Horizon Blue Cross Blue Shield of New Jersey optimizes agility and ROI

IBM WebSphere business rules and process management tools accelerate improvement in key processes

Published on 30-Oct-2011

Validated on 02 Dec 2013

"IBM BPM tools are definitely helping Horizon be a more efficient and smart organization. Our ROI is phenomenal, and we’re more agile; more able to adapt our processes to market conditions." - Bill Looney, enterprise architect, Horizon Blue Cross Blue Shield of New Jersey

Customer:
Horizon Blue Cross Blue Shield of New Jersey

Industry:
Healthcare, Insurance

Deployment country:
United States

Solution:
Business Process Management (BPM)

IBM Business Partner:
Prolifics

Overview

Horizon BlueCross BlueShield of New Jersey (Horizon BCBSNJ) is New Jersey’s oldest healthcare insurer, serving more than 3.6 million members with a wide array of medical, dental and prescription insurance products and services.

Business need:
Horizon BCBSNJ needed to become more efficient in business process management (BPM) and drive rapid, automated and continued process innovation.

Solution:
Horizon BCBSNJ teamed with IBM and IBM Premier-level Business Partner Prolifics to deploy a suite of IBM WebSphere® BPM and business rule management systems (BRMS) tools.

Benefits:
The WebSphere tools provide a platform for innovation, keeping costs down, increasing process agility and visibility, and significantly improving the efficiency of key processes.

Case Study

Horizon BlueCross BlueShield of New Jersey (Horizon BCBSNJ) is New Jersey’s oldest healthcare insurer, serving more than 3.6 million members with a wide array of medical, dental and prescription insurance products and services.

Challenge
Horizon BCBSNJ is a process-centric organization. However, the business was established in a manual, paper-intensive era, and virtually all critical processes had remained manual until four years ago, when the company launched a business process improvement initiative. To achieve both process improvement and its underlying business objectives, Horizon BCBSNJ needed to become more efficient in business process management (BPM) and drive rapid, automated and continued process innovation.

Solution
Horizon BCBSNJ teamed with IBM and IBM Premier-level Business Partner Prolifics to deploy a suite of IBM WebSphere® BPM and business rule management systems (BRMS) tools. The company worked with Prolifics to create a BPM center of excellence to provide Horizon BCBSNJ with methodologies, best practices and design patterns for the lifecycle of process improvement projects regarding enrolment, claims processing and coordination of benefits.

Horizon BCBSNJ business analysts now use IBM WebSphere Lombardi Edition software to identify and document business processes affecting the company’s partners and to automate, build and deploy BPM solutions on a portal. The IBM WebSphere Process Server application provides a platform that helps improve visibility into business processes and extend their availability, while IBM WebSphere ILOG® JRules software enables the company to create and centralize access to business rules that help claims processors adhere to best practices. The WebSphere tools provide a platform for innovation, keeping costs down, increasing process agility and visibility, and significantly improving the efficiency of each of the company’s key processes.

Benefits
• Reduces processing time for standard claims by 20 to 30 minutes each
• Generates an average ROI of 300 percent for each internal process improvement project
• Increases customer and provider satisfaction by freeing claims processors to focus on more complex claims

For more information
To learn more about IBM WebSphere software, please contact your IBM representative or IBM Business Partner Prolifics at www.prolifics.com, or visit: ibm.com/websphere

Products and services used

IBM products and services that were used in this case study.

Software:
JRules, WebSphere Process Server, WebSphere Lombardi Edition

Legal Information

© Copyright IBM Corporation 2011 IBM Corporation Software Group Route 100 Somers, NY 10589 U.S.A. Produced in the United States of America October 2011 All Rights Reserved IBM, the IBM logo, ibm.com, DB2, ILOG and WebSphere are trademarks of International Business Machines Corp., registered in many jurisdictions worldwide. Other product and service names might be trademarks of IBM or other companies. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at ibm.com/legal/copytrade.shtml Other company, product, or service names may be trademarks or service marks of others. The information contained in this documentation is provided for informational purposes only. While efforts were made to verify the completeness and accuracy of the information contained in this documentation, it is provided “as is” without warranty of any kind, express or implied. In addition, this information is based on IBM’s current product plans and strategy, which are subject to change by IBM without notice. IBM shall not be responsible for any damages arising out of the use of, or otherwise related to, this documentation or any other documentation. Nothing contained in this documentation is intended to, nor shall have the effect of, creating any warranties or representations from IBM (or its suppliers or licensors), or altering the terms and conditions of the applicable license agreement governing the use of IBM software. References in this publication to IBM products or services do not imply that IBM intends to make them available in all countries in which IBM operates. All customer examples described are presented as illustrations of how those customers have used IBM products and the results they may have achieved. Actual environmental costs and performance characteristics may vary by customer.