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Reducing Health Care Fraud, Waste & Abuse: How Much Is Enough?

Health Care Fraud Waste and Abuse Reducing Health Care Fraud, Waste & Abuse: How Much Is Enough?

Every day I see headline-worthy stories of convictions and legal settlements for fraud and abuse in health care around the world. Many health care payers’ SIUs or forensics teams spend their days “grinding it out” in the fight against health care fraud, waste and abuse — they may only aspire to these kinds of headline results.

So how does a health care payer measure success in payment integrity? How much is enough? Each payer tends to have their own point of view.

Here are four examples of “How much is enough?”

  • Some years ago, a payer came to us with a simple goal. With just one employee in their SIU shop and very simple tools, they had suffered a significant fraud loss while their one SIU employee was away during the Christmas – New Year’s holiday. In response to this loss, their Board of Directors defined “How much is enough?” as “Let’s not have that happen again.”
  • Historically, RFPs for administration of government-funded health care insurance programs in the United States have included a requirement that the administrator fight fraud. Since this kind of administration contract is often awarded to the bidder with the lowest price, it’s possible that a small, low cost SIU shop which produces any kind of result will be “enough.”
  • We did a one-off project for a payer that unexpectedly identified significant fraud and abuse committed by an extremely powerful provider. For this payer, “enough” did not include addressing the behavior of this powerful provider.
  • We have a client in a country that is publicly agonizing over a culture of corruption which permeates every industry, including health care. For this payer, “enough” will probably be the day that they are recognized as having achieved a level of payment integrity which defies that norm. They are on their way!

So how do you set your goals in the fight against losses to fraud, waste and abuse? How much is enough?

Whether your goal is to achieve structural change, or your goal is incremental improvement, we recommend that you do the following things.

  • Recognize that payment integrity includes attention to a range of types of losses, not just fraud, but also to waste (unintentional or unnecessary payment) and abuse (manipulation).
  • Fraud is traditionally addressed by the SIU or forensics. Engage your stakeholders to mitigate losses to waste and abuse.
  • Quantify your losses with a project that validates the integrity of your historical paid claims so that you can establish a baseline of losses which is relevant to your business.
  • Establish achievable goals for measurable results that impact your organization’s bottom line.
  • Be prepared to balance your goals and the needs of your stakeholders. Challenge your stakeholders to make the case for their interests in measurable terms.
  • Be prepared for change, because the people who inappropriately take your money are entrepreneurial.
  • Benchmark your losses and your results against industry best practices, for celebration of success and to support your case for the resources that you need to achieve your goals.

In my next blog on health care fraud, waste and abuse, I’ll ask: “Who Do You Task with Responsibility for Payment Integrity?” I welcome your comments.

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Football fans don't care about sports. Wait, what?

wi fi image 6 interior of levis stadium Football fans don't care about sports. Wait, what?

Video: IBM provides ultimate fan experience at Atlanta’s Mercedes-Benz stadium

Hello everyone! Happy New Year! I promised you that this year, now that my book is more or less out of the way beyond what is mostly cleanup, I would provide you with some fresh thinking and some great content from me and a host of guests — plus some exciting announcements.

Because I’m preparing a post that includes announcements about the CRM Watchlist changes for 2018 to 2019 and the rules of the Emergence Maturity Index battle royale, I’m starting the new year with a guest post from a really interesting guy who is positing a really interesting idea — one that as a set of principals and practices I have been a firm adherent of for many years.

Alex Slawsby goes by the title of director of innovation for Embraer, which, as all the road warriors among you know, is one of the largest producers of jets in the world. But prior to this job, Alex worked for the Sports Innovation Lab, putting forward the ideas of Clayton Christensen (who he also worked for) on disruption and innovation. I met him at the SEAT conference he is referencing in this post, and I have to say, I was thoroughly impressed. He and I are both strong advocates of Service Design and Service Dominant Logic — which, at its absolute simplest, means that products aren’t where the value is; the outcomes they produce and the tasks they support are where the value is. Value in Use is what it is often called. Alex is one of the most articulate people I have known in how he is able to explain, describe, and actually build plans and programs around these concepts. Sports is an area he not only is passionate about but has been successful in — and he is a helluva guy. So, Alex, start the new year right — and right at the time of the College Football championship game and shortly before the Superbowl, get us all going in 2018.

Your venue, sir.

