
have to scroll/toggle between multiple
from San Jose State University.
pages.
Rarely Daily
 PROCESS PAULA
SENIOR PROCESS
MANAGER
Functional Role: LOB Manager
Goal: Enable Paula to review and approve Process Models without needing to log-in
to and navigate through a web-friendly UI.
PROCESS PAULA
Business
I need my team to be more
effective at implementing
the processes that I define.
Senior Process Manager Line of
GOALS
What is she trying to achieve? TYPICAL WORKDAY
• Work with stakeholders and team to
• 50% Meetings
define, draw, and revise business
critical processes. • 25% Visio
• Work with Amy to make sure • 12.5% Web Tools
processes are implemented quickly • 12.5% Email
and correctly.
COLLEAGUES
• Improve bad processes and make the
company more efficient. Amy: Process Associate
• Deal with urgent process-related Deepak: Remote Developer
issues quickly and effectively. Steve: CIO

MOTIVATIONS
TECH COMFORT LEVEL
What drives her behavior?
• Use her deep domain expertise to Low High
Paula is a Senior Process Manager make a real impact. Software Tools
• Appear capable and in control. Low High
at a large healthcare payer (e.g.,
United, Cigna, Kaiser, Aetna), where BPMN
PAIN POINTS
she’s worked for 25 years. What slows her down?
• Unfamiliar drawing tools. If she can’t TOP 5 TOOLS USED
As a process owner, Paula is draw processes like she can in Visio, Visio
responsible for a number of business- it’s not for her.
critical processes, Paula leads a team • Needs a lot of support and training on Email
of analysts, including Amy, who she any new tools and technology. Can’t
considers her protégé. afford to waste time learning tools; it’s PowerPoint
not her job.
Paul is 55 years old and lives in • Does not know BPMN, so can’t easily Word
Connecticut with her husband. They verify the correctness of
implementations. Excel
have two college-aged children. Paula
has a BA from Penn State. Rarely Daily
 STRATEGIC STEVE
CIO
Functional Role: Executive

Goal: Enable Steve to have access to Bizagi’s analytics so that he can make
metrics-based informed decisions. He needs to know if all the healthcare IT systems
are running smoothly and be provided with early warning alerts if there’s something
that needs to remedied.
Strategic Steve CIO
Executive
Health IT shouldn’t be about GOALS: What is he trying to achieve?
technology at all – it should • Cultivate patient-centered healthcare TYPICAL WORKDAY
ecosystem.
be about putting the patient
• Make “change” the center for both • 50% In-person meetings
first. innovation and better care. • 25% Phone Calls
• Use KPIs to drive the business • 25% Phone Emails
forward. Analytics for accountable
care, strategy, and research.
COLLEAGUES
• Realize efficiencies through standards
and process improvement. Paula: Process Owner
• Remain agile in a dynamic
marketplace and regulatory
environment.
MOTIVATIONS: What drives his TECH COMFORT LEVEL
behavior?
• With the fear of ageism, has to be Low High
Strategic Steve is a future-oriented CIO of tuned in to the industry; networks with Software Tools
a large urban hospital. He’s a big CHIME. Low High
proponent of change yet acknowledges • Improve adoption success through BPMN
it’s difficult. planning and engagement.
• Align adoption strategy with business
His concern is always at 30,000-feet and TOP 5 TOOLS USED
objectives.
how strategy, governance, and policy fit Email
PAIN POINTS: What slows him down?
together from a systems perspective. He • Hospital-wide interoperability makes it
requires engagement at levels. PowerPoi
difficult to maintain pace of innovation nt
• Identifying business models for
Steve is 60 years old. He has a BS Excel
expanding health IT into community
degree in MIS from CalPoly and an and beyond.
Masters in Information Systems from UC • Planning past the foreseeable future. Skype/WebE
Berkeley. He plans to retire in 7 years. • Assessing organizational readiness x
and building a strong yet balanced
team Rarely Daily
Healthcare Personas Using Bizagi
11

Bizagi Studio “Sweet Spot”

Paula
Process Owner Steve
CIO

Amy
Process Manager

Nancy
Urgent Care Nurse

Deepak
Java Developer
Healthcare BPM Buying Team
• Business Decision Maker (BDM)
• Process Paula
• Technical Decision Maker (TDM)
• Strategic Steve
• Financial Decision Maker (FDM)
• Product Champions – official or unofficial
• Ambitious Amy
• Influencer – the largest group
• Nurturing Nancy, Diligent Deepak
• Initiator
• Process Paula
Participants Along the BPM Journey

