Process Design

Process and Rules: The Collaboration Effect

Blue Cross Blue Shield of MinnesotaTom Bazzarre, Manager Rules Management Office Sands Mcalees-Callanan, Sr. Process Developer

2

Agenda

> Introductions

> BCBSMN, Process and Rules

> Process & Rule Integrated Model

> Project Outcomes

> Process & Rule Repositories Co-Management

> Customer Reactions

3

Introductions

> Tom Bazzarre, Manager, Rules Management Office and Integration, Business Infrastructure Services

> 15 years experience with Enterprise Operations Support within Financial Industry

> 10 years analyzing, designing, and implementing process improvements

> Accountable for Business Rule Management, Business and System Analysis, Rule Automation and Enterprise Integration support.

4

Introductions

> Sands Mcalees-Callanan, Sr. Process Developer, Business Infrastructure Services

> 12 years experience in the healthcare insurance industry

> Background includes Provider Services, Knowledge and Learning Management and working with the Blue Cross Association Inter-Plan Programs team

> Certified in ITIL Foundations and is a Practitioner in Lean and IT Service Management

> Lead Process Developer in launching the Process and Rules Integrated Model

5

Agenda

> Introductions √

> BCBSMN, Process and Rules


> Project Outcomes



6

Who is BCBSMN?

BlueCross BlueShield of Minnesota> BlueCross BlueShield of MN is a non-profit health

insurance company providing local and national health coverage for the past 70 years

> Member enrollment is 2.9 million and we process over 39 million health claims per year

> Over 60% of our business is self-funded and we administer benefits for several fortune 500 companies

> Reduction of administrative cost, business differentiation, and agility are critical to remain competitive in this market

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BCBSMN, Process and Rules

Business Infrastructure Services

> Business Infrastructure Services collaborates with internal partners, by providing business solutions and deployment strategies to manage business rules and process, in order to maximize operational performance

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Business Infrastructure Services

Process Development

Rule Management Office

Integration/Rule Automation

Business DeploymentMe

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Ma

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Manager

VP, Business and Technology Infrastructure

Director

Rule Management Office

Intergration/RuleAutomation

Manager

Process Developer

Process DeveloperDeployment Consultant

Process Developer

Process Developer

System Integration Analyst

Rule Management Analyst


Rule Management Analyst


Rules Management Analyst


Rule Project Steward






Process Developer

Process Development

Process and Rules Organization

10

Agenda

> Introductions √

> BCBSMN, Process and Rules √


> Project Outcomes



11

Process-Rule Integrated ModelBackground> The development of the Process and Rules

Model happened by “chance” with the first project where process and rules staff were both assigned

> Prior to the implementation of this model, requirements were gathered in JAD sessions, where SMEs were expected to supply “everything they know” about a project scope, without any structure around how to organize and communicate their knowledge

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Process-Rule Integrated ModelBackground

With the Process-Rule model, SMEs are given a structured methodology

The customer decides what process and rule levels they would like to have created and documented

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Process and Rule relationships- levels 1 through 4 (working document) Process1 Level Description Rules Level

Description

Process and Rules Relationship

When is this level necessary

Level 1 This level shows the basic high level steps of a/the process (approx. 3-7 boxes) to gain a broad understanding of what is done during the process

Level 1 Rules allow for one or more concepts within the high level project scope, to be defined as terms.

Within Level 1 Terms in high level process steps are used consistently and include a clear definition for use throughout the process.

When a general overview of the process is needed and when a project needs to know high level common terminology and how these concepts relate to each other. When a project requires clear understanding of concepts (common terminology) and how these concepts relate to each other at a high level.

Level 2 This level shows which department, role or function, is responsible for specific actions and who is doing what from a task standpoint. Each step of the level 1 would be defined in more task detail with critical decision points.

This level identifies hand-offs and/or interactions by the players in the process.

Level 2 Rules identify the basic terminology, definitions and relationships between terms (aka: Fact Model) and the Governing Rules* within the project scope. *see “When Do You Need This Level” for definition of Governing Rules

Within Level 2 process steps will correlate to Process/Guidance Rules. Decision points will correlate to Decision Rules. Decision points may also be used to establish a classification and hierarchy structure for the rules (aka: Rule Groups).

