HTH930: Optimize your organization with Business Process Integration

1. HTH930: Optimize your organization with Business Process Integration Aisha El-ZorbaSenior Product ManagerAisha.El-Zorba@sybase.com Jeff SalmonSenior Systems ConsultantJeff.Salmon@sybase.com

2. Sybase Overview Healthcare Market Overview Benefits of BPM in Healthcare Industry Views BPI Suite for Healthcare Customer Story Q&A Agenda

3. Sybase Overview - Who We Are • One of the world’s leading providers of database and e-Business infrastructure software, mobile and wireless solutions, and vertical solutions for the financial services, healthcare and telecommunications markets • Operations in 60 countries • Eighteen-year history of open, scalable systems • 4,639 employees with over 45,000 customers • Wall Street runs on Sybase • 80 of Fortune 100 companies use Sybase products • Strong financial position

4. Sybase Powers Major Healthcare Solutions • Top six U.S. managed-care organizations • 29 of the 47 Blue Cross Blue Shield plans • 1,250 payer and provider organizations worldwide • Sybase teams with more than 95 application partners, offering clinical, financial, administrative and medical management solutions

5. Sybase Healthcare Expertise

6. Solution Partners

7. HealthNow New York BCBS Minnesota BCBS Michigan BCBS Texas and Illinois NASCO John Muir/Mt Diablo Universal Care University of Colorado Hospital Cole Managed Vision Quest Diagnostics Fortis Benefits Nemours Children's Clinic Children's Hospital - San Diego Williamsburg Community Hospital Healthcare Customers Partial Listing • Iowa Health system • Children’s Memorial Hospital • Baptist Health systems • Baylor University Hospital • Group Health Cooperative • Neighborhood Health Plan • St. Johns Hospital St. Luke’s Hospital • Wake Medical Center • Kaiser Permanente • Loma Linda University Medical Center • Quest Diagnostics • St. Vincent’s Hospital • Methodist Hospital Memphis • Northbay Health Systems • Catholic Healthcare West • Johns Hopkins Health System • Carilian Health System • UCSD Medical Center • Mayo Clinic • Hospital Sick For Kids • Arkansas Children's Hospital • Children's Mercy Hospital • Children's Healthcare of Atlanta • Stony Brook University Hospital • Sisters of Mercy • Sunnybrook Health Science

8. Healthcare Market Overview

9. Dynamics of the Healthcare market e-business is redefining the delivery, administration and management of Healthcare Rising medical costs, industry, consolidation, changes in the social culture and government legislation are driving the need for a change in traditional business strategies Healthcare costs in the US, increased 8 to 10 percent in 2002 and industry analysts predict double-digit increases in 2003 Healthcare Today BAM BPM EAI B2Bi • Healthcare market requirements • Integration products that adopt emerging standards • Operational and tooling support for standards • Ability to expose existing functionality • Collaborative Services – regulation requirements manageability and deployment

10. Improve Profitability Competitive Agility Patient/ Partner Loyalty HIPAA Regulations Healthcare Today Organizational Realities Drive the Needs for Technologies • Dynamics of Organizational Change • Analyst expect inflation of healthcare costs to continue to rise during the next five years due to escalating costs for pharmaceuticals, medical supplies, professional fees and new technology. • Organizations that do not leverage the opportunities presented by e-business will find it increasingly difficult to compete on a cost basis and will lack the key delivery mechanisms required to meet service demands and attract new revenue. BAM Healthcare Optimization Provider Payer

11. Organizational Priorities • Process improvement • Reduce cost of materials/procurement • Reduce cost of services Improve Profitability Regulatory/ Competitive Agility • New requirements, channels, geographies • Innovative business models • New services, competitive responsiveness Patient/ Partner Loyalty • Easier to do business with • Collaborative processes • Externally-facing applications