Over the last decade, the NFL has enjoyed tremendous success. In 2007, League revenue surpassed $ 6 billion. In 2016, League revenue surpassed $ 13 billion. Television commercials during NFL games now cost more than twice what they did 10 years ago.

At the end of 2006, the NFL expanded its schedule to include a few Thursday night contests. During this season, there were games every Sunday, Monday, and Thursday.

TechRepublic: How the NFL and its stadiums became leaders in Wi-Fi, monetizing apps, and customer experience

Success without humility frequently leads to contempt. The NFL clearly had a target on its back, even before it began to face a wide range of on-the-field and off-the-field challenges. During this season, there seemed to be nothing the sports media enjoyed more than publishing pictures of half-empty stadiums at kickoff. While the League and its owners frequently push back using selective statistics, NFL Commissioner Roger Goodell recently conceded that attendance is down.

Having spent many years working for Professor Clayton Christensen, guiding corporations, and their leaders through disruptive innovation, I now apply his Jobs-to-be-Done theory (a lens through which to identify disruptive threats and opportunities) in my daily life. If you are not familiar with the theory, the following quote by Theodore Levitt (once a professor at Harvard Business School as well) nails it in a nutshell: “People don’t want to buy a quarter-inch drill, they want a quarter-inch hole.”

The point is that we don’t really care about the drill, we care about the outcome — the quarter-inch hole — that the drill helps us achieve. “Help me make a quarter-inch hole” is the Job-to-be-Done. The drill is the solution we “hire” to get that job done. Now, if something else comes along — a dropper of wood-eating liquid, say — that helps us more satisfactorily (less noise, dust, and cost) get that job done, we might ditch that drill in two seconds.

Given that drill company executives probably spend their time trying to one-up their fellow drill company executives, they probably wouldn’t recognize that “liquid competitor” until we were all ordering from a different section on Amazon. And, as Professor Christensen’s most famous theory states, that’s exactly why Blockbuster, Kodak, Sears, and others were disrupted. And this might be why the NFL has an “attendance problem” — other things are beginning to get fan jobs done more effectively.

Also: NFL star Fleener to help VR tech firm detect concussions

To begin assessing whether the NFL is truly in danger of getting disrupted, let me first describe an “Ah ha!” moment that I had this past summer. Just before noon on July 18, I was sitting in a packed meeting room at the Atlanta Marriott Marquis, surrounded by athletic directors, team technology leaders, and venue managers. The session, one of many smaller discussions at the SEAT Atlanta conference, was titled “Connected Smart Cities and The Future Stadium.”

Over the last several years, the “smart stadium” has become all the rage in sports. Owners fear that the at-home sports watching experience will get so good at satisfying fan Jobs-to-be-Done that fans will decide to stay home. And so owners are investing heavily in stadium technology to improve the in-venue experience, which includes addressing major fan frustrations such as slow-moving traffic and long concession and bathroom lines.

For half an hour, the directors, leaders, and managers seated around me that day discussed many technology solutions (IoT, mobile, social, analytics, etc) and how they might address such frustrations. A common theme emerged early on: There is no shortage of technology solutions out there (e.g. fan experience applications with wayfinding features, stadium display boards showing line length, in-seat concession delivery), but they all cost a lot of money and no one really knows what kind of ROI they deliver.

Also: NFL bets on AWS for machine learning

I began to wonder if there was another way to tackle the problem. I thought to myself, what if, for a moment, we took lines for granted? What if we just accepted that there would always be lines of cars and people? Could we make those lines less frustrating?

Sitting at that round table, I had my “Ah ha!” moment. As a fan, we “hire” sports to get jobs done like “Excite me,” “Feel part of something much bigger than me,” “Bond with my family,” and “Distract me from the stress of my daily life.” Essentially, we don’t care about the stadium or the sporting event itself (drills), we care about what the stadium and the sporting event help us achieve (jobs).

Now, if we, as fans, can only achieve our desired emotional and social outcomes while sitting in our seats, then, of course, we’ll find frustrating lots of slow-moving cars or people keeping us from those seats (particularly if we’re also spending hundreds of dollars on tickets and concessions as well).

This insight led me to make a comment toward the end of the discussion. I wondered out loud that as a group, perhaps we should not only be thinking about how we can use technology to reduce lines but how we might use technology to make those lines inherently less frustrating as well.

