Sisters of Mercy Health System Selects Corticon as Business Rules Engine Standard

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Corticon Business Rules Management Systems, will be used to reduce the time-to-market of chornic disease management initiatives.

Within four hours, we had developed and deployed our first Corticon decision service (i.e. business rules), and were able to call it as a web service. We estimate we’ll see a 25% reduction in interest payments… very impressive.

Sisters of Mercy Health System (http://www.mercy.net), a leading integrated healthcare provider, has selected Corticon Technologies to provide their enterprise standard business rules engine. Corticon, the leader in model-driven Business Rules Management Systems, will be used by Mercy to reduce the time-to-market of chronic disease management initiatives and improve the quality and efficiency of their customer servicing operations.

Mercy is a Non-Profit network of 26 hospitals and other ambulatory facilities with over 36,000 employees geographically located in Missouri, Oklahoma, Kansas and Arkansas. The hospital network aims to provide the best possible care and outcomes at the lowest possible cost, which ultimately enables them to deliver more to their community. Mercy recognized that a business rules platform could help to achieve this goal by reducing development cost while increasing quality, moving traditional “development activity” from IT to the business (rules specification), and in the end, automating redundant activities and assuring that best practices are consistently followed.

Mercy identified the need for a business rules management system (BRMS) after several business process management (BPM) initiatives. BPM or “workflow” software is used to improve the efficiency of business processes by automatically routing work between people and systems. BPM software provides visibility into the overall business process, and where a work item sits in the process. BPM software excels in moving work through the process; however, it not a replacement for human decision-making. By contrast, Corticon is specifically designed to handle the automation of decision-making logic. According to John Conroy, Executive Director, the fit was obvious. “If there are more than two consecutive decision points in a process design, we successfully use Corticon to provide the rules to determine process flow. We try to keep our process diagrams simple, and use Corticon to manage the more complex and volatile conditional logic.”

Mercy Health Plans (MHP), the for-profit health plan of Mercy Health System, first piloted Corticon as part of a claims exception handling process. Like many leading healthcare companies, Mercy’s goal is to resolve all claims as quickly as possible. While the goal is to auto-adjudicate claims for straight-through–processing and payment, the reality is exceptions occur requiring manual review. The claim queue had grown faster than their people could efficiently handle; consequently, over 35,000 claims piled up in backlog. Claims exceptions are a sensitive and costly problem for healthcare providers; they result in time-intensive manual processing, impact customer satisfaction due to delays in closing, and result in a major expense. What type of major expense? Interest accrues and is due the provider for unpaid amounts outside of the contract window! This can amount to tens of thousands of dollars per month..

Mercy chose to build their pilot exception handling solution using Corticon and their BPM tool. In the new solution Corticon is used to evaluate the claim and determine the appropriate exception handling process. According to Mr. Conroy, it did not take long to prove Corticon’s unique benefits. “Within four hours, we had developed and deployed our first Corticon decision service (i.e. business rules), and were able to call it as a web service. We estimate we’ll see a 25% reduction in interest payments… very impressive.”

Mercy plans to expand Corticon to improve service center operations. This deployment will leverage Corticon to assist service center agents when diagnosing issues. With Corticon, Mercy anticipates reducing average call time by 50% (from 10 to 5 minutes per call) by guiding the call center agents to ask the appropriate questions in the right order. In addition, Mercy will use Corticon to more efficiently handle level 2 support problems that cannot be solved with the first customer service agent. Corticon will automatically evaluate these more complex cases and quickly assign them to the appropriate available level 2 agent. Mr. Conroy expects to reduce the manual effort by 67% and repurpose staff for more valuable production efforts. Mercy Health knows that addressing problems faster and more accurately improves customer satisfaction, significantly reduces costs, and allows their employees to focus more on relationships, not data analysis.

“Corticon is pleased to partner with Mercy Health System to provide more efficient operations and responsive customer service”, said Dr. Mark Allen, CEO of Corticon. “Health care providers like Mercy provide a most critical service to our communities; we welcome the opportunity to help their cause.”

Based on the successful proof-of-concept, Mercy selected Corticon for a number of reasons, including:

  •     Ease-of-Use: Mercy wanted their non-IT business analysts to manage the business rules, and identified Corticon’s unique ability to empower analysts to manage even the most complex business rules with relative ease. This both accelerates development and improves business transparency and control.
  •     Seamless SOA Integration: Mercy required a rules engine that can integrate with existing systems and work with the latest tools and technologies. Corticon offered simple, standards-based integration into both legacy environments and modern service-oriented architectures (SOA).
  •     Accelerated Data Integration: Many of Mercy’s business rules require the evaluation of data resident in relational databases. Corticon’s Enterprise Data Connector (EDC) enabled Mercy to integrate with the data source directly from the Corticon rules engine, rather than integrating through the BPM layer. Mercy estimates that Corticon EDC saves 90% of the development time spent on data integration.

About Business Rules Platforms
Also known as business rules engines (BRE) or business rules management systems (BRMS,) these platforms are an advanced technology used to deliver more agile IT systems. Business rules platforms enable the business logic of software applications to be externalized from programming code and managed by subject matter experts. Business rules platforms provide a number of key advantages such as accelerated application development and maintenance, increased transparency of functionality and control, improved audit-ability and rapid changes in business logic without affecting the systems’ code for core functionality. In addition, they enable the automation of sophisticated operational decisions that are too complex and volatile to automate via traditional programming techniques.

About Sisters of Mercy Health System
The Sisters of Mercy Health System (Mercy) was established in 1986 to serve as the parent corporation of a variety of health care facilities and services sponsored by Mercy Health Ministry, an entity established by the Catholic Church to oversee the healing ministry and Catholic identity of Mercy.. Mercy consists of 26 acute care hospitals, two heart hospitals, outpatient care facilities, physician practices, skilled nursing and long-term residential care facilities, clinics, a managed care organization and other health-related services. Mercy operates facilities and services in a seven-state area encompassing Arkansas, Kansas, Louisiana, Mississippi, Missouri, Oklahoma and Texas. Mercy is the 9th largest Catholic healthcare system in the U.S., based on net patient service revenue.

About Corticon
Corticon Technologies delivers Business Rules Management solutions that unleash "The Power of Decisions” , as enterprise assets. Many of the world's most successful organizations rely on Corticon to discover, model, execute, and improve operational decisions (and associated business rules) within their enterprise systems. Recognized as a leading business rules vendor by industry analysts and thought leaders, Corticon's patented Business Rules Management System is the only solution with a model-driven design environment that guarantees the consistent, efficient, and reliable execution of a company's business rules and decisions. Corticon is a privately held company headquartered in Redwood City, California, with European headquarters in The Netherlands, worldwide distribution through local Corticon offices, and an extensive partner network. Corticon's products are in use today at many of the world's largest banks, insurance companies, media companies, telecommunication providers and government organizations, collectively automating millions of decisions per day.

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Samira Abrari
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