12. Healthcare Process Optimization Challenge Isolated silos of automation Patients Providers Payers Business Process Improvement Customer Interaction Health Value Chain Collaboration • Automatic Billing • Patient Self-Service • Wireless updates • Web Information • Clinical & Patient care • Research • Institutional Reporting • Financial Systems • HR Self-Service • Wireless Solutions • Asset Management • HIPAA Collaborative Specifications • Exchange Connectivity • Automatic Payment Processing • ASP Connectivity • Outsourcing

13. Issues Facing Healthcare Today • HIPAA • Transaction Compliancy • Support for various data feeds (direct, web enabled DDE, paper) • Privacy & Security (audit trails, access controls) • Rising Costs of Healthcare require Advancements in Efficiency and Automation • Improving Customer Satisfaction

14. Issues Facing Healthcare in the Future • HIPAA • Constantly evolving requirements mandate a flexible, open environment • Enriched data content allows for comprehensive analytics • Continue to improve efficiencies and streamline business processes • Improving Trading Partner Satisfaction

15. The Solution …

16. BPI for HealthcareA Foundation for Today and Tomorrow • Provides a comprehensive set of integration and business process improvement tools allowing providers and payers to: • Integrate backend systems • Support multiple types of messages in a variety of protocols • Automate processes across multiple systems • Leverage efficiencies to other Trading Partners • Enables enterprises to rapidly deploy to respond to ever-changing market requirements

17. A Provider’s Perspective • Need to integrate and optimize current healthcare systems • Support service level agreements for reliable 7 by 24 operations • Reliance upon Practice Management Vendors and Clearinghouses who may not provide timely releases to support the full set of HIPAA transactions • Support the future HIPAA Claims Attachment Transaction (275)

18. BPI for Healthcare – A Provider’s Perspective • BPI for Healthcare supports various messaging formats (HL7, X12, etc) and provides the infrastructure to filter and deliver messages to any number of destination systems. • Advanced functions such as combining data from multiple sources to respond to a single request is critical especially when one considers the HIPAA Claim Attachment transaction (a combination of X12 and HL7 data) IntegrationBroker Business ProcessManagement Enterprise Portal Clinical Gateway EDI/HIPAACompliance

19. BPI for Healthcare – A Provider’s Perspective BPI for Healthcare provides an “out-of-the-box” transaction validation and transformation solution easing reliance upon PM Vendors and Clearinghouses to “do it for you” Dr. Smith What’s the status of my claim?Is the patient eligible?Was my referral accepted? Request Response Provider PayerResponse

20. BPI Suite for Healthcare Business Activity Monitoring BizTracker Messaging Gateways Physicians Process Management Integration Broker Clinical Gateway HR e-Biz Impact Patients Firewall Financial Wireless Server Process Server HL7 Payers HIPAA Studio External Gateways (EDI, XML)

21. Total Cost of Ownership Improve Return on Investment – Today, Tomorrow and Beyond • Business process • Integration architecture • Integration tooling • Increase top line revenue by managing and improving business processes • Leverage current investments by integrating with existing environment • Reduce maintenance costs - build once and reuse

22. BPI for Healthcare – The Real Time Solution

23. EDI Server for HIPAA • X12, HL7, XML, any-to-any, ODBC • High Performance translation engine • File-size unlimited translation engine • Supports one-to-one, one-to-many, many-to-many maps • Queue enabled for real-time integration (MQ, etc) • Cross-platform Scalability - WinNT, 2000, UNIX (SUN/SOLARIS, HP9000/UX, RS6000/AIX, etc.)

