And earlier this week, BPTrends published an interesting case study on Metastorm customer the Royal Pharmaceutical Society of Great Britain (RPSGB) – a professional body for pharmacists and the regulatory body for pharmacists and pharmacy technicians in England, Scotland and Wales.

The organization chose Metastorm ProVision® to model and improve the as-is management processes that the Secretariat undertakes, and the procedure for dealing with the ever-growing number of customer complaints and the paperwork associated with them. It also chose Metastorm BPM® to subsequently automate the new and improved processes.

Check out the case study to learn how RPSGB accomplished its goals of having at least 80% of the investigated cases passed to the Investigating Committee within 3 months of the completed investigation, and how the application has significantly reduced the number of investigations that remained incomplete after six months.

And don’t forget, the 2010 Metastorm Global User Conference, which will be held May 18-19 at the Baltimore Marriott Waterfront, is only 12 days away. We’re gearing up for an awesome time filled with interaction, insight, ideas and inspiration! Have you registered yet?!

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The inclusion of the Physician Payments Sunshine Act in the sweeping healthcare reform is not only a vehicle for transparency, but also for financing the overall cost of healthcare in the US. In my humble opinion, given the sufficient “advanced warning” provided – the bill passed on March 23, 2010, and physician payments tracking is required starting  January 1, 2012 – we are going to see the federal government hand out hefty fines for violations (up to $1M) on a regular basis.

Unfortunately for the Life Sciences industry, there is little sympathy given for large (or even small) payments – “transfers of value” as the government calls them – to doctors and other healthcare providers and organizations (known as HCPs and HCOs respectively). While it may be difficult to defend the clinical usefulness of sending a doctor to a conference in an exotic location, there is a true need for a healthy relationship between clinicians and Life Sciences organizations, and that need isn’t going away.

After all, doctors and other prescribers ultimately put new products to use when they come to market, and therefore represent a key customer segment. The industry also relies on clinician participation in current and future clinical trials of new medicines and medical devices. The challenge is how to maintain healthy interactions with HCPs and HCOs without creating a conflict of interest or the appearance of impropriety.

There are already a host of state regulations in place aimed at this problem; and more are on the way – making it increasingly difficult to navigate this delicate space and stay on the correct side of the law. Add to this the complexities of operating in and around major metropolitan areas that straddle state borders (New York, Boston, Chicago, Washington, D.C., Philadelphia), and the effort to identify and track every HCP’s state of licensure versus their state of residence and the problem of just knowing which provider is which quickly mushrooms.

Clearly a technology solution is needed.

For compliance, there are two main components required – data and process. While most large and even medium-sized Life Sciences companies have a customer master data solution in place, the quality of the data is a problem – “Garbage in, garbage out” – as the saying goes. In order to ensure quality data, the process by which said data is captured and entered into the master data solution is critical. Business Process Management (BPM) can solve this problem in two fundamental ways.

First, from the compliance standpoint, having standard processes that are controlled and enforced ensures that every payment has been approved following corporate compliance policies as well as all state and federal regulations. Furthermore, the flexibility that BPM provides allows companies to develop the processes required today knowing that these and the business rules that drive them can be easily adapted as the regulations and reporting requirements evolve.

Second, from a master data perspective these process controls also ensure that records of payment are added to the primary data source only after they have been officially approved. Each payment amount is confirmed and reconciled after the event takes place and an actual payment is made. This ensures that all of the data kept within the master source is accurate and was properly approved based on the rules at that point in time.

Taking a BPM approach addresses both sides of the compliance problem. It also provides the quality data and recorded approvals that, as part of the Physician Payments Sunshine Act, the US government now requires beginning January 1, 2012. The challenge and opportunity now becomes ensuring that the solution is in place in time to start tracking, and provide the organization an opportunity to review 2011 spending trends prior to compliance issues “going on your permanent record” with the Department of Health and Human Services in 2012.