Also: How to watch the NFL on the internet in 2017

Later, after I returned to my room, I searched online to find examples where people or companies had solved this problem. I quickly found the following quote from a June 9 Washington Postarticle describing Disney World’s new “Pandora: The World of Avatar” experience (emphasis mine):

You’ll wait even longer for Flight of Passage, but the payoff is greater and the line easier to endure. That’s because Disney has reached new heights in the design of the queue, which succeeds as an attraction unto itself. Essentially, they’ve built a mountain-hiking path that switchbacks up and up through a fantastical watershed. You ant-line past waterfalls and cliff walls, eventually entering a network of painted caves with ample (and how!) time to decipher the ancient history of the Na’vi. The tunnels give way to an abandoned RDA bunker and then (not there yet!) to a lab much like Weaver’s HQ in the movie, including a floating Na’vi avatar bubbling and breathing in a tank. Even when the line moved ahead I lingered here, which is akin to sitting on the plane for bit after landing in Australia.

Disney has long known that lines are one of — if not the greatest — barrier to guest satisfaction. To tackle this problem, Disney first replaced long straight lines with now common “switchback” lines that made the wait seem shorter and added shelters around the lines to make waiting more bearable.

Over the years, Disney then worked to make the line experience part of the attraction itself to help guests satisfy their enjoyment Jobs-to-be-Done before they even set foot on the ride. I’d say a guest preferring to stand in line a bit longer constitutes success.

The question this raises for sports business leaders is intriguing: How can we help fans sitting in traffic or standing in lines achieve at least some of the in-seat payoff?

We’ve all had the experience of sitting in slow-moving stadium traffic. What if, while stuck in our cars, we could receive live, targeted programming through a fan experience mobile app? Dedicated announcers could describe to us in detail what’s happening in the stadium, pipe through crowd noise, provide frequent traffic, parking, and weather updates, and even take questions from drivers and call out specific license plates to win prizes.

We’ve also all had the experience of standing in slow-moving concession lines. What if the lines themselves were elevated for a view of the field or passed by video walls displaying a line-only, high-definition, field-level “photographer’s eye” view of the action? What if, while standing in line, we could be randomly selected to appear on the jumbotron or accrue greater loyalty points and rewards if the line moves more slowly than expected?

Also: 3 things you can learn from the NFL about digital transformation

While some of these ideas are likely more viable than others, the broader objective here is to develop solutions that nail fan Jobs-to-be-Done — the Jobs for which fans “hire” the in-seat experience — even when the fan can’t be in their seat. It’s what Disney accomplished when it made the Flight of Passage line nearly as compelling a “drill” as the attraction itself. It might be time to balance trying to make lines go away with trying to make lines less frustrating.

This brings me back to the NFL and its attendance problem. If fans aren’t coming to NFL stadiums, it’s because other things are getting their jobs done more effectively. Owners can invest a lot of money in new smart stadiums, but few fans will not continue to “hire” the in-venue experience just because it includes the largest jumbotron or the fastest Wi-Fi. It is much more likely that fans will continue to come if owners invest in the things that reduce fan experience friction and truly nail fan emotional and social Jobs-to-be-Done.

This is true for the whole sport as well. When games only took place on Sunday and Monday and the in-venue sports consumption experience was far superior to any other, few things had the power to nail fan “Excite me” or “Distract me from the stress of my daily life” Jobs-to-be-Done like the NFL. While the NFL has become a revenue juggernaut over the last decade, it is now far more of a commodity frequently in the headlines for reasons which clearly diminish its value as a “drill” to fans.

Also: Robots get NFL tryout: Steelers experiment with robotic tackling dummies

As you think about the implications of this for the NFL and its future, think about what it might mean for you and your organization as well. Here are a few questions to consider:

1. What are your customers really buying? Peter Drucker once famously said, “The customer rarely buys what the company thinks it’s selling.” Combine this with the Levitt quote above and you might just see the, well, Matrix. It may be difficult for those in the industry to consider, but sports fans are not buying tickets to sporting events. They are buying tickets to outcomes, to Jobs-to-be-Done satisfaction. They are really “outcomes fans” as we all are in all areas of our lives. We don’t buy milk at the supermarket. We buy the outcomes (quench my thirst, improve my nutrition, and support my child’s good health) that milk helps us achieve. You don’t really care about this blog post. You care about what this blog post will do for you (ideally, if I’m lucky, entertain you, provoke your thoughts, and maybe help you work differently). It is very important that those in the sports industry — and leaders in any industry — consider carefully this question and its counter-intuitive answers, particularly for the following reasons…