Line of Business (LOB) Information Technology (IT) Contributors/Advisors

• Business Leadership * • IT Leader (CIO, CTO, IT • Enterprise Architect

• Process Owner Director, VP of Technology) * • Security Architect
• Process Manager • Process Architect • Data Architect
• Director of Process • Process Developer • Solution Architect *
• End User • Software/Service Developer • Business Architect *
• Process Analyst • Quality Assurance • Chief Architect *
• Documentation & • IT Administrators
Training • Operations Managers
• Director of Process • Business Analyst
• Director of Process
Improvement AD&D Leader Head of Transformation
• Project Manager
• VP of App. Dev. * • Head of Digital Strategy *
Citizen developers w/ • PMO Director * • VP of CX Mgmt. *
low-code requirements • VP PMO * • VP PMO *
• VP of Engineering * • VP Business Transform. *
*** Bizagi provided titles
Healthcare industry overview 1
Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
Appendix 5
Campaign Architecture (Healthcare)
Vertical
Brand
Campaign Digital Transformation Campaign - Change and the Digital Transformation of Healthcare

Each targeted campaign will include:

CX Transformation Operational Compliance & Email
Messaging Pillars -
Excellence Regulation - Blog
Engaging with Agile Process Agile/adaptable - Ungated Video
- Gated E-book /Report
Patients processes - Webinar
Value Proposition - Customer Case Study

ER Admittance Claims MACRA & Medicare

Use Cases
Submittal Investigations
+more +more +more

Examples Case
Studies

Product
Info Demo
 Change and the Digital Transformation of
Healthcare
1) CX Transformation 2) Operational Excellence 3) Compliance &
Regulation

▪ Bizagi Value: Faster ▪ Bizagi Value: Combo of BPM ▪ Bizagi Value:

implementation than competition.
Significant number of
integrations. Sophisticated
enough to support highly
complex workflows and
advanced digital process
automation. Minimize cost of
transition. Retain patients by
satisfying demand for new digital
capabilities. Maximize value of
existing system.
digitization and EMR reduces
steps and errors. Significant
integrations and interoperability.
Advanced analytic capabilities.
Minimize cost of errors and
miscommunications. Maximize
opportunities with existing
infrastructure.
Need more info about how Bizagi
BPM features support
compliance…Agile/adaptable
processes…. MACRA & Medicare
Investigations
Campaign Architecture (Horizontal)
Horizontal
Brand
Campaign Digital Transformation Campaign - Time to Digital

Each targeted campaign will include:

Targeted CX Transformation Operational Compliance & - Email
Horizontal Excellence Regulation - Blog
Campaigns - Ungated Video
- Gated E-book /Report
- Webinar
- Customer Case Study

Customer Loan
Use Cases
Origination EU GDPR
On-Boarding
+more +more +more

Examples Case
Studies

Product
Info Demo
Campaign Architecture (Vertical) - Banking
Horizontal
Brand
Campaign Digital Transformation Campaign – The Responsive Bank

Messaging CX Transformation Operational Compliance &

Pillars / Campaign Excellence Regulation
Themes

Customer Loan
Use Cases
Origination EU GDPR
On-Boarding
+more +more +more

Examples Case
Studies

Product
Info Demo
 Help with the speed Aggregate all processes Remove the repetitive Define high-level Run the hospital like a
development and that have been assigned nature of EHR systems. processes that run well-oiled machine with
increase me weekly as part of a workflow. through the organization. high profit margins and
output. Replace analog tasks (like CSAT.
Minimize the back and fax submittal) with digital Assess process errors
Maintain technical forth communication with processes. instantaneously. Use and showcase the
relevancy with development because it’s best practices in
development tools. inefficient. Allow knowledge worker to Reduce the number of healthcare IT to me a
model for similar sized
Bizagi Healthcare Remove any technical
experience less fatigue weekly, ineffective
hospitals.
Make me the subject and burnout by having meetings.
Campaign Theme matter expert, and not the obstacle that stands in the both more rest and human
way of implementing
#1 IT help desk for all
processes. HTML should
touchpoints. Use self-service options Manage & optimize all
IT resources from a
business users. and training to become
be the highest complexity Monitor patients progress more versed in BPM tools. single product/screen.
Enabling the Digital Highlight skill set to of code. to prevent recurring Learn multiple application,
Transformation of management, because admittance. so not only Visio Adhere, enforce, and
Healthcare I’m replaceable. Reduce mundane aspect dependent. maintain all GRC
of repetitive work. mandates.