This approach will allow the organization to ensure all compliance guidelines are being followed, HCPs/HCOs are not being overexposed for spend and provide time to modify compliance policies and the Aggregate Spend application itself before federal tracking begins. Additionally, to follow the new regulations, all Life Sciences manufactures whose products are reimbursed by any government program (Medicare, Medicaid, SCHIP) must have an Aggregate Spend Management solution rolled out and ready for use by the end of this year.

In order to roll it out by that time, you really should be starting to design and build it yesterday.

But fear not – Metastorm has already successfully deployed its Aggregate Spend Management solution for a number of our top Life Sciences clients, and our dedicated Life Sciences practice has the experience and tools to help your organization assess your process, data, applications, compliance and organization to quickly scope a solution. If you start now, end of year is completely feasible and your executives can rest easy knowing that their organization will be tracking all physician spend, will have the quality data available for review, and will still have time to make changes prior to the first federal reporting period.

For more information, please review Metastorm’s Aggregate Spend Management Solution brief or join us at any of our upcoming events. We’re here to help.

===========================

Ethan Smith is the Director of Life Sciences Solutions at Metastorm where he oversees business and account development and solution creation for Metastorm’s global life sciences customers, partners and prospects.

Ethan has extensive experience in business process consulting in the life sciences industry. His areas of expertise include enterprise BPM strategies as well as the utilization of Metastorm BPM® and Metastorm ProVision® to establish Process Centers of Excellence. He has driven process initiatives across research and development, sales operations, incentive compensation, physician spend management and compliance functions. Prior to Metastorm, Ethan spent over 10 years in process consulting for the life sciences and insurance industries.

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Check out this webinar, Countdown to Life Sciences Aggregate Spend Compliance, to learn how Metastorm’s Aggregate Spend Solution can help Life Sciences organizations manage, track and report on all physician payments by:

• Setting active alerts for corporate compliance policy and regulatory requirement breeches
• Defining and approving payment of all physician budgets and operating plans
• Enforcing proper approvals dynamically based on business rules governing giving

Webinar Date: Tuesday, April 6, 2010
Session1: 6:00 am PT / 9:00 am ET / 1:00 pm GMT
Session 2: 10:00 am PT / 1:00 pm ET / 5:00 pm GMT

Register for 9:00 AM EST session.
Register for 1:00 PM EST session.

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First of all, the revenue leakage problem is purely an operational issue – the drugs have already been discovered, approved, marketed and sold so most of the ‘hard part’ has been done. Unfortunately, in this space pricing is not simple. Almost all healthcare products are ultimately paid for by someone other than the end customer – the patient. This of course results in a complex web of regulations, government pricing, managed care formularies and tiers and wholesale distributors – just to name a few.

To that end, Metastorm has experience working with and developing process solutions for all of the players involved (including the United States government), and can help your organization too. Our technology has the ability to solve your organization’s revenue leakage problem, and more importantly, the fundamental issue plaguing the industry as a whole.

According to IDC, 4.4% of all pharma revenue, which equates to $11 billion annually, is lost to revenue leakage. This is a staggering figure considering that only the top 15 companies in the entire life sciences space generate that level of total revenue. Just think of what that number is relative to your company’s business!

To eliminate this unnecessary cost burden, pharma manufacturers need to automate the processes by which they communicate pricing information to their wholesaler trading partners. While many companies have an electronic data interchange (EDI) solution in place to address the issue, the IDC numbers tell a different story.

Most companies have found clever ways to use statistics to make it appear that the revenue leakage problem doesn’t exist in their organization. For example, many commercial contracting departments cite 98-99% success/accuracy rates for pricing. While those are impressive numbers, and should be commended, the flipside tells a different story – one of unnecessary profit loss in need of a solution.

Consider the same statistic another way: a 99% accuracy rate means that minimally 1% of total revenue is in dispute (i.e. chargebacks), or written off because of other operational and reconciliation issues. Any manager/director would love to lead a project that could reasonably promise to deliver 1% of existing revenue back to the bottom line. For any company with over $1 billion in total revenue, that’s a minimum return of $10,000,000 per year!

