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Case management in insurance

I recently wrote a paper on how case management technology can be used in insurance claims processing, sponsored by DST (but not about their products specifically). From the paper overview:

Claims processing is a core business capability within every insurance company, yet it is
often one of the most inefficient and risky processes. From the initial communication that
launches the claim to the final resolution, the end-to-end claims process is complex and
strictly regulated, requiring highly-skilled claims examiners to perform many of the
activities to adjudicate the claim.

Managing a manual, paper-intensive claims processing operation is a delicate balance
between risk and efficiency, with most organizations choosing to decrease risk at the cost
of lower operational efficiency. For example, skilled examiners may perform rote tasks to
avoid the risk of handing off work to less-experienced colleagues; or manual tracking and
logging of claims activities may have to be done by each worker to ensure a proper audit
trail.

A Dynamic Case Management (DCM) system provides an integrated and automated
claims processing environment that can improve claim resolution time and customer
satisfaction, while improving compliance and efficiency.

You can download it from DST’s site (registration required).

Camunda Community Day: @CamundaBPM technical sessions

I’m a few weeks late completing my report on the Camunda Community Day. The first part was on the community contributions and sessions, while the second half documented here is about Camunda showing new things that could be used by the community developers in the audience.

First up was Vladimirs Katusenoks, core developer on BPMN.io, with a presentation on bpmn-js: how it works, and how to extend it with custom functionality such as adding color to BPMN diagrams, which is a permitted extension to BPMN XML. His live coding presentation showed changing the colour of a shape background, either statically in code for the element class or by adding a colour picker to an individual element context palette; this was based on the bpmn-js core BPMN functionality, using bpmn-moddle to read/write into the metamodel and diagram-js to render it. There are a number of other bpmn-js examples on Github.

Next, Felix Müller discussed KPI management, expanding on his August blog post on the topic. KPI management is based on quantitative indicators for process cycle-time improvement, including cycle time and overdue time, plus definitions of the time period, unit of measure and calculation method. In Camunda, KPIs are defined in the Modeler, then monitored in Cockpit. He showed how to use the concept of element templates (that extend core definitions) to create custom fields on collaboration object (process) or individual tasks, e.g., KPI unit (hours, days, minutes) and KPI threshold (number). In Cockpit, this appears as a new tab for KPI Overview, showing a list of individual instances and target/current/average duration, plus an indicator of overdue status of the instance and any contained tasks; there is also a decorator bubble on the top right of the task on the process model to show the number of overdue instances on the aggregate model, or overdue status as a check mark or exclamation on individual models. The Cockpit modifications were done by creating a plug-in to display KPI statistics, which queries and calculates on the fly – a potential performance problem that might be improved through pre-aggregation of statistics. He also demonstrated how to modify this basic KPI model to include an expected duration as well as maximum duration. A good start, although I think there’s a lot more that’s needed here.

Thorsen Lindhauer, a Camunda core BPM developer, discussed how to contribute to the Camunda open source community, both at camunda.org (engine and desktop modeler, same as the commercial product) and bpmn.io (JS tools). Possible contributions include answering questions on forums; logging error reports; documenting ideas for new functionality; and working on code. Code contributions typically start by having a forum discussion about planned new functionality, then a decision is made on whether it will be core code (higher quality standards since it will become part of the commercial product, and will eventually be maintained by Camunda) versus a community extension; this is followed by ongoing development, merge and release cycles. Camunda is very supportive of community contributions, even if they don’t become part of the core product: community involvement is critical to the health of any open source project.

The last presentation of the community day was Daniel Meyer discussing the product roadmap. The next release, 7.6, will be on November 30 – they have a strict twice-yearly release cycle. This release includes updates to DMN, CMMN, BPMN, rolling updates, Cockpit features, and UI/UX in web apps; I have captured a few notes here but see the linked roadmap for a more complete and accurate description and the online documentation as it is rolled out.