When processes need to define, with more detail, what is determined in Level 1 but includes critical, high-level decision points and shows hand-offs with responsible parties defined. A level 2 process begins to identify the risks to the process that can be addressed using process improvement. When a project requires only a basic understanding of the Governing Rules related to its scope and the rules will not be implemented as part of the project scope. Examples of Governing Rules are: A legal statement (e.g., law, act, statute, etc.), formal regulation, binding agreement (e.g., contractual obligation), higher-level business policy or directive. Governing rules are often aimed at guiding or constraining the business, regulating its interactions with external parties, and/or limiting its exposure to risks or threats. A Governing Rule is at risk for misinterpretation. Risk is reduced or minimized, by reducing the Governing Rule down to one or more Operating Rules (Level 3) to be applied in an actual business process or system design. Governing Rules are non-automatable.

1 A Process map or flowchart is a method of making a process visible. Note: All process steps should begin with an action verb.

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Process-Rule Integrated ModelBenefits> The benefits of taking the time to

document the Process and Rules from a business perspective

– Project is clearly defined-”Walk the Wall”

– The captured business knowledge is understood

– Documented Process and Rules are a direct feed to complete Business Requirements

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Process-Rule Integrated ModelBenefits

– Once all of the process steps, decisions and rules are documented – the analysis of what can be, or even should be automated (agile vs. static), is an easier process for both the business and IT

– Business is provided with a means for effective change management; business artifacts (process, terms, rules) are maintained and available for change impact analysis, external to the applications

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Process-Rule Integrated ModelRoles and Responsibilities

Business SMEs andStakeholders

Rules Steward

Process Developer

Process FacilitatorBusiness Owner

IT Business Analyst

IT Project Manager

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Process-Rule Integrated Model

Project Assignment

DevelopCharter and Work Plan

Kickoff Conduct Meeting(s) Transition

Capture A

s Is

Terms and R

ules

Facilitate As Is Process

Docum

ent

As Is P

roce

ss

Capture To B

e

Terms and R

ules

Facilitate To Be Process

Document

To Be P

roce

ss

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Project Assignment

Develop Charter and Work Plan

Kickoff Conduct Meeting(s)

Process Facilitated (As Is) Process Documented

Process Developers guide the SMEs in gathering and documenting the process· 3 + hour

meetings on consecutive days if possible

· Agenda· Use post it

notes and wall posters

· Use probing questions

· Create a collaborative, fun atmosphere

The processes documented according to the Business Process Map Formatting Guidelines unless otherwise requested

· The group uses the wall process and is not interrupted by formatting, spelling etc. allowing for timing and synergy

· Using a lap top, the rough draft process is captured on line during facilitation

· Process Documenter and Process Facilitator meet after the meeting to ‘polish’ the documented processes

· Processes are ready to be validated at the very next meeting· The group sees immediate results of their time and effort· The processes are still fresh in their minds and detracts from

having to back track to re-fresh memories

Review and Gain Business Champion/ Owner(s) approval (sign off) for:· Business

Problem Statement

· Business Owner and Stakeholders Established

· Project Objective

· Process and Rules Deliverables

· Project Team· Process and

Business Scope

· Timelines and Milestones

· Business Engagement Assessment

· Process Detail Level

Establish Project Team’s understanding of:· Charter

Content· Each

person’s role/ responsibility

· Meeting schedule and/or participant availability

· Project approach

Resource and Project Planning Meeting· Process

Facilitator· Process

Documenter· Business

Rule Steward· Business

Rule Analyst· Business

Owner(s) and or Sponsor(s)

· Enterprise Project Management Office, when applicable

· Product Development, when applicable

· Virtual Design, when applicable

Expanded intake form is completed

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Project Assignment


Kickoff


Problem Statement





Business Scope





Content· Each



· Project approach

Conduct Meeting(s)

Process Facilitated (As Is)Based on the process map level (1, 2, 3, 4) determined in the Planning meeting, Process Developers guide the SMEs in gathering and documenting the process· 3 + hour meetings on consecutive days, if possible· Use post it notes and wall posters

Process Map (blank and/or work in process) Parking Lot Issues Opportunities Roadblocks

· Use probing questions to pull out the processHow, what, when, where, which, why, who












