Keeping Processing in the Game
As fast as the competitive, regulatory, and technological underpinnings of information management are moving these days, one thing is moving even faster: the proliferation of new ways to conceptualize, model and describe these changes with new phrases and acronyms. Like its brethren (BPM, TBI, EDM, etc.), Enterprise Content Management (ECM) is a phrase coined by industry analysts to help give business and IT professionals a 30,000-foot view of a new content management strategy that blurs the bounds of traditional corporate information silos. Over the past year, ECM has gained traction as the definitive term to describe the power of converging content from every corner of a company’s operation, including documents, Web content and rich media resources.
As a business with a long history of compartmentalized functionality, traditional methodologies and segregated business units, the insurance business may benefit more than many others from a realization of ECM’s ultimate promise of seamless, enterprisewide access to content. Yet the essence of the insurance business is its inextricable relationship with not only content, but also process. Insurance companies are, in essence, “information factories” whose end products constitute the result of systematized collecting, processing, researching and detailed decision-making on immense sums of data. It is out of this “Process-centric Content Management” that insurance ultimately delivers the intangible part of its product: financial security and peace of mind.
ECM embodies the idea of a single “virtual repository” that connects all forms of information, whether physical or virtual, paper or pixel, and structured or unstructured. ECM’s vision leverages a yet-to-be-realized technology infrastructure which provides instant access to data that: lives on virtually any platform; is created, revised or published using virtually any application; and which can be located at any company, customer, partner, vendor or collaborator site across the globe.
Transaction Processing
Although ECM concepts are rapidly eclipsing earlier business models and technologies for creating, storing, and delivering information, transaction processing remains at the heart of any insurance company’s mission-critical activities. Examples of these processes include claims adjudication and exception processing, enrollments, medical review, underwriting, management of agent and provider relationships and customer service operations. For an insurance company, these processes produce and in many ways constitute a company’s actual end-product. ECM strategies should be used to enhance and extend these processes in ways that create highly innovative competitive, service and financial advantages.
Marriage of Process and Content
Work process management, or more simply “workflow,” is a core enabling technology that touches virtually all corners of insurance business operations. By the same token, “content” that is submitted by an insurance company’s customers, agents, brokers, and providers, and that is created by internal staff, represents crucial information that facilitates these processes.
As such, technologies that manage content also enable your business operations, but it is difficult to imagine an insurer’s ability to fulfill its objectives in the absence of the processes that use the information.
“Process-centric Content Management” is in essence the marriage of process and content, as well as the marriage of Work Process Management and Content Management technologies. It brings the most critical functionality from both disciplines to bear on an insurance company’s single most important goal: the efficient processing of customer transactions. Moreover, recognizing the important interrelationships of process and content, it does so in a seamless, integrated fashion.
For example, when a step within a health insurance company’s claims adjudication process requires additional external information, Process-centric Content Management invokes Work Process Management functionality to automatically request it from the physician. When these medical records are ready for review, it calls upon ECM to automatically provide the information to a Medical Director.
Process-centric Content Management focuses exclusively on the tasks and activities within your business operations, applying Work Process Management and ECM to each transaction and supplying content appropriate to each processing step. To better understand the benefits that Process-centric Content Management can bring to your organization, it is helpful to explore each of the underlying concepts uniquely.
Content
Within the context of insurance business operations, content represents all of the information that may need to be called upon to complete a transaction. The documents your customers submit to your organization, such as paper claim forms, are one example of content, but so, too, are their EDI and Internet equivalents. The information that claims processors review in the adjudication of these claims—such as associated medical records—also represents content, as do the internal processing manuals to which staff members often refer to for guidance. Even data produced as output from legacy processing systems provides a relevant example of content, as do each of the following: ‘customer’ documents, electronic claims, correspondence, booklets, manuals and guidelines, brochures and directories, regulations, Web pages, phone calls, computer outputs, plan publications, medical records, contracts and reports.
As the types, variety, and sheer quantity of content rapidly increase, content management capabilities become a strategic necessity to support high volumes and thousands of users. As demonstrated by the prior examples, the business purposes for content increasingly overlap, with most information functioning as a part of multiple business processes.
Enablement of Real-Life Business Process
If “content” represents the complete range of information used within an operation, Enterprise Content Management enables its application to real-life business processes. Unlike traditional document management—which provides storage and retrieval for primarily paper-based and a few electronic types of documents—ECM expands the files that can be managed within content repositories to include hundreds of different types, including: paper documents, EDI data, mainframe reports, phone call records, Word documents, Web publications, HTML/XML data, facsimiles, legacy system data, e-mail and e-forms, spreadsheets, and audio/video files.
Extension to the Web
In the Internet-enabled world, wide-ranging file type support is a surprisingly important e-Business capability. Because of their ease of creation, submission, and publication, “document” volumes are proliferating every bit as quickly as the Internet, particularly as they become part of widely available Web-based processes.
