Archive for the ‘Insurance Industry’ Category

Where Do We Go From Here? – Part II of II

July 8th, 2009 2 comments

In my last post I wrote a bit about the perception bias that companies and people face when trying to solve a business problem, the idea that they view the problem with the filters of their experience in place. Experience can be a great teacher, but the potential downside is that this bias can lead to an attempt to solve problems with a pre-determined toolset or solution in mind. You’ll often see a manifestation of this in the RFP / RFI / RFQ process where it becomes clear that the author had a particular tool or technology in mind when writing the document. I also talked a bit about the feeling of déjà vu that I get sometimes when speaking to customers and prospects about many of the problems they’ve tried to solve in the past and still face today.
So where do we go from here? Good question. Clearly our approach and direction should be based on what we’re trying to accomplish, so let’s try and define that first.

We want to automate, and ultimately improve, the processes that drive our business. For a health insurer, we could be talking about an end-to-end process that spans multiple systems, for example Quote to Enrollment.

Ideally we’d need a graphical tool to capture the process, an execution engine to run it, and probably some simulation and optimization tools to improve it. We also need to keep track of all the content associated with that process including enrollment forms, customer and possibly group data, documents related to establishing identity, and miscellaneous other policy related information and documents. We’d want to be able to easily re-use processes, forms, and various “bits and pieces” without having to create copies or pre-define every possible combination or choice in our process. We certainly want to know all about how we are doing relative to our business goals and service level agreements we’re obligated to meet for our customers. And of course we want it all easily modified by business people who really understand their goals and challenges so that we can react to changes in our business rapidly.

If you think back to the perception bias of each of the solution providers I mentioned in my last post, you might realize that it’s not very difficult for any of them to say “I can meet most of those needs; after all, I have the best of breed Content / Process / Rules technology. We can deal with the others during implementation as a consulting effort”. For companies (in this case the health insurer) that are trying to solve their problems, it might sound slightly different. “Well, I tried this with an enterprise content management platform a couple years ago and it went ok, but not quite as well as we hoped. Maybe I would be better off using a Business Process Management Suite?”

In the example above, we’d like the modeling, simulation and execution capabilities of a BPMS. And we’d also want the versioning, content integration and audit capabilities of a Content Management tool. A Business Rules product would help us make the solution more flexible and might help us re-use components of our solution without significant rework. For the “how are we doing” part of the equation, we’re probably looking at some of the more advanced capabilities of a BPMS or Business Activity Monitoring solution. And it’s the combination of all of these components, implemented using best practices established by hundreds or thousands of implementations, that drives the flexibility and ability to make changes.

In short, we need a blended solution, something that brings all of the best of these solutions together. I’m not suggesting a “best of breed” approach where you bring in each of these solutions and stitch them together but rather finding a platform that incorporates most of these capabilities in a single configurable tool. The key word in that last statement is “most” because I don’t think any single vendor offers “best of breed” capabilities in a unified platform. I do believe that there are solutions that incorporate several of the key characteristics in a single tool, for example strong process and document management capabilities combined with robust modeling and analytics. The key is trying to find the right combination for your specific requirements.

Categories: Insurance Industry

Haven’t We Been Here Before? – Part I of II

June 28th, 2009 No comments

The Insurance industry is a fascinating ecosystem. Not so much the products as the actual business model and problems the companies face. I’ve had the fortune to work with all manner of carriers (Health, Life and assorted other segments) over the past ten years, and been able to observe the similarities and the differences across those segments. I’ve always been on the outside, a solution provider looking in, trying to better understand the business problems facing the various companies I’ve worked with. And in that time I’ve worked for a number of different software companies spanning disciplines like Content Management, Configuration and Rules, and Business Process Management, each of which experienced some degree of success in one of the many segments of the Insurance industry.

Spend enough time in the software business and you might start to feel like Bill Murray in “Groundhog Day”, doomed to repeat the same day over and over. I recall trying to help a Health insurer find a way to simplify the enrollment process (both individual and group) back in the late 90’s with a configuration and rules solution. And then I was in the same situation again around 2004 but this time with an enterprise content management company. Not surprisingly, I discussed a similar business problem again recently.

In each of these projects there were challenges meeting specific functional needs. The challenges varied based on the focus of the software we were using to craft the solution. For example, when using a rules-based technology to define the enrollment process it was difficult to do anything more than track the status of a particular application using an attribute which limited visibility into the actual process. Using the electronic forms capabilities of most traditional content management solutions didn’t quite get us there because the enrollment wasn’t about the document itself but rather about the customer and all their supporting information housed in many other systems. And most pure-play BPM solutions ignore paper entirely and focus on the process definition, glossing over the challenge that the content itself presents. And these same problems apply not just for enrollment but for many other core processes as well.

The difficulties inherent in using any one of these individual technologies might seem fairly obvious in hindsight. So what was it that prevented the teams (both the customers and software provider) from knowing that in advance? I believe it’s a phenomenon that I think of as a perception bias, the idea that we all see the world and the problems we are presented based on our past experience and from within our sometimes limited frame of reference. The phrase “when all you have is a hammer, everything looks like a nail” comes to mind. This mode of thinking unfortunately forces a high degree of customization in order for the solution to be implemented.

Despite the hurdles each project team faced, all of the projects were ultimately successful. Maybe not as wildly so as the return on investment calculations predicted, but each one rolled out and enjoyed a period of success. Still, I’ve heard over time that some of those solutions have since been replaced, and in some cases replaced again, each time with a different technology solution. Which brings me back to the title of this post, haven’t we been here before?

I have a theory how we can avoid repeating today again tomorrow that I’ll share in my next posting. Until that point, I’d be interested in your feedback and thoughts.

Categories: Insurance Industry