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Project Assignment


Kickoff Conduct Meeting(s)Process

Facilitated (As Is)Process

Documented

· Documented according to the Business Process Map Formatting Guidelines

· Use the wall process

· Using a lap top, the rough draft captured during facilitation

· Processes are ready to be validated at the very next meeting

· The group sees immediate results

· Processes stay fresh

Business Terms and Rules Captured

· Participate in meetings; learn the "language of the project"· Ask clarifying questions to capture details for terms,

definitions, fact model and rules· Identify synonyms · Promote the reuse of terminology and rules · Document and validate terms, definitions, fact model and

rules · Continually educate on the differences between business

rules and system rules· Develop rules based on business knowledge, not based on

system limitations, requirements, or expectations








Problem Statement





Business Scope





Content· Each



· Project approach











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Project Assignment



New Design Facilitated (To Be)

Based on the opportunities and steps gathered during the high level as is process, the process facilitator will· Gather utopia from the SME’s for the new

process· Using the project objectives, take utopia and

build the realistic to be process· Draw out enhancements and process

improvements for the new process· Incorporate rules supporting the new process· Identify automation opportunities in the to be

process


· Learn "language of the project"

· Identify synonyms

· Promote the reuse of terminology and rules

· Document and validate terms, definitions, fact model and rules

· Continually educate on the differences between business rules and system rules

· Develop rules based on business knowledge

Process Facilitated (As Is)

Process Documented














Problem Statement





Business Scope





Content· Each



· Project approach











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Project Assignment





Process Documented

Based on opportunities and steps gathered, the process facilitator will· Gather utopia

from the SME’s for the new process

· Using the project objectives, take utopia and build the realistic to be process

· Incorporate rules supporting the new process

· Identify automation opportunities

Business Terms and Rules Captured Validation

Begin the workgroup by validating processes created at last meeting· Ensures accuracy and includes any

changes missed · All necessary updates will be

documented and if needed another meeting will be set up

· Once the validation phases are complete, appropriate documentation will be moved out of ‘draft’ status and placed in ‘final’ status

· Updates are also provided on the assigned Parking Lot issues and opportunities




















Problem Statement





Business Scope





Content· Each



· Project approach











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Project Assignment





Process Documented


Validation

· Ensures accuracy

· Necessary updates documented

· Once the validation phase is complete, appropriate documentation is moved out of ‘draft’ status and placed in ‘final’ status

· Updates are also provided on the assigned Parking Lot issues and opportunities

TransitionProcess and Rule Developers meet with Sponsors, identified Business, Process and Map Owners to provide a final summary · Training for Business to

maintain processes and rules in the repositories

· Documentation and maintenance are the responsibility of the Process and Rule Owners

· Survey is sent out to determine lessons learned from the project

Based on opportunities and steps gathered, the process facilitator will· Gather utopia

from the SME’s for the new process

· Using the project objectives, take utopia and build the realistic to be process

· Incorporate rules supporting the new process

· Identify automation opportunities




















Problem Statement





Business Scope





Content· Each



· Project approach











24

Agenda

> Introductions √


> Process & Rule Integrated Model √

> Project Outcomes



25

Project Results: Collaboration Effect> We have 5 on-going projects using the

Process/Rules Integration model:– IT Engineering– Incentive Based Benefits– Business Incident and Request Management– Administrative Simplification– Integrated Health Management

> The one that started it all: – Corporate Security Event Documentation and

Investigation Management

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Project Results: Corporate Security Event Documentation and Investigation Management

•Project Objective: Purchase a Workflow/Rule Automation tool to facilitate Event Management tasks and cross-departmental handoffs and ensure accurate reporting

• All processes and rules “known” by two departmental employees; not documented

• Project Manager recognized need for process and rule documentation when trying to develop requirements for RFI/RFP processes

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Project Results: Corporate Security Event Documentation and Investigation Management

Process Development

Rules Management

Corporate Security

Information SecurityHuman Resources

Compliance

IT Project Manager

Project Participants

•Project Manager

•4 Business Departments/ 10 SMEs

•Process Facilitator

•Process Developer

•Rule Steward

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Project Results:More deliverables than meetings!

