Business Process Management for Wellness and Care Management

The Overview

Customer: Blue Cross Blue Shield of Michigan (BCBSM)
Industry: Insurance
Challenge: Roadblocks in BPM implementation
Solution: Apex specialists designed overall solution architecture, increased process implementation efficiency, and mentored the BCBSM team members
Outcomes: Three new wellness processes completed and launched, visibility on investment, enabled compliance

The Summary

Apex helped Blue Cross Blue Shield of Michigan build care management intervention processes with BPM. Intervention processes help people quit smoking, manage low back pain without surgery, and manage chronic diseases like diabetes. Apex’s engagement set BCBSM’s intervention designs up for success and launched three new wellness processes.

The Customer

Blue Cross Blue Shield of Michigan (BCBSM) is a nonprofit mutual insurance company. Blue Cross Blue Shield of Michigan works with a network of 33,000 doctors, the largest doctor network in the state. BCBSM serves 6 million members and employs over 8,000 people.

BCBSM provides affordable, innovative products that improve their customers’ care and health. Their plans are built with the modern customer in mind, with plans for employers and individuals to meet modern budgets and lifestyles. BCBSM aims to bring more accessible and affordable healthcare to the state of Michigan.

The Challenge

Intervention designs nudge BCBSM members to make wellness-maximizing choices. BCBSM’s intervention designs help people quit smoking, manage low back pain without surgery, and manage chronic diseases like diabetes.

BCBSM uses powerful analytical models to define the risk and reward for each of their intervention designs. These models provide key performance indicators about the effects members will incur from the designs.

With the previous case tracking system, BCBSM could not measure intervention design outcomes. BCBSM relies on outcome measurement to analyze risk and reward for the designs, making lack of measurement a big challenge.

BCBSM holds themselves to a high expectation to enable their members to live their healthiest lives. Outcome measurement shows BCBSM the impact of their work on their members’ lives.

BCBSM embarked on a solution to tracking intervention design outcomes. BCBSM had started on their IBM Business Process Management (BPM) implementation to manage and measure their wellness programs. The implementation progress stalled due to project complexity and vast needs, so BCBSM engaged Apex.

The Apex Action

Apex brought a fresh set of eyes on the BPM project. The project needed to be reset and grounded in the overarching needs. Once those were established, Apex dove into the details.

Apex provided experienced specialists to mentor the BCBSM team members and help design the overall solution architecture. Apex also worked to identify standard patterns to make the process implementations more efficient.

Apex consultants jumped in as team leads in three separate projects. Each team had a product owner responsible for the clinical design of the intervention. Team leads ensured the process implemented matched the intervention design.

The wellness interventions mainly consisted of mail and email outreach, along with telephone coaching from registered nurses. The process models developed guided the phone calls and ensured the calls were scheduled and completed within date windows identified by the intervention design.

The Apex leads helped mature the BCBSM intervention design process with the following actions:

Guided BPM solution architecture design
Identified standard patterns for efficient implementation
Became team leads on three intervention designs
Helped develop guided phone call process models
Mentored BCBSM team in BPM best practices
Encouraged standard pattern implementation
Worked with QA team and user community to ensure new solutions worked properly and addressed all needs

The Solution

Apex’s team of skilled process architects break down complex problems into manageable projects. Apex converted BCBSM’s complex BPM implementation for intervention design into a clear, simplified process to help members achieve their health goals.

In this case, the solution was Apex’s knowledge, expertise, and knack for strategy. Sometimes the key to a successful project is drawing the right lines between where one application ends and the next one starts.