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Decision Support

A new era promises better outcomes


Risk Profi le

Medium High Sally

Shopper Sally

Shopper Low Joe Bargain

BPM systems are the best decision for decision-support software. By Elizabeth Hart

rowing healthcare com- plexity and rising con- sumerism have come to- gether to create a greater

need for better decision-support tools – ones that are relevant, accessible and keep users actively engaged. Whether it’s clinical support software or con-

Persona Satisfaction Level

Satisfi ed

Dissatisfi ed Dissatisfi ed

Current Product

Goal Sales

complex decision making by accessing and assessing customer information, company objectives and real-time data to dynamically drive decisions across a myriad of processes. For example, benefi t selection, which can be intelligently conducted through BPM-powered Web sites by health plans


HMO Cross Sell Low Option Dental


Abandon None

Remediate Wellness Program

The system automatically analyzes the customer and situation ...

... and then dynamically assembles the best communication, process and decision components to guide the user to reach an optimal decision.

sumer-oriented applications, today’s decision-support tools must be expertly designed to refl ect the needs and pref- erences of specifi c users – promoting appropriate content via the right com- munication channel – so that optimal decisions happen. This is particularly diffi cult with consumer- based tools where the vast needs and profi les of users are so varied. Advanced business process management (BPM) technology and analytics are driving signifi cant progress and innovation in healthcare, specifi cally with decision-support functionality. These technologies provide intelligent and personalized navigation to individ- ual consumers, tailoring and simplifying

14 November 2011

Elizabeth Hart is principal, healthcare industry solutions, Pegasystems. For more on Pegasystems solutions:

moving to retail business models, is one of the most common deployments of decision-support tools for healthcare consumers. During open enrollment, as individual healthcare purchasers fl ood portals to investigate plan choices, BPM systems automatically collect pertinent information about each consumer from all back- end systems to guide and personalize the sales experience and increase sales-close ratios. Demo- graphic data, claims and

authorization data, service information and previous sales-inquiry data are instantly assembled and analyzed by the system. Using predictive analytics, the systems then compare the data to other known patterns of successful sales


transactions to generate the best sales experience for the consumer, includ- ing portal designs, product offerings and transactional navigation tailored for best fi t. For instance, the system might guide a young adult shopper to a Web site that highlights low-cost product op- tions and showcases gym memberships, dating clubs and other features known to infl uence plan selections for recent college graduates. Decision-support is further enhanced through system- driven content personalization. If the system discovers that the shopper is diabetic by prompting with questions during the on-line session or from existing customer data, it will display product comparisons that include coverage reviews of in-home glucose monitoring devices or insulin brands on and off formulary. Akin to leading retailers such as, health plans now are using analytics to share information on what has interested similar shoppers, in this case diabetics (Which endocrinologists are in network, and whose practices are closest to the shopper’s home and work?) to further enrich the decision-making process. By seamlessly orchestrating process with context and balancing decision rules between consumer need and company objectives, BPM systems not only increase customer value and satis- faction, they guide users to make better choices. The key is pushing the right content at the right moment, in the context of each specifi c interaction and user. Users need not waste time search- ing for best-fi t information because the system does it for them, accelerating and improving final outcomes. This

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