2. Who are your real competitors? If drill company executives realize they are selling holes and not drills, they are more likely to see threats that look nothing like other drills. They are also more likely to see opportunities (“How else could we help our customers create holes?”) they would otherwise miss. If those team owners realize they are selling outcomes and not sports, they might realize that they are competing with all kinds of things that help consumers achieve the same outcomes. So, yes, while the NFL is competing with MLB for viewers when their seasons overlap, it’s also competing with very different DNA’d things like eSports, Twitch, Netflix, Amazon Prime Video, Facebook, Snapchat, Instagram, and drone racing. When they view the business of football through a Jobs-to-be-Done lens, NFL owners might understand just why divisiveness and controversy so powerfully destroy the sport’s value to consumers. And those same owners — and leaders in any industry — might also discover new ways to double down on delivering what truly matters.

3. What is your traffic? Your concession lines? When organizations realize they are selling outcomes, they see opportunities and threats very differently. When organizations take the time to see their products and services and experiences through the eyes of customers and to do that faithfully (i.e. holding back “the customer doesn’t know what they’re talking about” bias), they often see friction they’ve ignored or dismissed, friction which could be deadly in a day when customers can identify alternative solutions and switch in the blink of an eye. As I’ve argued here, if owners don’t find ways to reduce the friction inherent to the live in-stadium experience (and realize that “bigger is better” doesn’t work), fans will flee more quickly than they can imagine. The same goes for leaders in any industry — if you don’t double-down on maximizing value to your customers (always seeking to increase the “Jobs-to-be-Done crushing” benefits of your solution while reducing friction), they will not be your customers for very long.

4. Finally, when should it be “Day 2?” The answer: Never. For years, Jeff Bezos has held close the belief that organizations on their first day are hungry, lean, and paranoid (homage to Andy Grove) when it comes to delivering customer delight. But on their “second day,” they lose their edge, even slightly. Earlier this year, Bezos was asked by an employee what Day 2 looks like. His response, “Day 2 is stasis. Followed by irrelevance. Followed by excruciating, painful decline. Followed by death. And that is why it is always Day 1.”

To paraphrase something Professor Christensen once wrote, the more successful an organization, the harder it is for the organization to change. Across professional sports leagues, Day 2 came and went a long time ago. A victim of its own success, the NFL is in fact approaching day 35,600 and it shows. In other industries, organizations like the NFL that prioritize their own products over their own customers come and go in the blink of an eye. Sports team owners — and leaders in any industry — must not take for granted that “if they build it, customers will come.”

To sustainably lead, much less survive, it is imperative that organizations and their leaders stay very close to their customers’ Jobs-to-be-Done and prioritize doing what it takes to continue to satisfy those jobs. While the NFL has enjoyed tremendous revenue growth over the last decade, there are signs that such growth has masked a widening fundamental — and potentially disruptive — gap between what it is selling and what its fans want to buy.


Thanks Alex. Thoughts, people?

OK, until next week (or so) when we launch with the announcements and some thinking on the subject of 2018 and where we will be same time next year. See ya.

Previous and related coverage

Verizon, NFL strike deal to bring game streaming to any mobile network

Verizon’s acquisition of Yahoo gives the mobile carrier a massive platform to stream NFL games, starting in January 2018.

Microsoft, NFL extend Surface sideline deal to another season

Microsoft Surface will continue to be ‘the official tablet of the NFL’.

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ZDNet | crm RSS

Engagement Insights Easily Delivers Marketing Metrics You Care About

blog title engagement insights 351x200 Engagement Insights Easily Delivers Marketing Metrics You Care About

The modern marketer is flooded with data. Website data. Pipeline data. Email data. Social  Media data. Views. Likes. Comments. Clicks. Cart abandonment. Conversions. There are vanity metrics, marketing metrics, and business metrics.

It can be – and often is – overwhelming. As Act-On blogger Pam Neely recently reported, “53% of marketing executives feel ‘overwhelmed’ by the amount of data produced by their marketing technologies.”

At Act-On, we believe marketers should quickly be able to access the key engagement analytics they and the executive team care about. That’s why we’ve developed Engagement Insights, an easy-to-use templated approach to measuring marketing performance using tools you’re already using – Google Sheets or Excel.