DMN:

Simpler decision table editing with drop-down lists of comparison/range operators instead of having to remember FEEL or Juel syntax
Ability to add list of selection values (advanced mode still exists for full flexibility)
Decisions with literal expressions
DMN engine performance 4-6x faster
Support for decision requirements diagrams/graphs (DRD/DRG) that can link decision tables; visualization in Modeler and Cockpit are not there yet but the structures are supported – in my experience, this is typical of Camunda, which builds and releases the engine capabilities early then follows with the visualization, allowing for a quicker start for executable diagrams

CMMN:

Modeler now completely models CMMN including technical attributes such as listeners
Cockpit (visualization still incomplete although we saw a brief view) will allow linking models of same or different types
Engine feature and functionality improvements

Rolling updates allow Camunda process engine to be updated without shutdown: guaranteed backwards compatibility of database schema to allow database to be updated first, then roll updates of engines by taking each offline individually and allowing load balancer to reroute sessions.
BPMN:

BPMN conditional event supported
Improved modeling including labels, collapsing/expanding subprocesses to switch between view types, and field injections in property panel.

Cockpit:

More flexible/granular human task monitoring
New welcome page with links to apps (Cockpit, Tasklist, Admin), user profile, and frequent links
Batch operations (cancel, suspend, etc.) based on batch action capability built for instance migration
CMMN and DMN DRD visualization

Daniel discussed some other minor improvements based on customer feedback, plus plans for 2017, including a web modeler for collaborative BPMN, CMMN and DMN modeling via a SaaS offering and a future on-premise version. They finished the day with a poll and community feedback to establish priorities for future versions.

I stayed on for the second day, which is actually a separate conference: BPMCon for Camunda’s enterprise (commercial) customers. Rather, I stayed on for Neil Ward-Dutton’s keynote, then ducked out for most of the rest of day, which was in German. Neil’s keynote included results from workshops that he has done with executives on digital transformation, and how BPM can be used to create the bridges between the diverse parts of a digital business (internal to external, automated to people-centric), while tracking and coordinating the work that flows between the different areas.

Disclaimer: Camunda paid my travel expenses to attend both conference days. I was not compensated in any way for attending or for writing this post, and the opinions here are my own.

Take Mike Marin’s CMMN survey: learn something and help CMMN research

CMMN diagram from OMG CMMN 1.0 specification document

Mike Marin, who had a hand in creating FileNet’s ECM platform and continued the work at IBM as chief architect on their Case Manager product, is taking a bit of time away from IBM to complete his PhD. He’s doing research into complexity metrics for the Case Management Model and Notation standard, and he really needs people to complete a survey in order to complete his empirical research. The entire thing will take 45-60 minutes, and can be completed in multiple sessions; 30-40 minutes of that is an optional tutorial, which you can skip if you’re already familiar with CMMN.

Here’s his invitation to participate (feel free to share with your process and case modeling friends):

We are conducting research on the Case Management Modeling and Notation (CMMN) specification and need your help. You don’t need to be familiar with CMMN to participate, but you should have some basic understanding of process technology or graphical modeling (for example: software modeling, data modeling, object modeling, process modeling, etc.), as CMMN is a new modeling notation. Participation is voluntary and no identifiable personal information will be collected.

You will learn more about CMMN with the tutorial; and you will gain some experience and appreciation for CMMN by evaluating two models in the survey. This exercise should take about 45 to 60 minutes to complete; but it can be done in multiple sessions. The tutorial is optional and it should take 30 to 40 minutes. The survey should take 15 to 20 minutes. You can consider the survey a quiz on the tutorial.

As an appreciation for your collaboration, we will donate $6 (six dollars) to a charity of your choice and we will provide you with early results of the survey.

You can use the following URL to take the tutorial and survey. The first page provides more information on the project.

http://cmmn.limequery.org/index.php/338792?lang=en

He wrote a more detailed description of the research over on BPTrends.

Mike’s a former colleague and a friend, but I’m not asking just because of that: he’s also a Distinguished Engineer at IBM and a contributor to standards and technology that make a huge impact in our field. Help him out, take the survey, and it will help us all out in the long run.

Now available: Best Practices for Knowledge Workers

I couldn’t make it to the BPM and Case Management Summit in DC this week, but it includes the launch of the new book, Best Practices for Knowledge Workers: Innovation in Adaptive Case Management, for which I wrote the foreword.

In that section, which I called “Beyond Checklists”, I looked at the ways that we are making ACM smarter, using rules, analytics, machine learning and other technologies. That doesn’t mean that ACM will become less reliant on the knowledge workers that work cases; rather, these technologies support them through recommendations and selective automation.