Integration of Messaging
Across Personas
Landscape
Diligent Deepak Ambitious Amy Nurturing Nancy Process Paula Strategic Steve
Development should be Connect the dots. Glue Technology’s my
easy withy my choice of between process and Make IT easy. I want to get Great process, which I competitive advantage, but
back to my patients. define, leads to great and how do I measure if I’m on
tools. development. vital output. top of my game.

IT LOB Knowledge LOB IT

Tactical
Worker 41

Strategic
 Alternate Theme Overview
1) Change and the Digital
Transformation of
Healthcare
▪ Proof: Faster implementation
than competition. Significant
number of integrations.
Sophisticated enough to support
highly complex workflows and
advanced digital process
automation.
▪ Value: Minimize cost of
transition. Retain patients by
satisfying demand for new digital
capabilities. Maximize value of
existing system.
2) Efficiency,
Streamlining Healthcare
Systems and
Communication
▪ Proof: Combo of BPM digitization
and EMR reduces steps and
errors. Significant integrations
and interoperability. Advanced
analytic capabilities.
▪ Value: Minimize cost of errors
and miscommunications.
Maximize opportunities with
existing infrastructure.
Call this operational excellence
3) Something for Everyone
Bridging the LOB and IT
Gap
▪ Proof: Lower comparative price
point with similar/greater feature
set. Capability to span healthcare
system.
▪ Value: A single solution that
satisfies the needs of LoB and IT.
Underlying Theme Concepts
1. Enabling the digital transformation of healthcare
2. Lost in translation
3. Feel the love between LOB and IT
4. Humanizing healthcare
5. Extending and improving on EHR
6. Don’t consolidate, integrate – reduces IT wastage
7. From a patient’s connected health to a connected healthcare system
8. Reducing healthcare latency
9. You have your healthcare IT in place, we have your BPM workflows covered.
10. Continuous healthcare improvement
Internal Messaging
1. LOWER costs while improving innovation

2. REDUCE the amount of unnecessary paper work

3. ISSUE faster payments

4. INCREASE worker productivity, thereby requiring less staff

5. APPROVE authorization/approval forms/appointment times at a quicker pace

6. OFFER the highest levels of customer service

7. ADHERE to increasing regulatory pressures

8. INCENTIVIZE patients active role in their own well-being

9. ACCELERATE processes for improving insights into patient data

10. HARNESS new technologies aiding in lifelogging a patient’s health

11. DIGITIZE everything

Healthcare industry overview 1
Healthcare use cases 2
Target healthcare personas 3
Healthcare messaging framework 4
Appendix 5
 Resources
• http://www.performancedesignlab.com
• Fierce IT Health
• https://decisions.com/company/
• http://healthcare.mckinsey.com/sites/default/files/the-trillion-dollar-prize.pdf
• PwC Healthcare Study
• OECD
• https://hbr.org/2015/02/the-biggest-u-s-health-care-challenges-are-
management-challenges
• American Hospital Association http://www.aha.org/research/index.shtml
• HIMMS 17
• http://www.mckinsey.com/business-functions/digital-mckinsey/our-
insights/disruptive-technologies
• BPMNext 2017 conference
– BPM 2017 – 201: Outlook for the Next Five Years, Nathanial Palmer, BPMNEXT CoChair
– The Top 10 Technologies That will Impact BPM in the next Five Years (or Don’t Get Caught with
your technologies down), Jim Sinur, Aragon Research
– The new wave of automation, MWD Advisors
– The Great Migration: How to Survive the leap from BPM as we knew it to the era of the digital
workforce, Clay Richardson, Digital Fastforward
– The Recipe for Successful Digital Transformation: Derek Miers, Structure Talent
Bizagi Healthcare Landscape
Bizagi Offerings and Markets
• Bizagi 11 BPM Digital platform–Suite
of Bizagi Modeler, Bizagi Studio, and
Bizagi Engine.
• Both on-premise and SaaS options
Market Size and Growth
• BPM market size projected to reach $23 billion by 2024.
14.2% CAGR from 2016 to 2021 –Markets&Markets. NA
dominates 30%+ share in 2015
• BPM for hospital management systems, including bed
management and patient monitoring, are anticipated to be
key factors fostering growth in healthcare.
• Appian and Pega are the leaders, followed by IBM.
Appian has 280 customers with 37 of Fortune 500
companies and recently has an IPO.