• 25 drilled down (level 4) processes documented and validated

• 22 detailed processes (level 2 & 3) captured and approved

• 178 terms defined and validated • Fact model developed and validated • 337 business rules captured and validated• Road blocks mitigated and parking lot items

documented• Process improvement and automation opportunities

identified and assigned• 44 Meetings over a 4 month time frame

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Where We Started

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> Insert picture of process documented with few stickies

Validate the Process

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Final process with business rules

Eagan Campus

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Receive notification of an

event type- medical

emergency

Notification may be received via:· Phone call to

security officer in SCC at X21212 (SCC is available 24 hrs)

· In person via lobby or communication center

· Direct observation by Corporate Security Staff

Begin to fill out the Medical Injury Report form with the reporting party on-line.

Is the location District

Office, Eagan Campus, or Northern Campus?

District Office

Go to 01.03.1.1

ME DistrictOffice

Wait for resolution. Complete gathering information from the

reporting party, contract security and medical team

and document in the Medical Injury Report form

indicating if person was transported

Dispatch Medical Team via AlertFind

indicating if 911 has been called

Does impacted

party exhibit any of the symptoms/injuries on the list that

may require 911/CER? e.g.· Severe breathing· Shortness of breath· Chest pain· Signs of stroke

Does 911/CER need to be

called if hasn’t?

NoDirect Security Communication Center that 911/CER should be

called

Instruct reporting party help is on the way-· Request not to move the impacted

person· If CERS were called request if someone

is available to meet them at door when they arrive.

Yes

Is 911/CER needed?

Call taxi and

give out voucher

Does impacted person require

nonambulance transportation for further medical

attention?

Go to 01.03.1.3

ME Northern Campus

Northern Campus

Is this Medical

Emergency occurring during BCBSMN business hours?

No

Call 911/CER

Yes

Dispatch contract Security

· Arrive at scene· Direct CER if called to the

site, and stay until they leave· Assist medical team if

present· Perform crowd control if

necessary· Gather data for the event and

report back to SCC

Instruct reporting party help is on the way-· Medical team has been called· Request not to move the

impacted person· Request someone to stand in

aisle to direct medical team when they arrive

· If CER was called instruct someone to meet them at door

Yes

call 911/CER

No

Is this Med

Emerg occur-ing during business hours?

No

Call 911/CER

Me

dic

al

Te

am

Was 911/CER called?

No

Yes

EndYes

Call taxi and give out

voucher and notify Security

Communication

Go to Impact Business on

01.03.1.1

Where is the list? Needs to be formalized

Arrive at scene and assess condition of

impacted person and treat

Does impacted person have

someone who is a nonblue cross employee who could come pick

them up?

No

EndNo Yes

Obtain:· Name of impacted person if

available · Name of reporting party · Call back # and office # of the

reporting party Description of the event from the

reporting party

*CER=Community Emergency Responder

Remain on scene till

ride arrives

Complete Emergency Medical Report and route to Corp Safety Coord.

Receive Emergency Medical Team Report several days after the

event.

End

Review report along with AlertFind and Incident report if

requested

Does medical team

need to be consulted?

Consult filth

Medical Team

Yes

No

Go to A

A

Contract-First responders are

CPR and first-aid trained

Go to B

B

Does impacted person

require nonambulance transportation

for further medical attention?


have someone who is a nonblue cross employee

who could come pick them up?

No Yes

Yes

No

Yes

Go to C

C

Yes

No

Receives AlertFind and calls into SCC to indicate if

available. If available to respond, obtain details of

event such as location, etc

Receive report from AlertFind after

notifying Medical team indicating which team members responded

to the emergency.

Was notification received

of first report of injury?

No

Go to 01.03.1.1

First report of injury

Yes

01.03.1.2 Med Emerg

Eagan

Notify Security Communication

Does investigation

need to occur?

NoGo to investigate Yes

32

Fact Model Delivered!

Case

Case numberCase statusCase status dateCase status typeCase status type dateCase ownerCase originatorCase origination dateCase origination timeCase notesRestricted access Case assignmentCase assignment dateCompliance Hotline response

Investigation

Event

Event-related Party

Event Notification

Review

Referral

Case review dateCase review update

Investigation findingsInvestigation completion date

Referral dateReferral descriptionReferral responseReferral response dateReferred to partyExpected referral response dateReferral time

Event time Event date Event description Event categoryEvent subcategoryEvent typeEvent buildingEvent building floorEvent locationEvent resolutionNature of event Event itemEvent item typeRoot cause / motive (has employee factors and workplace factors)

Event notification timeEvent notification dateEvent notification method

Project Fact Model: Corporate Safety and Security Event Management and Documentation

includes

includes

includes

includes

includes

requires[Case Review]

assigned to

includes

Event roleEvent role typeEvent role subtype

ConsultationConsultation dateConsulted party

includes

Case review requirement

Case review requirement date

includes

is highly confidential?is Compliance Hotline referral?

