HTH930: Optimize your organization with Business Process Integration

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HTH930 Optimize your organization with Business
Process Integration
Aisha El-ZorbaSenior Product ManagerAisha.El-Zor
ba_at_sybase.com
Jeff SalmonSenior Systems ConsultantJeff.Salmon_at_
sybase.com
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Agenda

• Sybase Overview
• Healthcare Market Overview
• Benefits of BPM in Healthcare
• Industry Views
• BPI Suite for Healthcare
• Customer Story
• QA

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Sybase Overview - Who We Are

• One of the worlds leading providers of database
  and e-Business infrastructure software, mobile
  and wireless solutions, and vertical solutions
  for the financial services, healthcare and
  telecommunications markets
• Operations in 60 countries
• Eighteen-year history of open, scalable systems
• 4,639 employees with over 45,000 customers
• Wall Street runs on Sybase
• 80 of Fortune 100 companies use Sybase products
• Strong financial position

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Sybase Powers Major Healthcare Solutions

• Top six U.S. managed-care organizations
• 29 of the 47 Blue Cross Blue Shield plans
• 1,250 payer and provider organizations worldwide
• Sybase teams with more than 95 application
  partners, offering clinical, financial,
  administrative and medical management solutions

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Sybase Healthcare Expertise
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Solution Partners
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Healthcare Customers
Partial Listing

• HealthNow New York
• BCBS Minnesota
• BCBS Michigan
• BCBS Texas and Illinois
• NASCO
• John Muir/Mt Diablo
• Universal Care
• University of Colorado Hospital
• Cole Managed Vision
• Quest Diagnostics
• Fortis Benefits
• Nemours Children's Clinic
• Children's Hospital - San Diego
• Williamsburg Community Hospital

• Methodist Hospital Memphis
• Northbay Health Systems
• Catholic Healthcare West
• Johns Hopkins Health System
• Carilian Health System
• UCSD Medical Center
• Mayo Clinic
• Hospital Sick For Kids
• Arkansas Children's Hospital
• Children's Mercy Hospital
• Children's Healthcare of Atlanta
• Stony Brook University Hospital
• Sisters of Mercy
• Sunnybrook Health Science

• Iowa Health system
• Childrens Memorial Hospital
• Baptist Health systems
• Baylor University Hospital
• Group Health Cooperative
• Neighborhood Health Plan
• St. Johns Hospital St. Lukes Hospital
• Wake Medical Center
• Kaiser Permanente
• Loma Linda University Medical Center
• Quest Diagnostics
• St. Vincents Hospital

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Healthcare Market Overview
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Healthcare Today

• Dynamics of the Healthcare market
• e-business is redefining the delivery,
  administration and management of Healthcare
• Rising medical costs, industry, consolidation,
  changes in the social culture and government
  legislation are driving the need for a change in
  traditional business strategies
• Healthcare costs in the US, increased 8 to 10
  percent in 2002 and industry analysts predict
  double-digit increases in 2003

BAM
BPM
B2Bi
EAI

• Healthcare market requirements
• Integration products that adopt emerging
  standards
• Operational and tooling support for standards
• Ability to expose existing functionality
• Collaborative Services regulation
  requirements manageability and deployment

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Healthcare Today
Organizational Realities Drive the Needs for
Technologies

• Dynamics of Organizational Change
• Analyst expect inflation of healthcare costs to
  continue to rise during the next five years due
  to escalating costs for pharmaceuticals, medical
  supplies, professional fees and new technology.
• Organizations that do not leverage the
  opportunities presented by e-business will find
  it increasingly difficult to compete on a cost
  basis and will lack the key delivery mechanisms
  required to meet service demands and attract new
  revenue.

