Published on 23-Nov-2011
Horizon Blue Cross Blue Shield of New Jersey
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.
Horizon BCBSNJ was using a lot of homegrown custom developed applications and found it was replicating functionality.
Horizon BCBSNJ chose to deploy IBM software on IBM Power7 Blade series servers.
The solution has helped Horizon BCBSNJ improve efficiency, It has been able to cut 30 minutes down to one minute for 10,000 claims a month, leading to a significant ROI.
Horizon Blue Cross Blue Shield of New Jersey teams with IBM and IBM Premier-level Business Partner
Prolifics to deploy a suite of IBM WebSphere® BPM and business rule management systems (BRMS) tools.
IBM Horizon Customer Reference Video
As Produced Transcript
Interview: Bill Looney, Enterprise Architect, Horizon
Horizon has about 3.6 million members, about 64,000 groups that we serve.
We’re one of the nation’s oldest healthcare insurers. We’re typically manual, you know, our organization grew up over 80 years and everything was pretty much a manual process, many older legacy systems involved.
We were using a lot of homegrown custom developed applications and we found we were replicating functionality. We did look at a number of different products and different competitors.
Horizon chose to deploy the WebSphere Business Process Management suite on IBM’s Power7 Blade series. And we had the right relationships with business partners like Prolifics to help us be successful.
We found that they had the skills and the technology that we needed to be successful with our business process center of excellence.
We are using the Lombardi product on the BPM side for human-centric tasks. And underneath the Lombardi, we are using the WebSphere processor for straight-through business processes and exposing those processes as services.
We are using ILOG to create the business rules and store them in a central place and expose those to give guidance to our claim processors to ensure best practices.
The BPM tools and the ILOG tool is definitely are helping us get speed to market in conjunction with the WebSphere Portal server.
They’ll help us give a guided experience to our brokers, whether they are signed on to a computer in their office from a mobile device, wherever they are, we want to be able to give them the information they are looking for and put it right at their fingertips.
We have been able to take certain processes now that are high volume, maybe 10,000 claims a month. They take up to a half an hour to work through manually, and we are taking some of those processors from half an hour literally down to one minute.
The ILOG tools, the BPM tools, it's helping us do care management, it's helping guide our processors through care, find the type of documents, medical records that are needed in order to help people deliver their care.
Analytics, the BPM tools, the rules, it is really helping us to deliver on our goals of making healthcare work for our members, providers, and brokers.
BPM is definitely helping Horizon be a more efficient organization. Taking 30 minutes down to one minute for 10,000 claims a month is really offering the organization tremendous ROI, big savings.
We are typically seeing $3 return for every dollar invested, so our ROI is really we are hitting the ball out of the park.
IBM and Prolifics really came up strong for us and helped us put those things in place, and we feel that we are going to be able to execute better because of what they have been able to help us do.