Key Competitors Market Position and Momentum

• Appian • Bizagi appears on both Gartner’s MQ and Forrester WAVE.
• Pegasystems • It’s the only solution that appear on the ‘Challengers’ portion
of the MQ, a testament to Bizagi’s strength in execution and
• IBM
price/value ratio.
• Oracle
• Bizagi’s “freemium” model was introduced long before the
• Software AG term was coined and popularized.
• TIBCO • The oldest kid on the block, with a strong track record
• K2 • Both Appian and Pega have identified healthcare as a
• Lexmark vertical with dedicated real estate:
– www.pega.com/industries/healthcare, and
– www.appian.com/industries/healthcare
Healthcare Terminology
Healthcare Healthcare IT Bizagi’s Three Pillars
Mandate/Security ● Business Intelligence 1. Agile
● ACA/PPACA – Affordable ● CIS (Clinical Information 2. Connected
Care Act System) 3. Engaged
● CHIP DICOM
● EPCS - e-Prescribing of
● EHR/EMR
controlled substances
● E-prescribing Value propositions
● Fraud
● HIPAA ● HIE ● Citizen developers
● HITECH ● HIS ● Cloud-first, but not
● ICD-10 ● HL7/FHIR cloud only
● MACRA ● KLAS Research ● Lowest code
● Meaningful Use ● Lab Integration
● MIPS – Merit Base Incentive
● Medical Billing
Program
● Protected Health Information ● mHealth/mobile health
(PHI) ● PACS (Picture Archive
● Smart card/patient card Com. Sys.)
● Patient Portal
● Patient Scheduling
● RIS – Radiology Information
System
Extended Healthcare Use Cases
Accessing EMR/EHR systems
Admission notification via patient administration system
Alternative health and services
Automated determination of drug interactions - EHR ***
Call center for healthcare provider
Care manager
Care planning and discharge readiness ***
Casement management to handle applications ***
Chronic disease management with patient reported outcomes
Claims pre-auth./eligibility, consultant selection, and status ***
Clinical trial program
Commercial claims testing audit
Compensation processing and automated disputes
Credentialing of temporary health workers
Discharge communications and readmission avoidance
ER Visit – triage via ER consult
Employee adherence of policies and procedures
Expediting Medicaid application approval
Financial clearance – proof of medical insurance
Financial tasks management
Healthcare providers regulatory and compliance
Health care claims processing ***
Health insurance exchange
Hospital bed rotation *** (example of machine learning)
Hospital administration for back-office processes
Identification of conditions based on patient data
IoT for healthcare workflow optimization (wrist ID)
IoT for inventory management (pharmacy)
IoT for medical device integration
Insurance data automation and claims processing
Intelligent referral letter triage
Knowledgebase system
Medical Card Exchange
Medical bill processing/triggered email
Medical device tracking
Member enrollment for payment and provider ***
Optimizing care and avoiding non-urgent use of ER
Patient access to medical records
Patient assessment/risk stratification ***
Patient on-boarding ***
Patient data migration and processing
Patient record storage
Patient registration and check-in
Patient transfer between providers
Personal health record (PHR) portal
Physician referral, directory, and second opinion
Physician access to patient clinical data anywhere
Policies and procedures application
Preferred drug prescription audit – EHR
Pre-visit/patient intake via PAS
Printing application workflow
Recruiting, job placement, licensing, credentialing, travel and
accommodation of temp. workers ***
Medicaid application, appeal, and recertification process*
Remote monitoring
Remote nursing work management
Remote and secure express care for patient communication
Reporting by doctors
Resource scheduling of employer shifts
Scheduling and prescription management
Test results notification
Training/certification programs for employees
Wayfinding apps - Patient centric
Trends in BPM and Digital
Process Automation
“Many organizations are either beginning, or in the midst of, digital business transformation
initiatives. We expect that only 30 percent of these efforts will succeed. To be part of that 30
percent, business and IT leaders must be ready and willing to innovate rapidly from a business
model, business process, and technology perspective.”
Julie Short, Research Director, Gartner

“Through 2017, insufficient business process management (BPM) maturity will prevent 80
percent of organizations from achieving the desired business outcomes from their digital
business strategies.”
Julie Short, Research Director,
Gartner

“The primary driver for the rise in DBP is the need to make businesses more responsive with
faster and more effective processes or applications while dealing with frequent change and
increasing demands for customer-driven approaches.”
Jim Sinur, VP of Research and
Research Fellow, Aragon Research