BAM
Healthcare Optimization
Payer
Provider

• Improve Profitability
• Competitive Agility
• Patient/ Partner Loyalty
• HIPAA Regulations

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Organizational Priorities

• Process improvement
• Reduce cost of materials/procurement
• Reduce cost of services

Improve Profitability
Regulatory/ Competitive Agility

• New requirements, channels, geographies
• Innovative business models
• New services, competitive responsiveness

Patient/ Partner Loyalty

• Easier to do business with
• Collaborative processes
• Externally-facing applications

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Healthcare Process Optimization Challenge
Isolated silos of automation
Patients
Providers
Payers
Business Process Improvement
Customer Interaction
Health Value Chain Collaboration

• Automatic Billing
• Patient Self-Service
• Wireless updates
• Web Information

• Clinical Patient care
• Research
• Institutional Reporting
• Financial Systems
• HR Self-Service
• Wireless Solutions
• Asset Management

• HIPAA Collaborative Specifications
• Exchange Connectivity
• Automatic Payment Processing
• ASP Connectivity
• Outsourcing

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Issues Facing Healthcare Today

• HIPAA
• Transaction Compliancy
• Support for various data feeds (direct, web
  enabled DDE, paper)
• Privacy Security (audit trails, access
  controls)
• Rising Costs of Healthcare require Advancements
  in Efficiency and Automation
• Improving Customer Satisfaction

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Issues Facing Healthcare in the Future

• HIPAA
• Constantly evolving requirements mandate a
  flexible, open environment
• Enriched data content allows for comprehensive
  analytics
• Continue to improve efficiencies and streamline
  business processes
• Improving Trading Partner Satisfaction

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The Solution
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BPI for HealthcareA Foundation for Today and
Tomorrow

• Provides a comprehensive set of integration and
  business process improvement tools allowing
  providers and payers to
• Integrate backend systems
• Support multiple types of messages in a variety
  of protocols
• Automate processes across multiple systems
• Leverage efficiencies to other Trading Partners
• Enables enterprises to rapidly deploy to respond
  to ever-changing market requirements

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A Providers Perspective

• Need to integrate and optimize current healthcare
  systems
• Support service level agreements for reliable 7
  by 24 operations
• Reliance upon Practice Management Vendors and
  Clearinghouses who may not provide timely
  releases to support the full set of HIPAA
  transactions
• Support the future HIPAA Claims Attachment
  Transaction (275)

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BPI for Healthcare A Providers Perspective
IntegrationBroker
Business ProcessManagement
Enterprise Portal
Clinical Gateway

• BPI for Healthcare supports various messaging
  formats (HL7, X12, etc) and provides the
  infrastructure to filter and deliver messages to
  any number of destination systems.
• Advanced functions such as combining data from
  multiple sources to respond to a single request
  is critical especially when one considers the
  HIPAA Claim Attachment transaction (a combination
  of X12 and HL7 data)

EDI/HIPAACompliance
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BPI for Healthcare A Providers Perspective
Dr. Smith
Whats the status of my claim?Is the patient
eligible?Was my referral accepted?
Request
Response
Provider
PayerResponse

• BPI for Healthcare provides an out-of-the-box
  transaction validation and transformation
  solution easing reliance upon PM Vendors and
  Clearinghouses to do it for you

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BPI Suite for Healthcare
Business Activity Monitoring
BizTracker
Messaging Gateways
Physicians
Process Management Integration Broker
Clinical Gateway
HR
e-Biz Impact
Patients
Firewall
Financial
Wireless Server
Process Server
HL7
Payers
HIPAA Studio External Gateways (EDI, XML)
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Total Cost of Ownership
Improve Return on Investment Today, Tomorrow
and Beyond

• Business process
• Integration architecture
• Integration tooling

• Increase top line revenue by managing and
  improving business processes
• Leverage current investments by integrating with
  existing environment
• Reduce maintenance costs - build once and reuse

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BPI for Healthcare The Real Time Solution
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EDI Server for HIPAA

• X12, HL7, XML, any-to-any, ODBC
• High Performance translation engine
• File-size unlimited translation engine
• Supports one-to-one, one-to-many, many-to-many
  maps
• Queue enabled for real-time integration (MQ, etc)
• Cross-platform Scalability - WinNT, 2000, UNIX
  (SUN/SOLARIS, HP9000/UX, RS6000/AIX, etc.)

