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Duwboot 6-8

3991 CD Houten

PO Box 123

Health insurers and output management 3990 DC Houten


the Netherlands
About realizing a manageable output process
T +31 30 600 19 00
F +31 30 600 19 01
Health insurers act in a market where competitors
E info@truston.com
distinguish themselves by minimum price variations
and quality of service. The latter ensures high I www.truston.com

investments in technical innovation, particularly


concentrated on communication towards external Output process in scheme
parties. Since the correspondence frequently contains
medical and financial information, maximizing control
of the output process is of the utmost importance. It is
necessary to comprehend the entire process and
recognize all different factors in play.
by Thomas Truijen

OUTPUT PROCESS
The output process as a chain could be divided in three THE HEALTH INSURER
segments. Combining customer service and accuracy should be the
main focus in the health insurer’s correspondence.
Personalized mail and specifications contain financial and
Input data medical data, therefore accuracy of the information shown
The chain’s input data is being generated by the back office is essential. Customer service is one of the primary aspects
application(s) and holds a selection of the information on which a health insurer distinguishes itself from the
needed to determine most of the variables in the process. competition.
XML is currently the industry’s leading standard data format.
Multiple data sources could possibly be used to deliver all A health insurer communicates with numerous parties:
necessary information. insured clients, collectivities, care providers and the
government. Despite the health insurer’s innovative
attitude, an inevitable, extensive physical output flow
Document generation remains. Paper documents are and will be the company’s
Once the input data has been read into the OutputManager, ‘business card’.
the correct template will be linked. Specific, possibly
adjusted, data elements will be used to show different
variables within the template. Clients
The most important output flow towards the clients
remains paper documents. Each year, this target group
Output receives ‘high volume’-documents (for instance the annual
The OutputManager combines the input data and template to policy, payment specifications, medical approvals) and ‘low
generate output. The output will be available in different volume’-documents (irregular letters and forms, ad hoc
formats, depending on the distribution channel(s). correspondence). Standardization is in both cases
important to keep the company’s house-style recognizable
with its clients.

FROM TECHNOLOGY TO TRUST


© 2010 Truston KvK 30150944 Utrecht, NL
Nowadays, almost every health insurer offers its clients the In scheme:
possibility to view and use certain forms through the
Internet. Adjusting personal data online also increasingly
reduces the usage of paper documents.

Collectivities
Health insurers have a great commercial interest in a flexible
attitude towards collectivities. These parties often represent a
large number of insured clients, but unfortunately use diverse
administrative processes. Technical limitations regarding
mutual information exchange creates a potential risk for the
relationship with the collectivity.
OUTPUTMANAGER
The health insurer’s OutputManager should be able to
generate output batch wise, ad hoc and interactively.
Health care providers
House style documents containing the right data will be
General agreements between health insurers and health care
distributed via the chosen channel. More than other
providers stimulate standardization of information exchange
organizations, the health insurer is offered the utmost
and quality of information privacy. Digital distribution channels
flexibility in document composition and data integration.
have taken a prominent role in the financial output process;
conformance is necessary.

Document Composition
Alongside this digital message exchange, the paper document
Numerous OutputManagers offer extensive possibilities in
flow mainly consists of medical approvals. Health records’
composing documents. A WYSIWYG (What You See Is
sensitivity and legal aspects are causing a slow movement
What You Get) -interface is the key feature to introduce
from paper to digital.
document composition to users, so they will be able to
rapidly develop templates on their own.

Government
The interface allows the user to develop the template and
Government institutions wish to periodically receive data from
combine it with the necessary input data. Since the input
the health insurer. Distribution takes place digitally, through
data is generally in XML format, defining Xpath queries is
several channels, and on paper.
another key feature.

Personnel & Management


Distribution
Internal correspondence is diverse and manifests itself in
Distribution channels such as printing, web delivery, e-
many ways. For instance: employees need to view sent
mail, fax, sms and archiving ask for associated file types
documents at all times via a digital archive. And the
which should be available in the OutputManager. Third-
organization must be able to generate management
party print vendors also often require print jobs to be
information of the output process for data analysis and
delivered in a specific format.
publication.

FROM TECHNOLOGY TO TRUST


© 2010 Truston KvK 30150944 Utrecht, NL
Open standards VISION
Using open industry standards improve integration and The OutputManager not only needs to comply with the
synergy with other (existing) business processes. Moreover, a current wishes of the health insurer, but must also be
platform independent OutputManager offers no restrictions in prepared for market developments and technological
future usage of other technologies and hardware. innovation. Examples of features which will be important in
the near future are described below.
Workflow Monitor
A Workflow Monitor is indispensable for good management.
The entire process as well as the underlying activities should
Digital invoice
be registered and monitored in real time. Strict production The breakthrough of the digital invoice seems to be at
control demands for presentation of all different stages which
hand. It’s just a matter of time before clients will be paying
have been passed through, including associated details. their bills with a couple of mouse clicks, instead of
receiving paper invoices and perform a manual transaction.
Besides monitoring, other additional features are preferred: A digitally pre-filled financial transaction has a significant
manually re-starting activities and creating reports. A user impact on the paper output process and prevents adjusting
friendly interface allows users without any specific technical incorrect payment data.
background to operate and manage the process.

Intelligent Forms
In scheme: Health insurers aim at providing self-regulating
mechanisms for external parties to reduce overhead costs.
Clients are able to execute policy mutations and request
information online. These services are very popular and
health insurers can’t do without. But unfortunately, the
technical realization often consists of actions foreign to the
back office application and therefore results in a difficult-
to-manage process.

Intelligent Forms improve responsiveness of external


parties and automate back-end processes and data
integration. In this interactive environment, it is possible to
consult personal data in real time and validate entered
mutations. The OutputManager uses the input from these
actions, if necessary, to generate digital or paper output.

Functional instead of technical


An intelligent, graphical WYSIWYG user interface allows
users without specific technical knowledge to
independently compose and manage documents. Time-
consuming activities will shift from the IT department to
the actual users. These users are in most cases the
document experts and owners and, after the shift, also
functional developers. Long waiting times for change
requests will belong to the past.

FROM TECHNOLOGY TO TRUST


© 2010 Truston KvK 30150944 Utrecht, NL
ADVICE
Biggest downfall in the OutputManager selection process
appears to be the scope of the output process. Certain aspects
are wrongfully left outside consideration or allocated to
another business process. This leads to a shattered approach,
where too much effort is spent solving separate situations.
Minimization and simplicity of the number of used applications
in the entire output process, is essential for IT management.

Product selection demands a long term vision and


understanding the output process as well as other business
processes which are affected. When the health insurer
possesses this knowledge, it will help selecting the right
OutputManager and will confidently look forward to the
implementation and the resulting, manageable, output
process. Make sure to approach the solution for the output
case as simple as possible: ‘Simplicity is prerequisite for
reliability’ (E.W. Dijkstra, 1975).

TRUSTON
Truston is an ICT service provider with a focus on ICT
services for health insurers and managing information
systems and Truston is Oracle Certified Advantage Partner
as well as Microsoft Certified Partner. With its expertise,
technical skills, products and services, Truston offers an
indispensable contribution to the success of its clients and
is proactively involved in development.

For more information, please visit www.truston.com.

Thomas Truijen is an international lead implementation


consultant for the Truston Output Manager (TOM) and
Scriptura and specialist in business processes at health
insurers.

If you wish to receive more information based on this


article, feel free to contact t.truijen@truston.com.

FROM TECHNOLOGY TO TRUST


© 2010 Truston KvK 30150944 Utrecht, NL