Now, Act-On customers can gain real-time insight on how their audience is engaging with them. And those insights should not only be actionable and easily shareable with key stakeholders throughout your organization, but also drive optimization and improvements for your marketing programs.

With Act-On’s Engagement Insights – powered by Data Studio – marketers will be able to quickly have visibility into what they care about:

  • Email & Message: Measure key metrics across all email campaigns including number sent, opened and click thru rates
  • Forms: Know exactly what forms are converting visitors into leads and see trends over time
  • Landing Pages: Better understand what campaign landing pages are performing best, as well as see the engagement trends over time
  • Content Assets: Focus future activities by learning exactly what your audience is engaging with on your website, as well as when they are engaging

At Act-On, our mission is to empower marketers to do the best work of their careers. With Engagement Insights, we’re giving marketers the cypher to find meaningful signals from all the data being collected.

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AI – What Chief Compliance Officers Care About

AI Technology Compliance AI – What Chief Compliance Officers Care About

Arguably, there are more financial institutions located in the New York metropolitan area than anywhere else on the planet, so it was only fitting for a conference on AI, Technology Innovation & Compliance to be held in NYC – at the storied Princeton Club, no less. A few weeks ago I had the pleasure of speaking at this one-day conference, and found the attendees’ receptivity to artificial intelligence (AI), and creativity in applying it, to be inspiring and energizing. Here’s what I learned.

CCOs Want AI Choices

As you might expect, the Chief Compliance Officers (CCOs) attending the AI conference were extremely interested in applying artificial intelligence to their business, whether in the form of machine learning models, natural language processing or robotic process automation – or all three. These CCOs already had a good understanding of AI in the context of compliance, knowing that:

  • Working the sets of rules will not find “unknown unknowns”
  • They should take a risk-based approach in determining where and how to divert resources to AI-based methods in order to find the big breakthroughs.

All understood the importance of data, and how getting the data you need to provide to the AI system is job number one. Otherwise, it’s “garbage in, garbage out.” I also discussed how to provide governance around the single source of data, the importance of regular updating, and how to ensure permissible use and quality.

AI Should Explain Itself

Explainable AI (XAI) is a big topic of interest to me, and among the CCOs at the conference, there was an appreciation that AI needs to be explainable, particularly in the context of compliance with GDPR. The audience also recognized that their organizations need to layer in the right governance processes around model development, deployment, and monitoring––key steps in the journey toward XAI. I reviewed the current state of art of Explainable AI methods, and where their road leads to getting AI that is more grey-boxed.

Ethics and Safety Matter

In pretty much every AI conversation I have, ethics are the subject of lively discussion. The New York AI conference was no exception. The panel members and I talked about how any given AI system is not inherently ‘ethical’; it learns from the inputs it’s given. The modelers who build the AI system need to not pass sensitive data fields, and those same modelers need to examine if inadvertent biases are derived from the inputs in the training of the machine learning model.

Here, I was glad to be able to share some of the organizational learning FICO has accumulated over decades of work in developing analytic models for the FICO® Score, our fraud, anti-money laundering (AML) products and many others.

AI safety was another hot topic. I shared that although models will make mistakes and there needs to be a risk-based approach, machines are often better than human decision-making, such as autopilots on airplanes. Humans need to be there to step in if something is changing, to the degree that the AI system may not make an optimal decision. This could arise as a change in environment or data character.

In the end, an AI system will work with the data on which it has trained, and is trained to find patterns in it, but the model itself is not necessarily curious; the model is still constrained by the algorithm development, data posed in the problem, and the data it trains on.

Open Source Is Risky

Finally, the panel and I talked about AI software and development practices, including the risks of open source software and open source development platforms. I indicated that I am not a fan of open source, as it often leads to scientists using algorithms incorrectly, or relying on someone else’s implementation. Building an AI implementation from scratch, or from an open source development platform, gives data scientists more hands-on control over the quality of the algorithms, assumptions, and ultimately the AI model’s success in use.

I am honored to have been invited to participate in Compliance Week’s AI Innovation in Compliance conference. Catch me at my upcoming speaking events in the next month: The University of Edinburgh Credit Scoring and Credit Control XV Conference on August 30-September 1, and the Naval Air Systems Command Data Challenge Summit.

In between speaking gigs I’m leading FICO’s 100-strong analytics and AI development team, and commenting on Twitter @ScottZoldi. Follow me, thanks!

