Celebrate the Success Stories of Knowledge Management - 2022 KMWorld Awards

KM past and future: closing the knowledge loop

Maintaining a high level of customer service is a primary driver for the use of Web self-service. “Keeping an existing customer happy is critical for protecting brand reputation,” says Santi Pierini, CMO of InQuira. When used effectively, information derived from those customer interactions can also improve the company’s performance. “Not only does InQuira let customers get relevant information quickly,” Pierini says, “it also supports continuous improvement.”

Empowering the patient

Nowhere is the need for closing the loop more pressing than in healthcare. By all accounts, healthcare information exists in huge quantities in many different databases, but it’s not always put to good use. Interoperability remains a challenge. Some software companies, however, are bridging the gap and delivering major value-added to insurance companies and consumers alike.

The TriZetto Group was formed to provide software and related services to make the healthcare supply chain more efficient. “The healthcare supply chain is complex, and there is no single fix,” says David MacLeod, VP of R&D at TriZetto, “but we can make much better use of the information that is already sitting in silos.”

MacLeod also points out inconsistencies in the current reimbursement scheme, such as payment for procedures rather than for outcomes. “Neither physicians nor patients are presented with compelling incentives for improvement in healthcare management,” he says. Until complete feedback to doctors and patients becomes routine, the appropriate course of action may remain unknown.

FACETS, TriZetto’s flagship product, processes claims for many major healthcare insurance companies, including the majority of Blue Cross/Blue Shield companies. In addition, FACETS provides real-time adjudication to determine the costs of procedures so that physicians can see the payment information prior to carrying them out. MacLeod, who previously worked for a Medicare claims processor operated by a large affiliation of Blue Cross and Blue Shield organizations, was responsible for selecting TriZetto’s product at that organization, to replace almost a dozen antiquated enterprise administration and healthcare claim reimbursement systems. “We picked it because of its maturity, scalability and flexibility,” he explains.

An innovative software option in FACETS helps families select the best healthcare insurance plan for their needs. “Our system knows what plans each participating employer offers,” says MacLeod, “and it also knows the employees’ medical histories. Employees can go through a ‘what-if’ process and see which of the plans offered in the next year would optimize their benefits, based on a known medical history.”

That link between patient, plan and history previously has been unavailable. In addition, TriZetto provides technology for online patient forums, which is another way to get patients actively involved in their own healthcare. The forums are particularly valuable for patients with chronic diseases such as diabetes, where patient compliance plays a critical role in outcomes.

KM supports government

KM has taken root in both the civilian and military agencies in the federal government, and is being sustained by several new initiatives. The U.S. Army issued a memorandum in July 2008, “Army Knowledge Management Principles,” that outlined a dozen KM principles related to people/culture, process and technology. At the top of the list was “train and educate KM leaders, managers and champions.” In addition, the Army is developing a KM competency model that defines skills and knowledge required to promote KM practices.

Those initiatives are designed to address the fact that KM has great value for knowledge-intensive activities carried on at many different levels of government, but does not have a standard, recognized body of knowledge. Art Schlussel, who was serving as a KM consultant at the U.S. Army War College Center for Strategic Leadership, began work based on the first principle, to produce KM leaders. He helped create and co-taught a course to train senior leaders in how KM can be used to meet the needs of the Army.

The approaches fostered by the course, and in other education and training venues within the Army have helped promote best practices in knowledge sharing. “Students attend courses in numerous subjects, are deployed and then once they are in the field, they can comment on the utility of what they learned, according to guiding principles of knowledge sharing and dissemination,” says Schlussel. “This now happens within a week or two. The Army has picked up very quickly on the value of this rapid feedback because in many cases, it’s a matter of life or death.”

Through the Battle Command Knowledge System (BCKS), for example, a forum provides an environment in which each command can share information. “We can get comments almost in real time and then incorporate them for the next group being trained,” Schlussel explains. The collaboration backbone is provided by Tomoye (tomoye.com), and the Army Knowledge Online (AKO) platform.

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