Not surprisingly, ECM also provides sophisticated tools for controlling that information, making it available when it is needed and to whom it is needed, while restricting access in accordance with regulatory requirements such as Gramm-Leach-Bliley and the Health Insurance Portability and Accountability Act (HIPAA). It also organizes the information by applying index values and document relationships, making it more useful to your organization and providing numerous opportunities for “re-purposing” or re-using it. In support of publication needs, ECM provides version control and Internet formatting functionality that allows you to produce documentation, such as benefit plan descriptions and provider directories, on your Web site. And it allows you to make mainframe reports such as premium bills, EOBs, and provider vouchers accessible on the Internet.
ECM’s Technology Umbrella
The proliferation of ECM-related technological capabilities (and acronyms) gives testament to the rapidly expanding nature of the business view of ‘content’:
- Document Management (DM);
- Integrated Document Archive and Retrieval Systems (IDARS);
- Knowledge Management (KM);
- Web Content Management (WCM);
- Digital Asset Management (DAM);
By no means all-inclusive, and without attempting to distinguish among the various types of products, this list demonstrates broad market acceptance of the fact that ECM has become a required component of enterprise infrastructure. Once the capability to manage all forms of content across the diversity of the enterprise is assumed, the most important question to business leaders is how to apply ECM to real-world business needs. Within the insurance industry, the most critical application of ECM is in transactional processing, marrying the content with operational business processes to achieve Process-centric Content Management.
Process
In the simplest terms, a process consists of the sequence of actions, activities, and tasks that are performed to complete a business transaction. For example, the servicing of members typically involves many distinct activities, such as fielding telephone calls, confirming eligibility, and initiating claim reviews. It is the combination of these activities, from the time an inquiry is initiated until it is completely resolved, that represents “Customer Service” as a business process. Business processes usually involve many different business transactions, each with unique actions and tasks that must be performed, as in the case of the thousands of customer service inquiries your organization handles each month. Representative health insurance industry business processes include: underwriting, enrollment, preauthorization, claims processing, reimbursement, credentialing, contracting, billing, referral, customer service, commissions, and medical review.
A business process also consists of the resources that are called upon to perform various tasks and activities, such as staff members and computing systems. In our previous example, these resources obviously include your customer service representatives, but might also encompass a mainframe system through which eligibility is confirmed and the customer relationship management (CRM) system into which the facts of each inquiry are entered. These types of processes are at the heart of all insurance business operations.
The existence of such large numbers of transactions within so many different business processes makes the need for tools to manage these processes somewhat self evident. Only the smallest organizations attempt to manage business operations without them, and thereby miss significant opportunities for increasing productivity and efficiency while reducing administrative expenses.
The ECM Workhorse: Work Process Management Software
Work Process Management software handles every aspect of operational business processes. It assigns processing transactions to the appropriate resources, be they human or application systems, in the correct sequence and at the right time. Using rules-based work distribution and routing capabilities, it allows multiple processing tasks to be accomplished simultaneously. It establishes and manages priorities and time limits for each transaction uniquely, ensuring that cycle-time performance objectives are achieved. It provides automated work performers to execute tasks that don’t require human intervention. When the human touch becomes necessary, Work Process Management software provides sophisticated functionality for handling exception transactions, including user interfaces appropriate to specific processes and even to steps within a process. Once the interface directs and presents exception work to them, end-users are provided tools for initiating, routing, and completing mission-critical business transactions. Work Process Management software also provides robust tools for operational managers, allowing them to track work-in-process, balance workloads, and perform real-time and historical inventory analysis and reporting. Behind the scenes, business analysts (rather than IT developers) use table-based configuration tools to design and maintain the entire system without reliance on programming. And increasingly, Work Process Management software tightly integrates with other user applications, particularly host-processing systems, to provide a complete linkage between all systems involved in a process.
Work Process Software Enables Process-Centric Work Process
When married with ECM systems, Work Process Management software enables Process-centric Content Management. Because it intelligently recognizes the interrelationships of processes and information, Process-centric Content Management extends the functionality of Work Process Management and ECM technologies to enable capabilities not possible when process and content are treated separately. Applying Work Process Management to each transaction, with ECM supplying content appropriate to each processing step, Process-centric Content Management uses evolutionary technologies to revolutionize the way you do business.
ECM: Vision Meets Reality
As with any new breakout technology, ECM will ultimately become defined not by those who would conceptualize, but by those who sit down to work every day with tangible, looming quarterly performance expectations on their desks. These end-users will define the reality of how and when ECM’s vision can be realized, what vendor solutions should be acquired and what should be postponed or rethought, and what business benefits ECM can tangibly bring to the bottom line. For insurance people, the inseparable relationship of content and process provides clear direction: leverage solutions and technologies that enable a wider diversity of content to drive a stronger and more profitable process.