Sound too good to be true? It isn’t, and Metastorm has the experience and customer successes to prove it.

Our business process management (BPM) suite of software tools has been used by multiple companies in the space to deliver these types of results to their organizations. With Metastorm BPM you can automate these processes to submit and update pricing between a manufacturer and wholesalers, then provide both trading partners with a combined audit trail to ensure that pricing information is sent immediately, and that both parties have complete visibility (at a line item level) into every price and pricing/eligibility change.

These capabilities first ensure prices are updated prior to the contract effective date (eliminating chargebacks related to the timeliness of information), and second that when discrepancies do occur that both companies’ representatives have the same view of the same information for each transaction (minimizing the time required to resolve the issue). Both of these benefits seriously increase your bottom line by eliminating dollars going out the door unnecessarily while also providing the added benefit of reduced processing time, which frees up resources for more value-adding activities.

But don’t just take my word for it. I invite you to review our customer testimonials and other solution information to see for yourself how Metastorm has, and can solve the pharmaceutical revenue leakage problem and can improve the financial health of your organization.

Want to know more? Check out our life sciences solution page, and read this article about how Metastorm helped two major pharma’s collaborate on chargeback management. 

===========================

Ethan Smith is the Director of Life Sciences Solutions at Metastorm where he oversees business and account development and solution creation for Metastorm’s global life sciences customers, partners and prospects.

Ethan has extensive experience in business process consulting in the life sciences industry. His areas of expertise include enterprise BPM strategies as well as the utilization of Metastorm BPM® and Metastorm ProVision® to establish Process Centers of Excellence. He has driven process initiatives across research and development, sales operations, incentive compensation, physician spend management and compliance functions. Prior to Metastorm, Ethan spent over 10 years in process consulting for the life sciences and insurance industries.

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According to the corresponding release this number is “the equivalent to total revenue for a top 20 pharma simply disappearing each year.”

The culprit? Revenue leakage.

According to the release, one of the major sources of revenue leakage, which costs pharmaceutical companies 4.4% of their overall revenue per year, is chargeback discrepancies. The release also states that “63% of manufacturers believe chargeback-related revenue leakage is a serious problem. This is up nearly 25% from a similar survey in 2006.”

With these staggering numbers it is very apparent that pharmaceutical companies have a huge problem on their hands. Fortunately, there are technologies available that can alleviate revenue leakage, and help these companies realize significant ROI along the way.

 For example—one of America’s largest pharmaceutical services companies, which ranks among the Fortune 25, has utilized the functionality of Metastorm BPM® to streamline and automate its contracts management and chargeback processes as well as over 175 other process across the enterprise, enabling it to:

• Establish more efficient and accurate tracking capabilities,
• Reduce chargeback disputes,
• Rapidly and efficiently  respond to changing market conditions, and
• Improve transaction transparency and supplier collaboration.

With the help of Metastorm BPM, these and many other benefits have been realized, enabling this company to achieve an exponential return on its investment, and helping it to avoid revenue leakage from poor process management.

Want to know more? Watch this customer video testimonial, and read this solution sheet.

You can also check out the Solutions for Life Sciences page on our website.

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The award recognizes organizations that have excelled in implementing innovative process improvement solutions to meet strategic business objectives.

AmerisourceBergen has certainly done exactly that—to date the organization has established a BPM Center of Excellence, deployed and optimized nearly 200 processes throughout the enterprise, and has approximately 3,000 users on the Metastorm software globally.

The AmerisourceBergen award entry highlights the company’s senior executive support for Metastorm BPM as an enterprise solution. It also outlines some of the key objectives that BPM software helps the company meet on an ongoing basis, including:

• maintaining high quality standards while managing growth,
• creating efficiencies,
• making better and faster decisions, and
• ensuring regulatory and legal compliance

“The pharmaceutical industry is extremely complex and competitive, and AmerisourceBergen has embraced the Metastorm BPM suite as an enabler to help effectively address market demands in a highly competitive environment,” stated Manoj Kumar, manager of Business Process Automation at AmerisourceBergen. “The results and return on investment have been significant.”