Response

receives Referral response dateExpected referral response date

[Referral Response]

includes

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> Rule 100212 StatementA case assigned to a Corporate Security event must include all of the following:- Case number - Valid case owner - Valid case status - Valid case status type - Case originator - Case status date - Case review indicator - Case review date (s), if case review is indicated- Case review update , if case review is indicated - Valid initial event category - Valid initial event subcategory , if applicable- Valid initial event type , if applicable - Valid event building - Event building floor - Event location - - Event notification time - Valid event notification method - Investigation findings , if investigation was warranted

What Rules Look Like

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Process with Rule References

Eagan Campus

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Receive notification of an event

type- medical

emergency

Fill out the Medical Injury Report form with the reporting party on-line.

Is the location District

Office, Eagan Campus, or Northern Campus?

District Office

Go to 01.03.1ME District

Office

Wait for resolution. Complete gathering information from the

reporting party, contract security and medical team

and document in the Medical Injury Report form

indicating if person was transported

Dispatch Medical Team via AlertFind

indicating if 911 has been called

Does impacted

party exhibit any of the symptoms/injuries on the list that

may require 911/CER? e.g.· Severe breathing· Shortness of breath· Chest pain· Signs of stroke

Does 911/CER need to be

called if hasn’t?

NoDirect Security Communication Center that 911/CER should be

called

Instruct reporting party help is on the way-· Request not to move the impacted

person· If CERS were called request if someone

is available to meet them at door when they arrive.

Yes

Is 911/CER needed?

Call taxi and

give out voucher

Does impacted person require

nonambulance transportation for further medical

attention?

Go to 01.03.3 ME Northern

Campus

Northern Campus

Is this Medical

Emergency occurring during BCBSMN business hours?

No

Call 911/CER

Yes

Dispatch contract Security

· Arrive at scene· Direct CER if called to the

site, and stay until they leave· Assist medical team if

present· Perform crowd control if

necessary· Gather data for the event and

report back to SCC

Instruct reporting party help is on the way-· Medical team has been called· Request not to move the

impacted person· Request someone to stand in

aisle to direct medical team when they arrive

· If CER was called instruct someone to meet them at door

Yes

call 911/CER

No

Is this Med

Emerg occur-ing during business hours?

No

Call 911/CER

Me

dic

al

Te

am

Was 911/CER called?

No

Yes

EndYes

Call taxi and give out

voucher and notify Security

Communication

Go to Impact Business on

01.03.1Where is the list? Needs to be formalized

Arrive at scene and assess condition of

impacted person and treat

Does impacted person have

someone who is a nonblue cross employee who could come pick

them up?

No

EndNo Yes

*CER=Community Emergency Responder

Remain on scene till

ride arrives

Complete Emergency Medical Report and route to Corp Safety Coord.

Receive Emergency

Medical Team Report several days

after the event.

End

Review report along

with AlertFind

and Incident report if

requested

Does medical team

need to be consulted?

Consult filth

Medical Team

Yes

No

Go to A

A

B


require nonambulance transportation

for further medical attention?


have someone who is a nonblue cross

employee who could come pick them up?

No Yes

Yes

No

Yes

Go to C

C

Yes

No

Receives AlertFind and calls into SCC to indicate if

available. If available to respond, obtain details of

event such as location, etc

Receive report from AlertFind after

notifying Medical team indicating which team members responded

to the emergency.

An hour later

Was notification received

of first report of injury?

No

Go to 01.03.1

First report of injury

Yes

01.03.2 Med Emerg

Eagan

Notify Security Communication

Does investigation

need to occur?