I also cover the ongoing challenges of collaboration within ACM, particularly the issue of encouraging collaboration through social metrics that align the actions of individuals with corporate goals.

You’ll find chapters by many luminaries in the field of BPM and ACM, including some real-world case studies of ACM in action.

Pega 7 roadmap at Pegaworld 2016

I finished up Pegaworld 2016 at a panel of Pega technology executives who provided the vision and roadmap for CRM and Pega 7. Don Schuerman moderated the panel, which included Bill Baggott, Kerim Akgonul, Maarten Keijzer, Mark Replogle and Steve Bixby.

Topics covered:

OpenSpan RPA and RDA is the most recent technology acquisition; by next year, the workforce intelligence will be a key differentiator for Pega to help their customers analyze user behavior and detect patterns for potential improvement and automation
Questions about Javascript “flavor of the month” technologies come up a lot in competitive situations; they are keeping an eye on what’s sticking in the marketplace and what they can learn from it, selectively including technologies and capabilities where it can add value and fits into their framework
Digital channels are now outpacing call center channels in the market, and they are enabling chat and other social capabilities for customer interaction but need to consider how to integrate the text-based social channels into a seamless experience
Developing with Pega 7 models isolates the applications from the underlying cloud and/or containerization platforms, so that new platforms and configurations can be put in place without changing the apps
New data visualizations based on improved analytics are evolving, providing opportunities for discovery of business practices
A simpler modeling environment allows non-technical designers to create and configure apps without accessing the Designer Studio; at this point, technical developers are likely needed for some capabilities
They are looking at newer data management technologies, e.g., NoSQL and blockchain, to see how they might fit into Pega’s technology stack; no commitments, but interesting to hear the discussion of the use of blockchain for avoiding conflicts and deadlocks in active-active-active scenarios without having to build it into applications explicitly
Some new technology components, developed by Pega or third parties, may be available via Pega Exchange as add-on apps rather than built into the product stack directly
They hope to be able to offer more product trials in the future, which can be downloaded (or accessed directly in the cloud) for people to check out the capabilities
DevOps is seen as more of a cultural than technology shift, where releases are sped up since code isn’t just thrown over the wall from development to deployment, but remain the responsibility of the dev team; a container strategy is an important component of having this run smoothly
UX design is critical in creating an appropriate customer experience, but also in supporting developers who are developing apps; Pega Express is regularly fine-tuned to provide an optimal modeling/design experience, and Pega Design provides insight into their design thinking initiatives
All of the data sources, including IoT events, contribute to analytics and machine learning, and therefore to the constant improvement of Next Best Action recommendations
They would like to be able to offer more predictive and intelligent customer service capabilities; lots of “wish list” ideas from the entire panel

This is the last session on day 2; tomorrow is all training courses and I’ll be heading home. It’s been a pretty full couple of days and always good to see what Pega’s up to.

American Express digital transformation at Pegaworld 2016

Howard Johnson and Keith Weber from American Express talked about their digital transformation to accommodate their expanding market of corporate card services for global accounts, middle market and small businesses. Digital servicing using their @work portal was designed with customer engagement in mind, and developed using Agile methodologies for improved flexibility and time to market. They developed a set of guiding principles: it needed to be easy to use, scalable to be able to manage any size of servicing customer, and proactive in providing assistance on managing cash flow and other non-transactional interactions. They also wanted consistency across channels, rather than their previous hodge-podge of processes and teams depending on which channels.

AmEx used to be a waterfall development shop — which enabled them to offshore a lot of the development work but meant 10-16 months delivery time — but have moved to small, agile teams with continuous delivery. Interesting when I think back to this morning’s keynote, where Gerald Chertavian of Year Up said that they were contacted by AmEx about providing trained Java/Pega developers to help them with re-onshoring their development teams; the AmEx presenter said that he had four of the Year Up people on his team and they were great. This is a pretty negative commentary on the effectiveness of outsourced, offshore development teams for agile and continuous delivery, which is considered essential for today’s market. AmEx is now hiring technical people for onshore development that is co-located with their business process experts, greatly reducing delivery times and improving quality.