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What is a Citizen Developer, and Why Should I Care?

080317 1926 WhatisaCiti2 300x201 What is a Citizen Developer, and Why Should I Care?

There’s a term floating around more and more lately: Citizen Developer. While it’s on the cusp of becoming a more mainstream phrase, its meaning has yet to become widespread, and that’s a shame because it describes a person with enormous potential. A Citizen Developer has the capability to grow an organization’s ability to do business. So, let’s break down this new term down for you so you can learn what it takes to become one!

You probably already know what a citizen is, right? They look kind of like this:

080317 1926 WhatisaCiti1 What is a Citizen Developer, and Why Should I Care?

Citizens are people, plain and simple. And then, of course, there’s the developer:

080317 1926 WhatisaCiti2 What is a Citizen Developer, and Why Should I Care?

Developers are also citizens, but they know varying degrees of coding language and typically require caffeine to operate.

As you can see, caffeine aside, there’s one big distinction: developers have a more in-depth technical breadth which allows them to customize things, such as CRM for Microsoft Dynamics 365, in ways a non-technical person could not. Up until recently, Microsoft Dynamics 365 didn’t have much of an in-between – you either had to know code or live with your existing system. Enter the Citizen Developer; they look something like this:

080317 1926 WhatisaCiti3 What is a Citizen Developer, and Why Should I Care?

The Citizen Developer is an exciting new role because they don’t believe coding knowledge should limit an organization’s ability to drive success through Dynamics 365. As they work within their Dynamics 365 environment, they see ways to improve it. While technical knowledge of CRM for Dynamics 365 is still needed, in-depth coding knowledge is not required. A Citizen Developer has learned how to leverage the new tools available in Dynamics 365, which allow CRM admins and customizers to customize their environment with no code and low code solutions. They enable an organization to run more efficiently and smoothly and they bridge the gap between the non-technical and technical skillsets of a business.

We know you’re wondering: how does one become a Citizen Developer? You’re in luck! PowerObjects has just released its new Dynamics 365 University Fall Course Catalog, and with it, there is a brand new CRM Citizen Developer Training for Dynamics 365 training. This course will get you on your way to propelling your organizations to new heights. Whether you are starting to learn code or don’t have any interest in coding at all or if you’re looking to customize your Dynamics 365 environment with no code/low code solutions, this class is for you.

Happy Dynamics 365’ing!

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PowerObjects- Bringing Focus to Dynamics CRM

Self care ideas? 

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 Self care ideas? 
Deep Fried Bits

University of Chicago Medicine Improves Patient Care with Data

ucm blog University of Chicago Medicine Improves Patient Care with Data

Combining compassionate patient care and groundbreaking medical and biological research, the University of Chicago Medicine (U Chicago Medicine) is at the forefront of facing the world’s most pressing medical challenges.

“One of our goals is to deliver superior healthcare, and part of our mission is to be a leader in our industry through advancements in medical innovation and through serving health needs,” says Chief Enterprise Architect Christine Watts. “We have silos within technology as well as functional areas, and we needed to change our culture. We needed a technology platform that allowed us to integrate systems and centralize data so we could get information into the hands of the people who need it.”

U Chicago Medicine chose TIBCO BusinessEvents streaming analytics, TIBCO BusinessWorks integration, TIBCO Enterprise Messaging Service message-oriented middleware, TIBCO HAWK monitoring and management, and TIBCO Spotfire data analytics. These technologies were used to integrate systems, centralize and correlate data, and get the right information to the right people at the right time, so they could turn it into action. The results were stunning:

  • Cardiac arrests in the hospital reduced by an estimated 15 to 20%
  • Real-time alerts based on real-time data flowing directly from devices monitoring patients throughout the hospital and ICU
  • An anticipated $ 600,000/year in cost savings from reducing operating room (OR) turnover time by 15–20% (4 minutes/room)
  • Another $ 500K/year in savings and another 15–20% in reduced OR turnover time anticipated in the next phase of implementation
  • Fewer patient re-admissions for certain patient classes by using a predictive algorithm that combines static and real-time data to better identify those patients and make sure they get the right care
  • A TIBCO Trailblazer award

Find out more about U Chicago Medicine and their life- and cost-saving projects.

Join the TIBCO customer reference program to have your business transformation story shared globally with the technology industry, and trade and business press. Your story in print, web, and video format can boost your status as a thought leader and increase awareness with technology leaders, helping you raise your company visibility and attract and retain top talent. Email customermarketing@tibco.com today!