Go to investigate

Rule 100256Rules100267100274100275

Rules:Case Fields1002121002511002130100213510021161002951002611002114100293

Rule 100272

Rule 1002177

Rules1002177100298

Rule 100296

Rule 100299

Rule 1002105

Rule 100296Rule

1002102

Rule 1002102

Rule 1002113

I don’t see much that is rule material through this

section, until investigate

Rule 100279Verified with Steve and Jenn that over 80% of the time, taxi vouchers will be handled by the

Medical Team

Rule100295

1002108

Rule 1002108 Rule 1002108

Rule 1002108

Rule 1002108 Rule 1002109Rule 1002108

Rule 1002106

This is about making sure anything you specified be captured in your case information be completed. It’s not a separate rule, in my opinion.

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Process documentation benefits for our customers• Clear point of reference

• Training

• Continuity

• Adaptability

• Accountability

• Efficiency

• Opportunities Identified

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Opportunities Captured

Mtg Date Issue Assigned to: Do-ability Outcome StatusKeep two invoicing processes alike - Need to make them consistent and streamlines as today they are varied and different.- most manually done-

accurate number of non-benefit information for billing requirements – need billing info automation of rates - would save re-work of reentering the info Don’t always match – increased error – not enough time and staff to catch.

Order form in Lotus database – just send auto notification – saves space and it is there in one accessible placeOne copy if there is a revision current on Lotus – reduces errors if declined - removed – documented

Invoicing - Opportunities

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Benefits of Terms and Rules Captured • Consistent, defined language

• Natural language rule statements

• Granular level rules - can't be misinterpreted

• Traceability

• Motivation

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Wins from the first project:

> It is more efficient for the customer to combine rules and process – although the focus of Rules and Process are different

> Rules Steward gains a deeper understanding of the process and does not have to spend as much time on the back end reviewing

> Rules Steward gains trust of the customer from the beginning – doesn’t have to build the relationship

> Customers gain a better understanding of what the rules are and how they work because they are discussed during the process

> Rules are written for the business, by the business – our business customers are happy to speak their own language and have someone else wonder who will make the system stuff happen!

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Lessons Learned from our first project:> Need strong communication between Rules and

Process team to know when review of Rules needs to be done

> If terminology is introduced by the Rules Team the Process team will re-use it

> Facilitation skills are critical along with human relation skills – for both process design and rules capture

> Need to obtain commitment up front by having sponsor/governing body sign off

> Charter needs to declare the processes and rules levels to be designed and their priority

40

Agenda

> Introductions √



> Roles & Responsibilities √

> Project Outcomes √



41

Process/ Rule Repositories Co-Management

42


43


44

Agenda

> Introductions √



> Roles & Responsibilities √

> Project Outcomes √

> Process & Rule Repositories Co-Management √

> Customer Perspectives

45

Customer Perspectives

IT Project Manager

> Thank you for your help and involvement with this effort. My main observation is that the involvement of your team really helped to clarify and articulate business requirements relating to potential technical work. It is always a challenge to bridge the 'business/IT gap'. I think your work really helped to close the gap, and enable the BA to complete his work with less effort on his part.

Lead IT Business Analyst

> Your team successfully brought together the Product Management Department in a consistent and reliable manner and produced good deliverables that I could use to further refine and define business requirement documentation.

> You established a good rapport with the subject matter experts and were able to gather a significant amount of detail for some complicated processes.

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More from our Customers

Project Subject Matter Expert

> The success that I saw was your team’s ability to gain commitment from the IT department to attend the beginning part of the meetings. You assisted in the detailed documentation of the process. These meetings were between 2-3 hours and you made them enjoyable and yet productive. You and the team’s ability to drill down to the details, capture parking lot issues/concerns and document opportunities was extremely helpful to the Product Management team.

Project Manager

> One big success is simply the fact that your team took the time to move this project forward. We needed someone with the experience of your team to lead the effort of getting things documented thoroughly and accurately, and keeping things organized & tracked. Members of the project team haven't had time to do this on our own due to the workload (which is why we are doing this work!) so we truly appreciate your efforts!

> Another success is that these efforts are reusable for future projects

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Thoughts? Comments? Questions?

48

Contact Information

> Tom Bazzarre, 651-662-4749– [email protected]

> Sands McAlees-Callanan 651-662-8545– [email protected]

Process Design

Economy & Finance

process rule

rule integrated

business infrastructure

tom bazzarre

rule repositories

business analyst

bluecross

sands mcalees