“Aragon expects that the DBP market is poised to grow into a $50-billion market by 2021.”
Jim Sinur, VP of Research and
Research Fellow, Aragon Research
Value Driver
Improve Business Effectiveness &
Productivity (Grow Revenue)
Manage Risk and Regulatory Compliance
(Mitigate Risk)
Operational Efficiency and Process
Improvement (Reduce Costs)
Description
Improve business collaboration across organizational boundaries, and enable employees to be more productive by giving them
greater insights, richer context and a single view of customers.
Protect high-value information yet at the same time provide greater transparency on data and processes mapped to regulation and
compliance requirements, automating much of the approach to mitigating risk.
Identify areas for process improvement, orchestration between disconnected systems, core processes or supporting processes, all
with the goal of reducing costs and increasing throughput.
Improve Business Effectiveness & Productivity (Grow Revenue)
Business Situation (Challenges) • Disconnected systems prevent having a single view of a customer
• Organizational silos ensure no cross group collaboration, inability to support across customer lifecycle
• Lack of alignment between executive vision and day-to-day execution across organization
• Existing systems are too complex and take too long to implement or change
• Cultural resistance to change and fear of failure
Consequences • Threat of challenger brands or more innovative firms taking market share
• Poor customer experience will lead to reputational risk and potential negative PR (social media campaigns)
• Cost of doing business escalates and is less responsive to increasing customer demands to be more digital
• Loss of customers and loyalty as they switch to competitor products or services
• Inefficiency in dealing with customer requests, lack of opportunity to cross-sell upsell
• Caught in trap of wanting to change but unable to due to constraints, hits employee morale and increase staff turnover
Bizagi Position (what needs to be done) • Connect legacy systems by creating a ‘wrap around’ integrating systems, data and streamlining processes to derive greater agility
• Executive sponsor responsible for aligning organization to the vision and goals and day-to-day execution (transformation)
• Identify key processes that can be automated and map across the customer lifecycle
• Use Studio to align Business and IT to map common goal and approach to what needs to be fixed
Benefit • Reduce customer waiting times
• Increase customer satisfaction scores
• Create true customer loyalty (retention strategy)
• Drive down the cost of doing business
• Grow revenues as more successful at attracting and retaining customers
• Increase average revenue per customer
Proof Points Customer Onboarding:
• Old Mutual | Challenge: Disconnected systems, silo businesses (loans, cards, mortgages, savings), advisors unable to meet all
customer needs | Solution: Bizagi wrap around silo systems integrating to UX | Result: Net Promoter scores up 15%, Customer
resolution up 30%, branch queue time down 9x, customer onboarding time cut 10x.
• Mentis Neuro Health | Challenge: Patient onboarding taking 2-3 weeks, wait times for patients left in hospital too long, losing out
to other healthcare providers | Solution: Needed to quickly scale to support growth plans, worked with Partner InnoVelocity,
business and IT worked together to map the processes | Result: Up and running in 90 days, worked on 3 week sprint cycles
thereafter based on user feedback, Patient intake dropped from 2-3 weeks to 2-3 days, Mentis have now seen a 21% increase in
Patient demand.
Manage Risk and Regulatory Compliance (Mitigate Risk)
Business Situation (Challenges) • Manual processes for monitoring transactions
• Deep collaboration required between departments to ensure consistency
• Hard to maintain SLAs due to unpredictable nature of processing tasks
• Often lack of transparency leading to unexpected outcomes
• Paper-based processes prevent responsiveness and agility as regulation requirements evolve
Consequences • Inconsistency in how transactions are conducted, leading to breaches of policy
• Misalignment between departments
• No process aligned to regulation requirements, no ‘safety net’ to ensure policy met
• Inability to manage policy and regulation changes proactively, always behind the latest compliance and regulation requirements
Bizagi Position (what needs to be done) • SPARK methodology, identify a core process to map in it’s entirety
• Ensure project leads are trained and involved in process design (Business and IT) using Studio
• Ensure alignment to Exec vision and day-to-day deliverables
• Review and iterate as the project progresses
Benefit • Meeting regulation and compliance requirements
• Seamless and automated processes improve collaboration across the organization
• Greater transparency leads to improved reporting and insights driving better business decision making