Technology-wise, they have moved to an omni-channel platform that uses Pega case management, standardizing 65% of their processes while providing a single source of the truth. This has resulted in faster development (lower cost per market and integration time, with improved configurability) while enabling future capabilities including availability, analytics and a process API. On the business side, they’re looking at a lot of interesting capabilities for the future: big data-enabled insights, natural language search, pluggable widgets to extend the portal, and frequent releases to keep rolling this out to customers.

It sounds like they’re starting to use best practices from a technology design and development standpoint, and that’s really starting to pay off in customer experience. It will be interesting to see if other large organizations — with large, slow-moving offshore development shops — can learn the same lessons.

Case management at TIBCONOW 2016

Breakout sessions continue with Jeremy Smith and Nicolas Marzin of TIBCO presenting their case management functionality. Marzin went through the history of process and how we have moved from pre-defined processes and automation to more flexible and personalized work methods; in general, this is driving the application of case management and other unstructured work tools in addition to structured BPM. It’s no longer just about cost-cutting and efficiency, but also about innovation, agility and competitive differentiation. Although he made a link between case management and digital disruption, there are also many use cases for more flexible work handling, such as claims management and incident handling.

Smith talked about the case-centric capabilities enabled by ActiveMatrix BPM, presenting it as an approach to building applications rather than a separate product offering. He made the distinction between back office processes, where the organization determines the employees’ journey (I don’t fully agree, since there is a lot of back office knowledge work), while the path of front office processes are driven by the customer. TIBCO takes a data-centric approach to case management, where any entity can be a case, and a case can contain processes (or process fragments), rules, actions, analytics, and collaboration. Unlike the usual big process application built with AMX BPM, case management can start much simpler with the objects, data and basic actions, then add in more of the capabilities as the needs emerge.

He showed a transportation-related case dashboard used by a knowledge worker, with a milestone/stage timeline, business actions (which may trigger processes), case details, and contextual details (linked cases, processes, tasks and navigation). States and actions drive the cases forward rather than pre-defined processes, so that actions can be triggered when certain states are reached or data values updated. Workers can select actions based on the case state and their permission level.

This seems to be more of an application framework/example than a case management platform, although the claim is that semi-technical analysts can create these applications. There’s another session later today on the low-code application development environment used to create case management applications; there are certainly a lot of questions left unanswered by this session about how case really fits in with AMX BPM.

bpmNEXT 2016 demos: W4 and BP3

Second round of demos for the day, with more case management. This time with pictures!

BPM and Enterprise Social Networks for Flexible Case Management – Francois Bonnet, W4 (now ITESOFT Group)

Adding ESN to case management (via Jamespot plugin) to improve collaboration and flexibility, enhancing a timeline of BPM events with the comments and other collaboration events that occur as the process executes. Initiates social routing as asynchronous event call. Example shows collaborative ownership assignment on an RFP, where an owner must self-select within the ESN before a process deadline is reached, or the assignment is made automatically. Case ID shared between W4 BPM and Jamespot ESN, so that case assignments, comments and other activities are sent back to BPM for logging in the process engine to create a consolidated timeline. Can create links between content artifacts, such as between RFP and proposal. Nice use of BPMN events to link to ESN, and a good example of how to use an external (but integrated) ESN for collaborative steps within a standard BPMN process, while capturing events that occur in the ESN as part of the process audit trail.

A Business Process Application with No Process – Scott Francis, BP3 Global

Outpatient care example with coordination of resources (rooms, labs) and people (doctors, patients), BPMN may not be best way to model and coordinate resources since can end up as a single-task anti-pattern. Target UI on tablet, using their Brazos tools with responsive UI, but can be used on desktop or phone. Patient list allows provider to manage high-level state of waiting versus in progress by assigning room, then add substatessuch as “Chaperone Required”, immediate updates regardless of platform used. Patient and doctor notifications can be initiated from action menu. A beautiful UI implementation of a fairly simple state management application built on IBM BPM, although the infrastructure is there to tie in events and data from other systems.

bpmNEXT 2016 demos: Salesforce, BP Logix and RedHat

Day 2 of bpmNEXT is all demos! Four sessions with a total of 12 demos coming up, with most of the morning focused on case management.