We congratulate AmerisourceBergen and Manoj Kumar, the company’s manager of Business Process Automation, for their dedication and hard work. Receiving this award is a great recognition of the broad scope and remarkable success of its BPM initiative.

To hear more comments from Manoj Kumar, listen to this audio clip

Watch the video below to learn more about how AmerisourceBergen leverages Metastorm BPM.

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“As we rolled out standard end-to-end business processes to users, BPM tools enabled users to see the big picture and put their role in context by understanding upstream and downstream process and data flows,” said an executive of the pharmaceutical company.

The article highlights how the company used BPM for various purposes from clinical trials to supply chain optimization. It started adopting BPM so much in fact; that it established a BPM Center of Excellence.

The article further discusses how BPM can be used for other purposes within the pharmaceutical industry such as integrating and managing communications between various manufacturing-related systems

Read the full article for more details on how the pharmaceutical company was able to fully adopt BPM throughout the company.

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Needing to coordinate clinical submissions with a global workforce while meeting FDA pharmaceutical guidelines, the company decided to use Metastorm BPM to create a 24 x 7 automated lifecycle of its clinical submissions. Deploying BPM, the company was able to generate metrics and reports quickly, increase employee productivity and decrease the standard turnaround time required to submit reports to the FDA while handling all document preparation offshore.

Below a senior systems analyst delves further into the advantages of using Metastorm BPM in his global clinical team.

Please visit Metastorm’s Web site to learn more about its solutions for pharmaceutical companies.

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This season debuts seven episodes featuring customers who have successfully deployed Metastorm’s software to deliver business improvements across critical processes. Participating organizations include:

• BTAS/US Air Force
• Vets4Pets
• EKS&H
• PSCU Financial Services
• Wyeth Pharmaceuticals

Read the full announcement for more information on the latest series.

The 34 episodes of the Metastorm Customers Speak Out video series can be viewed on Metastorm’s website at www.metastorm.com/videos or on the MetastormMedia YouTube channel.

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According to CIO, the 2009 CIO 100 Awards honors 100 companies that are creating new business value by innovating with technology. The award entry highlighted the deployment of an electronic data capture system for the collection of drug trial data using both Metastorm BPM and Medidata Rave. It notes that the customer’s clinical data is now available almost immediately following patient visits, enabling dynamic trial execution methods and “early fail” business decisions for study projects.

The CIO 100 award applicants were asked what technologies were most important to executing their projects, and business process management and enterprise architecture technologies emerged #1 and #2 in the overall list – providing strong industry validation on the value that these applications deliver.

More information on the CIO 100 winner profile can be found at: http://www.cio.com/cio100/detail/1997.

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Geoff says Inova Health is implementing IT changes in phases. Right now, they are in the process of computerizing physician order entries. The next step is to create systems that will capture and store hospital information. These types of process improvements are slowly being implemented in hospitals across the country.

In a recent eWeek podcast, Laura Mooney, VP of Corporate Communications for Metastorm, explains how to improve the process management practices that are holding back advances in health care IT.

Healthcare IT has received quite a bit of buzz lately – namely because improvements in IT directly impact the quality of care for patients. An article in Fierce Healthcare notes that “improved documentation is key to healthcare’s future.” The article highlighted findings from a recent study conducted by the Health Management Academy that revealed the top three best practices for successful hospitals:

• Stronger strategic planning to solve the root causes of key emergency department (ED) issues, such as throughput, patient satisfaction and capacity;
• A corporate executive designated to oversee ED management and performance system-wide, considering it a core business area; and
• Greater utilization of information technology solutions

While a number of factors affect the progression of the healthcare industry – it is certain that IT will play a major role in the coming years as hospitals across the country begin to find value and necessity in making technology investments that will improve their processes and ultimately the quality of care they are able to deliver to patients.