• Extend participation and visibility to end clients, boosting quality and customer satisfaction scores
Proof Points Industry Policy & Regulation:
• Stone Coast | Challenge: “Back Office” operations, accounting, and valuation services require deep, daily collaboration between
clients and administrators, Needed to move away from paper-based operations to digital services to boost competitiveness while
cutting operational costs | Solution: Over the course of six weeks, the project team designed and deployed their first solution
covering Cash Movement, worked closely between business and IT to map the cash movement process | Result: With the first
application in production, Stone Coast feels it has already proved ROI. The BPM COE is now working with other teams to tackle new
projects, Cases move from business teams to cash teams without any paper, Greater data accuracy and straight through processing.
Strong data integrity naturally makes the team more efficient and effective, Customer service teams can now extend participation
and visibility to end clients, boosting quality and net promoter scores.
• infoCaja | Challenge: Needed to implement a new system to meet changing regulation (MiFID), Needed to deliver without
impacting profits | Solution: Working with PwC to implement Bizagi Studio | Result: Implemented a new process within 4 months 6
less than expected, infoCaja were able to quickly adapt BPM processes to each banking affiliate, This allowed them to reduce the
projected costs of complying with MiFID by 80%.
Operational Efficiency and Process Improvement (Reduce Costs)
Business Situation (Challenges) • Lack of process visibility due to paper-based processes
• Inconsistencies in the way business is conducted
• Slow, cumbersome and unresponsive to customer requests
• Disconnect between systems, silos of data and no intelligence
Consequences • Rising costs with growing inefficiencies and increasing competition
• Poor experience for customers expecting intelligent, personalized experiences
• Financial penalties due to defaulting on policy and regulation requirements
• Inability to make key decisions based on data
Bizagi Position (what needs to be done) • SPARK methodology, identify a core process to map in it’s entirety
• Ensure project leads are trained and involved in process design (Business and IT) using Studio
• Ensure alignment to Exec vision and day-to-day deliverables
• Review and iterate as the project progresses
Benefit • Speed to deliver new automated processes
• Responsiveness in delivering customer products and services
• Support for delivering more digital experiences with the ability to bring new capabilities such as AI and BOT services
• Greater transparency of processes allows for greater reporting and insights, leading to more effective troubleshooting
• Ability to effectively control costs and evening reducing in places
Proof Points • AgFirst |Challenge: Streamline and standardize loan approval processes | Solution: Replace existing Infopath forms with workflow
engine, mobile BPM solution for staff working remotely | Result: Loan approvals closed 60% faster, 1st process delivered in 16
weeks.
• Generali | Challenge: Renewal time slashed by 50%, Making the leap to automated and efficient processes and workflows has
delivered immediate benefits. Bizagi's system architecture enables reuse, meaning multi-country, multi-language deployments
become more effective with scale. The initial project cost saving was 60% when compared to other systems, expected to rise to
90%.
 IDC Health Insights Main Research Areas
for 2017
• IoT
• How does Healthcare providers progress towards IoT platforms?
• What are the top IoT platforms in healthcare and what are their capabilities?
• What are the top services for IoT: e.g. Integration services and how are they applied in healthcare?
• Integrated care
• Is there a real market for integrated care solutions across countries?
• What are the trend in patient data management?: 360° view of the patient vs. specific clinical pathways
and what are the main drivers?
• What are the best practices in value-based care?
• How does healthcare providers empower patients, so they move from passive recipients to active
participants?
• How do you assess the maturity of integrated care initiatives or organizations?
• DX
• Legacy – how does legacy challenge DX initiatives in healthcare?
• Cognitive
• What are the main use cases and users for cognitive solutions?
• What are the preferred delivery models of cognitive capabilities?
• What defines the different types of cognitive capabilities and how are they adopted?
• Is there a lack of trust in cognitive capabilities and why?
• Digital Hospital
• How are hospitals progressing toward a higher maturity as digital hospitals?
• What is the role and best practices for healthcare providers when engaging with a local system integrator
and implementing an international based platform?
IDC’s ACO Maturity Model