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Millions of veteran health care records are being used to train this startup’s artificial intelligence

8187378482 57661b63c3 k 780x518 Millions of veteran health care records are being used to train this startup’s artificial intelligence

Last spring the startup Flow Health began a five-year contract with the Department of Veteran Affairs to examine all historic and ongoing medical records.

The startup will use information obtained from those records to train artificial intelligence to, among other things, fight illness and predict disease for the more than eight million people cared for by the Department of Veteran Affairs.

Advice and predictions from Flow Health will be presented to health care professionals through Vista, the DoD’s open source system for electronic medical records. Doctors can then choose to apply or ignore the advice drawn from the VA’s vast storage of medical records.

“When a veteran comes in and presents certain clinical symptoms, we can better understand and make predictions about ‘What is the likely diagnosis? What is the best diagnostic test? What’s the best care pathway?’ and so forth,” CEO Alex Meshkin told VentureBeat in a Skype interview.

Data gathered by Flow Health will track a patient’s personal, family, and possibly even genetic history. The aggregate of that data will continuously improve the Flow Health knowledge graph and its ability to predict the illness of a veteran patient.

“The essence of it is that the VA supplies all its historical data, historical and ongoing,” he said. “The graph is built around the co-frequency or co-occurrence of relationships and all the unstructured and structured data — clinical notes, medical images, even molecular diagnostics like genetics and of course traditional lab tests and so forth.”

Although Flow Health will receive data from a public institution, the private company stands to gain from access to millions of veterans’ health records. Anyone who wants to benefit from the publicly obtained data will have to pay Flow Health for the privilege.

“Everything we develop with the VA, we own the intellectual property and can make available to any other hospital within the U.S. or abroad, and that’s kind of the goal here of the collaboration, to create really powerful tools and machine intelligence that can impact health care for everyone,” Meshkin said.

In addition to its partnership with the Department of Veteran Affairs, Flow Health works with academic medical centers and one of the largest health care providers in the country to provide similar predictive insights to health care professionals.

Health care centers provide episodic data that may come from a doctor or a few specialists, but VA health care data is unique, Meshkin said, and offers far more complete records.

“They [private health care centers] don’t have the complete picture, and that’s what’s unique about the VA. It’s the largest integrated health care organization in the country, so they have your primary care, your specialty care, your hospital care, all your medications,” he said. “So we’re able to better understand what are their earlier symptoms that present before a diagnosis is made, and that can mean all the difference in the world of saving lives at the VA.”

The sharing of public health data with private entities focused on machine learning has sparked controversy in the past.

Earlier this year, Google was criticized when details of a collaboration with the National Health Service in the United Kingdom were discovered. Initially the deal was thought to only collect data to make a predictive app that helps doctors treat patients with kidney disease. Later the program was found to be more extensive and to include more than one million retinal eye scans.

Google says DeepMind’s computer vision could greatly reduce the risk of blindness for people with diabetes, and the program has gained the backing of sight-related charities and organizations. But critics are upset that their data was shared with a private company who stands to benefit financially as a result, and that their personal data, though anonymized, will be shared without their consent.

The difference between Flow Health and Google, Meshkin said, is that Flow Health is both a business associate and research partner with the Department of Veteran Affairs. “I think the key thing is we’re very focused on, just like other organizations that work with the VA, helping veterans, and without access to the data, we’re not going to be able to build machine learning that’s going to be accurate, so it benefits everyone by making the data available,” he said.

Multiple requests were made for comment by the Department of Veteran Affairs. No response was received at the time this story was published.

During the presidential campaign, Donald Trump told NBC’s Chuck Todd that veterans’ issues will be a priority, and a part of his first State of the Union address to Congress. Trump has committed to allowing veterans to seek health care from providers outside the VA should they feel they aren’t getting access to health care in a timely fashion.

A more robust voucher program could affect Flow Health’s ability to provide predictive analytics or customized health care plans, Meshkin said.

“If veterans get care from non-VA health care providers, there will still be some data flowing back to the VA (and thus to Flow Health). However, most likely, it will be less rich, and subsequently, not as complete than the data generated from within the VA,” he said.