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Real-Time Environment
Dr. Smith
Whats the status of my claim?Is the patient
eligible?Was my referral accepted?
Request
Response
Real-timerequestfromprovider
Payerapplicationsendsresponseto provider
Security, Reliability, Scalability X12 and
HIPAA Compliance Process Management
Transformation/Integration Performance
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Real-Time Solution with HIPAA
Dr. Smith
Whats the status of my claim?Is the patient
eligible?Was my referral accepted?
HIPAA Studio
Real-time/SecureCommunications
Real-timeRequestFromProvider
ProviderApplication
HIPAA Validation
Integration
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Real-time solution with HIPAA Studio

• Real-time/secure communications
• Supports the following protocols
• Networks TCP/IP Sockets
• Web HTTP/S SOAP WSDL UDDI
• Security LDAP, IIOP, VPN, Public Key
• Database ODBC
• Queuing MSMQ MQSeries
• Communication CPI-C R232 TTY
• HIPAA compliance validations
• Contains the required and situational data
  elements as defined in the Implementation
  Guidelines
• Integration
• Provides transformation, routing, process
  management

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Real-Time solution example
Dr. Smith
Whats the status of my claim?Is the patient
eligible?Was my referral accepted?
HIPAA Studio
HIPAA Accelerator
TCP/IPSockets
ODBC
Comm.Mgr.
EDIServer
Message Transport Layer
Message Transport Layer
PayerAdjudicationSystem
Real-timeRequest
Process Server
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Integration Server e-Biz Impact 5.3
Proprietary
Legacy Packaged
Integration Server
Application
Application
e-Biz Impact
Direct API
Adapters
Impact Manager
XML
HL7
Transport Layer
Application
Application
Impact Production Objects
Data Objects
AIM
Web Services
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Process Management

• Required to service timeout requirements
• Even when there is a single submitting system,
  without Process Server there is no practical way
  to manage the state of the real-time submitted
  transaction. For example, if the receiving
  system fails the sending system must take some
  action.
• To coordinate complex processing requirements
  among multiple systems
• sequential processing
• parallel processing
• split processing
• join processing
• iteration processing

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Process Server
Process Server
Process Server
Start
Check Source
Check Source
Check Source
Provider
Timeout
Y
N
Submit Claim
Notify Customer
End
AdjudicationSystems
Notify Customer
Submit Claim
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Process Server
Touch Points Labs Claims Processing Providers etc.
Workflow 10-20 of all transactions
Process Server 80-90 of all transactions
Exceptions
WorkflowRepository
XML
ProcessRepository
CorrectInstances
XML
Correct the Process
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Process Server
Manages a Range of Business Flows
Sequential
Parallel
And/Or SplitAnd/Or Join(key part of 837 or 835
trans.)
Iteration
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BAM - Powerful, Efficient Message Analysis
New Era Message Events
Alert Management
Drill-Down Message Display
XML Events
Message Store
Message Handling Rules
MessageRepair
MessageRe-processing
Message Analysis Rules
Aggregation Objects Persistent Cumulative Efficie
nt
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BizTracker Groups Business Transactions...

• Real-time Status Updates
• Assign Any Status To Any Step
• View Individually or As Group

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Including A Historical View of Transaction
Messages
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And Single Message View...
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Customer Story - Fortis Benefits, Kansas City, MO
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BPI Suite Customer - Product Usage

• EDI Server
• Provides for HIPAA Compliance Checking
• Splits transactions into separate individual
  claims
• Auto-Generates Claim Numbers
• Verifies maximum 5 detail lines per claim or
  splits into multiple claims due to Adjudication
  System requirement
• Integration Engine
• Used for Routing and Business Logic
• Translation from different formats (MF and back
  to TP)

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BPI Suite Customer - Product Usage

• Process Server
• Manages state of transaction and real-time
  message support
• Manages Time-Outs if slow response from
  Adjudication
• BizTracker
• Used for tracking messages in the system and
  real-time reporting
• Used for Error Handling

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Complementary Products to BPI Suite for HC

• HIPAA Repository
• Used to maintain all transactions on a
  field-by-field basis
• Used for supporting paired transactions
• 837/835, 270/271, 276/277, 278
• Custom Web Application (WebSphere)
• Enrollment and Premium Payment converted into EDI
• Validates for Compliance, sends ACK

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Summary
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Summary
Enabling the Health Value Chain

• Business Process Integrator Suite for Healthcare
  Improves Efficiency and Lowers Operation Costs
  for Healthcare Payers and Providers
• Leverages New Era of Networks proven healthcare
  technology and innovative process management and
  monitoring.
• Brings business process optimization technology
  used in successful commercial enterprises to the
  healthcare market.
• Eliminates the technology gap between healthcare
  payers and providers with the first solution
  built on an open foundation, improving
  communication capabilities between disparate
  systems by supporting cross industry standards.

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QA