Ad Hoc Opportunistic Repeatable Managed Optimized

● Analytics, ● Demonstrated
workflow, and IT efficiency
patient ● Mobile
engagement technology for
technologies. patient
engagement
POV: Embracing the Provider’s Employees
Nurse and Administrator
Healthcare Challenges
Industry-Agnostic Challenges Healthcare-Specific Challenges
1. Greater agility and productivity 1. Increase Efficiency ***
2. New Payment Models
2. Increase efficiency
3. Cost Reduction ****
3. Consistent, repeatable, and efficient
4. Quality of care improvement ***
outcomes
5. Controls re: privacy
4. Reduce expenses
6. Pricing revision
5. Drive growth 7. Business model realignment
6. Ability to make better and faster 8. Balancing innovation with cost
decisions 9. Harnessing new technology
7. Navigating the complexity of regulatory 10. Internal mindset (change) – HBR ****
compliance 11. Outdated/ineffective IT infrastructure – HBR
8. Mitigate regulatory compliance risk 12. Cultural resistance ****
9. Minimize redundancies 13. Misalignment with physicians
10. More satisfied customers 14. Ensuring regulatory compliance with everchanging
regulations***
11. Lowering costs or reducing costs of 15. Alignment of divergent IT (integrate, not consolidate)
operations 16. Accelerating pharma clinical trails and streamlining FDA
12. Increased revenues/improved revenues approval
17. Managing enrollment process
13. Motivate employees
18. Monitor and improve care delivery
14. Boost/improve visibility 19. Identify and avert resource bottlenecks
15. Accelerated innovation 20. Automate the identification of critical conditions using analytics
16. Increased speed to market 21. Improve methods of gathering and reporting data
17. Penetration and expansion into global 22. Monitor cost, quality, and compliance metrics
markets 23. Automate non-value added tasks and eliminate non-value
added ones
Infused Terminology
BPM Terms BPM Terms
• Composite Process Application
BPM Terms BPM Terms
• Standard Deviation
• Activity • Computer Aided Software • Model
• Standard or Normal Bell-
• Activity Cost Worksheet Engineering (CASE) • Model-Driven Architecture
Shaped Curve
• Ad Hoc Workflow Systems • Continuous Process • Modeling
• Sub-processes
• Administrative Workflow Systems Improvement • .NET
• Subsidiary Business
• AI/machine learning • Core Business Process • Nodes
Processes
• API • COULD Process • Object Oriented
• Super-system Diagram
• Asynchronous Process • CRM • Packaged Applications
• Supplier-oriented eBusiness
• Balanced Scored • Dashboard • Parallel Process
Applications
• Batch Processing • Data Warehouse • Portal
• Supply Chain Council
• Benchmarks • Database • Process
• Supply Chain Management
• BPEL • Decision Point or Diamond • Process Analytics
(SCM)
• BPM Software • Development framework • Process Architecture
• Swimlane
• BPMN • Digital Business Platform • Process Automation/Robotic
• Synchronous Process
• BPSIM • DMAIC • Process Designer
• Tasks
• BPMS/iBPMS • DMN • Process Diagram
• Three levels of organization
• Business Analytics • ebXML • Process Engine
(Performance Framework)
• Business Intelligence • EDI • Process Instance
• Total Quality Management
• Business Activity Framework • Enterprise Application • Process Management
• Transaction or Production
• Business Activity Monitoring (BAM) • EAI • Process Measures/Process
Workflow Systems
• Business Process • ERP-Driven Design Output Measures
• Transitioning to a new process
• Business Process Design/Redesign • Exceptions Processing • Process Modeling
• Transformation
• Business Process Improvement • Gaps and Disconnect Processing • Resource Optimization
• UML
• Business Process Management • IoT/Internet of Medical Things • Rules Engine
• UDDI
• Business Process Modeling • IS Process Diagram • Rummler-Brache Methodology
• Use Case Diagram
• BPM Platform • ISO 9000 • SaaS BPM
• Value Chain
• Business Process Management • Java • Scorecards
• Web Services
Initiative (BPMI) • J2EE • SHOULD Process
• WSFL
• Business Rules/Business Rules • Junction/Junction Bar • Silo thinking
• Work portal
Management • KANO Analysis • Simulation
• Workflow
• Business Process Outsourcing • Key Performance Indications • SIPOC
• Workflow model
• Business Process Rengineering (KPIs) • Six Sigma
• Workflow Reference Model
• Case management/adaptive • Knowledge Management • SOAP
• Workflow System or Engine
• CMMN • Lean Manufacturing • Software Engineering
• XML
• CMS • Measures Hierarchy • Software Requirements
• XML Business Process
• Collaborative BPM • Middleware • Software as a Service (SaaS)
Language
Weighing Bizagi’s Strengths
1. Cost
I think is the biggest strength.
1. Scalability
What does scalable mean? # of users? Number of workflows?
1. Interoperability (Integration)
I like the notion of being able to work with existing BPM solutions.
This should be a part of the architectural diagram.
1. Performance
How do you measure performance in BPM?
1. Availability
In hardware, this is usually the system being up?
1. Management
Which product manages? Can you use a third-part tool?
1. Security
Which modules and/or features allow for adherence?
Elements of BPM
• Analytics embedded in enterprise apps
• Potentially lighter-weight process workflows
• Case management for managing complex and evolving situations (called
cases). Usually requires fixed milestones and. They tends to be long running,
complex, emerging, and involve deep knowledge and skills.
• Goal directed flows, situational flows where the goals or milestones change it
provides a good solutions. With rapid change, goal directed processes win the
day.
• Little process drivers – First mile content management journeys are a popular
use to capture, sign, and manage documents as they hit all of the required
stops
• Cross skill/departmental flows are the life blood of organizations. These are driven by
low or no code and light weight process capabilities.
• Event response where, expected or not, trigger off appropriate actions to deal with the
situation of patters of events. This is where canned process responses can be
inventories and pulled out when needed.
• Harmonizing work, content, and data tend to flow when action is taken in
response to attaining a set of goals or responding to events.
BPM Quotes
• Basic investment in BPM Suite can yield significant returns. Gartner
states that by simply “making the current-state handoffs, timing, and
responsibilities explicit, productivity improvements of more than 12
percent are normally realized.1
• 78% of projects see an IRR of greater than 15%2
•The same repo indicates that these projects were deployed quickly
(67% in less than six months, 50% in less than four months.)
•Advantages: Grow revenues quickly while containing their growth in
headcount. Process more with less effort and higher quality.
 BPM Vectors
Basic efficiencies that a more controlled process brings, the next RPA for efficiency, BPM for effectiveness
step is to make the process more effective. There are variants that
are often less scripted. For example, handling exceptions, or
making better decisions. This could include claims disputes. For
regulated processes, as it in healthcare, this level of control and
consistency provides an added benefit. The avoidance of fines Efficiency
because of incorrect or inconsistent execution of the process. Or Perhaps because of manual effort, poor hand-offs between departments,
the lack of timely execution of a process. and a general inability to monitor overall progress. One healthcare
Effectiveness company realized savings of 21,000 hours (10 FTEs) for their employee
on-boarding process in the first year.