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The pharmaceutical company was experiencing challenges with its current process for several reasons. First, employees were situated globally so it was difficult for work to be distributed. At the time, work was being distributed via email and tracked with Microsoft Excel spreadsheets so there was no precise or reportable audit history. There was also poor visibility into the status of the task, low management insight, and tedious administrative reporting.

The company wanted to improve this process and listed the following items as some of its project goals:

• Standardize and streamline processes
• Reduce manual entry of administrative informatio
• Automate assignment and delivery of wor
• Automate notification
• Ensure appropriate authorizations /approvals of outputs of advancement to next step
• Increase visibility to work status and issue
• Enhance reporting and metrics

They decided on Metastorm BPM to automate the clinical document process for a number of reasons including its ability to automate complex business processes and its speed of implementation and delivery. Using BPM, they implemented a new process where it intelligently routes and tracks tasks defined by business processes, rules, standards, and deliverables. It provides more than 3,000 users with the capability to automatically select and initiate processes based on document type, task, and resource availability; along with providing the capability to prioritize tasks.

The organization has been using this new process for about a year and has seen visible business results. With Metastorm BPM, it now has the ability to categorize work priorities; ensure that work is being completed by the right person; enhance visibility into the request for all users; define and enforce consistent processes; and automate email notifications.

Just another example of BPM excellence at work.

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Veterans experienced delays in processing their benefits because paperwork is lost or held up. With an electronic system, this would give all veterans affairs sites access to the complete medical record, reduce administrative mistakes, and prevent delays associated with lost documents.

In some of our previous blog posts, we presented case studies in which paperwork is often the culprit for delaying processes. Hospitals are slowly but surely transitioning from the paper-based world to a digital one with the help of information technology. Further, streamlining administrative processes while continuing to invest in patient care is not mutually exclusive, commented a Metastorm executive in this HealthCare IT News article.

Similarly, the administration is committed to improving quality of care by investing in healthcare IT. In this February blog post, we discussed how by automating processes through BPM, hospitals can become more efficient while improving patient care by reducing the amount of time needed to manually process tasks. BPM technology can transform the many processes involved with running a hospital organization – from reducing paperwork and managing records effectively to improving communication across hospitals and improving data management.

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The article cites four specific areas that hospitals need to focus on:
• Areas to automate manual tasks
• Opportunities to improve the complex revenue cycle
• Materials management efficiency
• Technologies that offer high and quick ROI

Though these priorities may seem ambitious, a single investment in Business Process Management (BPM) technology can achieve a hospital’s efficiency and ROI goals and improve their quality of patient care by reducing the amount of time needed to manually process tasks.

A few examples of hospitals who took the BPM plunge:

A 238-bed osteopathic teaching hospital located in Grand Rapids, MI for example used BPM to improve the efficiency of key functions in the hospital. These functions included reducing the large amounts of paper used to execute various administrative tasks. Aside from the time required to manually handle and process paperwork, using the previous methods, the hospital staff also lost documents, incurred process delays and had no visibility into the history of a process.

To help drive and manage its important business processes, the hospital has leveraged BPM to automate over 40 processes throughout the organization.

A 442-bed North Carolina not-for-profit hospital also used BPM to facilitate administrative functions including incident reporting, financial planning, job posting,
and employee new hire and termination processes. After automating their organization, the hospital saved money on paper costs, improved access to forms by hospital employees, significantly reduced errors resulting from manual routing issues, and decreased time spent on paper-based administration.

And, now that the new Obama administration has made electronic health records a priority of its stimulus plan, there is definitely a spotlight on healthcare IT. A recent article notes that as much as $20 billion will be pumped in the healthcare system to accelerate this use.

To successfully make this transition and sustain efficiency in a hospital for the years to come, BPM offers healthcare providers a number of benefits and should certainly be a top of mind technology for healthcare CIOs.

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