24. Real-Time Environment Dr. Smith What’s the status of my claim?Is the patient eligible?Was my referral accepted? Request Response Real-timerequestfromprovider Payerapplicationsendsresponseto provider Security, Reliability, Scalability • X12 and HIPAA Compliance• Process Management• Transformation/Integration• Performance

25. Real-Time Solution with HIPAA Dr. Smith What’s the status of my claim?Is the patient eligible?Was my referral accepted? HIPAA Studio Real-time/SecureCommunications Real-timeRequestFromProvider ProviderApplication HIPAA Validation Integration

26. Real-time solution with HIPAA Studio • Real-time/secure communications Supports the following protocols: • Networks: TCP/IP Sockets • Web: HTTP/S SOAP WSDL UDDI • Security: LDAP, IIOP, VPN, Public Key • Database: ODBC • Queuing: MSMQ MQSeries • Communication: CPI-C R232 TTY • HIPAA compliance validations • Contains the required and situational data elements as defined in the Implementation Guidelines • Integration • Provides transformation, routing, process management

27. Real-Time solution example Dr. Smith What’s the status of my claim?Is the patient eligible?Was my referral accepted? HIPAA Studio HIPAA Accelerator TCP/IPSockets ODBC Comm.Mgr. EDIServer Message Transport Layer Message Transport Layer PayerAdjudicationSystem Real-timeRequest Process Server

28. Integration Server – e-Biz Impact 5.3 Proprietary Legacy & Packaged Application Integration Server Application e-Biz Impact Direct API Adapters Impact Manager XML Transport Layer HL7 Application Application Impact Production Objects Data Objects AIM Web Services

29. Process Management • Required to service timeout requirements Even when there is a single submitting system, without Process Server there is no practical way to manage the “state” of the real-time submitted transaction. For example, if the receiving system fails the sending system must take some action. • To coordinate complex processing requirements among multiple systems: • sequential processing • parallel processing • split processing • join processing • iteration processing

30. Process Server Process Server Process Server Start Check Source Check Source Check Source Provider Timeout Y N Submit Claim Notify Customer End AdjudicationSystems Submit Claim Notify Customer

31. Process Server Touch Points Labs Claims Processing Providers etc. Process Server 80-90% of all transactions Workflow 10-20% of all transactions Exceptions WorkflowRepository XML ProcessRepository CorrectInstances XML Correct the Process

32. Process Server Manages a Range of Business Flows Sequential Parallel And/Or SplitAnd/Or Join(key part of 837 or 835 trans.) Iteration

33. BAM - Powerful, Efficient Message Analysis New Era Message Events Alert Management Drill-Down Message Display XML Events Message Store Message Handling Rules MessageRepair MessageRe-processing Message Analysis Rules Aggregation Objects: Persistent Cumulative Efficient

34. BizTracker Groups Business Transactions... • Real-time Status Updates • Assign Any Status To Any Step • View Individually or As Group

35. Including A Historical View of Transaction Messages

36. And Single Message View...

37. Customer Story - Fortis Benefits, Kansas City, MO

38. BPI Suite Customer - Product Usage • EDI Server • Provides for HIPAA Compliance Checking • Splits transactions into separate individual claims • Auto-Generates Claim Numbers • Verifies maximum 5 detail lines per claim or splits into multiple claims due to Adjudication System requirement • Integration Engine • Used for Routing and Business Logic • Translation from different formats (MF and back to TP)

39. BPI Suite Customer - Product Usage • Process Server • Manages state of transaction and real-time message support • Manages Time-Outs if slow response from Adjudication • BizTracker • Used for tracking messages in the system and real-time reporting • Used for Error Handling

40. Complementary Products to BPI Suite for HC • HIPAA Repository • Used to maintain all transactions on a field-by-field basis • Used for supporting paired transactions • 837/835, 270/271, 276/277, 278 • Custom Web Application (WebSphere) • Enrollment and Premium Payment converted into EDI • Validates for Compliance, sends ACK

41. Summary

42. Summary Enabling the Health Value Chain • Business Process Integrator Suite for Healthcare Improves Efficiency and Lowers Operation Costs for Healthcare Payers and Providers • Leverages New Era of Networks® proven healthcare technology and innovative process management and monitoring. • Brings business process optimization technology used in successful commercial enterprises to the healthcare market. • Eliminates the technology gap between healthcare payers and providers with the first solution built on an open foundation, improving communication capabilities between disparate systems by supporting cross industry standards.

43. Q&A