Agility

The ability to change and quickly adapt or modify processes is essential. Customers change
processes 4-7 times per year. The drivers could be internal or external. New partners supports a
different way of doing business. Regulations can also require you to change processes. Agility
benefits typically support adapting to regulations faster, as to not incur chances of a fine or
penalty. In addition, the ability to change a process to accommodate unforeseen events. Claims
process and approval are very important, especially during certain windows like December.
Benefit
Efficiency
Eliminate Manual Data Entry
Reduce Process Cycle Time
Reduce Manual Analysis/Routing
Effectiveness
Handle Exceptions Faster and Better
Make Better Decisions
Consistent Execution
Agility
Faster Regulatory Compliance
Support New Business Models
Example
Reduction in time to add a new employee record into HR systems
from 9 hours to 10 minutes.
Reduction in compensation processing timing for 12,000 sales reps
from 33 days to 7.
Elimination of 80% of the manual work previously required to route
invoice exceptions to the appropriate resolution teams.
Evolve process from saving 5% of distressed shipments to saving
70% - yielding $2M per quarter in saved revenues.
Better review process results in $3M saved in billing dispute write-
offs that would formerly have just been processed because the
process was poorly controlled.
CSAT improvement to 92% based on proactive tasks that help
ensure the home loan process executes better and faster.
Change customs related processes after 9/11, within 90 days to
comply with new federal regulations for better shipping visibility.
Ability to change shipping partners within 10 minutes in core process
allows manufacturer to change primary shipper every quarter –
based on best bid provided.
Benefit Example
Eligibility Determination of eligibility, Medicaid, HIE

Calculation of premiums, co-payment amounts, and health incentive

payments.
Online advice tool (Basque’s Health’s Self-Assessment Tool)

Interactive guidance for contact center staff to triage patients,

generation of treatment plans, and follow-up steps (KP On-Call)
Top Healthcare Compliance Initiatives (Provident Consulting)

Meaningful Use Requires adoption of EHR systems. However, HER implementations

have failed. Many are not user-friendly or fully compliance. And now
there is also patient use of EHRs.
Privacy, Security, and Technology BPM can help with the audits

MACRA More incentive on value and quality or quantity. Requires changes in

data reporting and records, as well as collaboration with other
departments.
Medicare Investigations Medicare reimbursement frauds involving $900 million. Compliance
leaders will need to improve their Medicare documentation and
justification processes. BPM bolsters compliance. A link can be
made between BPM capabilities and compliance efficiencies