Cloud Architecture Accelerating Innovation in Application Development – Linus Chow, Salesforce

App dev environment that allows integration of Salesforce data with other sources, such as SAP. Schema builder allows data models to be visualized and linked in an ERD format, with field-level security and audit capabilities. Process Builder is an environment for visual creation of Salesforce-related data-driven processes, typically simple update actions triggered by data updates. User experiences created using Lightning App Builder, including support for mobile devices. Work-Relay as a more traditional process orchestration environment leveraging the Salesforce environment. Although mostly live demo, the entire Work-Relay section was a pre-recorded screencast, which was a disappointing violation of the bpmNEXT format.

One Model, Three Dimensions: Combining Flow, Case and Time Into a Unified Development Paradigm – Scott Menter and Joby O’Brien, BP Logix

Process Timeline as a GANTT chart view of process, where highly-parallel tasks must have conditions of precedence, eligibility and necessity met in order to execute, as the underlying structure for case management. An application can include a goal (objective, KPI) that can drive actions and impose conditions while being evaluated independent of any process. Define process as a timeline where activities have “start when” (precedence), “completed when”, “needed when” conditions plus due date, forms and participants. Drag and drop activities on each other to establish precedence dependencies, and group into parent/child relationships to organize sections of process. Can use predictions of completion dates for activities, based on historical data, as triggers for actions. Data virtualization for external data sources, allowing more technical designer to publish the results of queries/views on external sources for other designers to use in applications. Integrated form builder with validation rules based on the shared data and rules previously defined. External events of various types can trigger actions in an event-condition-action paradigm.

Building Advanced Case-Driven Applications – Kris Verlaenen, RedHat

Extension of jBPM from structured process to dynamic case management, seen as a spectrum rather than distinct functionality. Building blocks to add ad hoc choices, milestones, case participants and other case constructs on the core process capabilities. Workbench for authoring case definitions, including creating BPMN process models with ad hoc tasks and structured process snippets, decision tables that can include automatic task triggering. Roles are defined to limit access to data, tasks and functionality. UI for admins, but demonstrated UI built for end users using their UI building blocks that allows selection of the ad hoc tasks in the context of the case data; this extracts the structure data from the case definition that will self-adjust if new data or tasks are added. UI functionality limited, and likely useful more as a prototype than full production UI. As with other open source tools, more targeted at developers than low-code environment. Interesting use of BPMN ad hoc tasks for case tasks rather than CMMN, supporting their basic premise that it’s a spectrum of capabilities rather than two distinct work modes.

Positioning Business Modeling panel at bpmNEXT

We had a panel of Clay Richardson of Forrester, Kramer Reeves of Sapiens and Denis Gagne of Trisotech, moderated by Bruce Silver, discussing the current state of business modeling in the face of digital transformation, where we need to consider modeling processes, cases, content, decisions, data and events in an integrated fashion rather than as separate activities. The emergence of the CMMN and DMN standards, joining BPMN, is driving the emergence of modeling platforms that not only include all three of these, but provide seamless integration between them in the modeling environment: a decision task in a BPMN or CMMN model links directly to the DMN model that represents that decision; a predefined process snippet in a CMMN model links directly to the BPMN model, and an ad hoc task in a BPMN model links directly to the CMMN model. The resulting models may be translated to (or even created in) a low-code executable environment, or may be purely for the purposes of understanding and optimizing the business.

Some of the points covered on the panel:

The people creating these models are often in a business architecture role if they are being created top down, although bottom-up modeling is often done by business analysts embedded within business areas. There is a large increase in interest in modeling within architecture groups.
One of the challenges is how to justify the time required to create these models. A potential positioning is that business models are essential to capturing knowledge and understanding the business even if they are not directly executable, and as organizations’ use of modeling matures and gains visibility with executives, it will be easier to justify without having to show an immediate tangible ROI. Executable models are easier to justify since they are an integrated part of an application development lifecycle.
Models may be non-executable because they model across multiple implementation systems, or are used to model activities in systems that do not have modeling capabilities, such as many ERP, CRM and other core operational systems, or are at higher levels of abstraction. These models have strategic value in understanding complexity and interrelationships.
Models may be initiated using a model derived from process/data mining to reduce the time required to get started.
Modeling vendors aren’t competing against each other, they’re competing against old methods of text-based business requirements.
Many models are persistent, not created just for a specific point in time and discarded after use.

A panel including two vendors and an analyst made for some lively conversation, and not a small amount of finger-pointing. 🙂