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Why you should care about Agile marketing

As industries have morphed and sped up, so has marketing. As a result, the customer journey has evolved, putting…

customers in control of the path to purchasing. The growth of mobile, big data, predictive analytics and programmatic advertising is changing the ways in which marketers interact with buyers. Other functions, such as sales and finance, now demand greater accountability from marketing. Also, a dizzying array of marketing technologies (more than 4,500, at last count) provide new opportunities to interact with prospects, manage campaigns, measure results and much more.

Regardless of the markets you serve, change is coming — and fast. If you don’t adopt these new approaches, your competitors will. For marketers, an accelerated pace of change is as inevitable as death and taxes.

However, change creates opportunities to grab competitive advantage, as well. So while the other guys struggle to deal with the digital onslaught (and transformation), you can jump ahead. Although it is a one-size-fits-all solution, Agile marketing can provide a methodology to help your organization make the necessary changes in all of your marketing efforts.

Don’t get soaked under the waterfall

Typically, waterfall development has driven marketing departments, where plans are developed and executed over months, or even years, to deliver the final product, content and/or campaign. In a complex environment with many moving parts, this make senses. But, by the time your marketing campaign or new content hits the market, it may be out of date or irrelevant. Waterfall development is inward-focused, and as such, prevents marketers from receiving the critical market feedback that tells them if they are heading in the right direction.

Jumping ahead of the pack with Agile marketing

By contrast, Agile marketing (with roots in Agile development) breaks projects into smaller chunks, or “sprints,” that can be rapidly adjusted to address changing market conditions and the constant flow of new data from prospects and customers. Agile marketing sprints range from two to four weeks, with larger projects, or “epics,” spanning multiple sprints.

Agile marketing enables marketing teams to rapidly adapt to a changing environment; to more quickly integrate new strategies, tactics and technologies; and to optimize tactics to focus on those that are most effective. It speeds time to market so marketers can take advantage of new trends, bring products to market more quickly and jump ahead of competitors.

Agile marketing is about reliably creating value for both the business (such as profitable revenue growth) and the prospective customer (such as branded content that can help them make better decisions about the products and services they need) in a rapidly changing environment.

Guiding principles

Agile marketing is a constant cycle of customer-focused learning, doing and improvement that borrows from Agile development. It’s built around several principles that build on each other. These include a focus on the customer, continuous learning based on data, adaptive and iterative projects and campaigns (instead of “big bang” campaigns), and transparency and collaboration with other functions. Many of these are discussed in the Agile Marketing Manifesto, which was created five years ago by a group of Agile marketing experts.

A focus on the customer — both external and internal

The most important element of Agile marketing is understanding customers, their needs and the buyer’s journey. Built around buyer personas and buyer journeys, Agile marketing also incorporates frequent data about prospects’ responses to offers, content, messages, tactics and more, enabling marketers to continually grow an understanding of the buyer.

“Agile marketing allows you to deliver personalized and relevant information to customers by having a deep understanding of their needs and preferences,” said Ajay Khanna, marketing expert and VP of product marketing at data management firm Reltio Inc.

Data-driven, continuous learning

Unlike the big bang waterfall approach, which releases code after long increments of testing and development, Agile marketing relies on short sprints that provide continuous opportunities for learning based on market feedback and data. The idea is to “fail fast” or “succeed fast” to determine the best path forward, while burning through the fewest resources.

“We value learning as rapidly as possible, which means we don’t need to spend a full quarter writing and producing a marketing white paper,” said Pete Bernardo, EVP of product at digital product development agency 352 Inc. “Instead, we can validate the idea for that big piece of content via social or a lightweight blog post, test the hell out of them and then move forward based on what we’ve discovered.”

“Agile marketing also lets you fail fast and keep a closed loop between marketing and sales, content, and campaigns,” Khanna added.

One might think of this process as: Test, improve based on what you’ve learned and scale when the right combination has been identified.

Iterative, adaptive and scalable

Instead of big steps that take years to complete, Agile marketing focuses on an iterative process of continuous and small improvements designed to adapt to the latest trends, new marketing technologies, evolving needs and changing market conditions.

“Agile marketing means you and your team are ready to adjust tactics based on the results of past efforts,” said Will Sullivan, VP of marketing at software as a service-based writing tool vendor TheRightMargin. “You’re willing to try new things, abandon tactics that aren’t bearing fruit and are always looking for new methods to keep you delivering true value to your customers.”

Agile driven by goals

At the same time, Agile marketing is heavily goals-driven. The whole idea is to complete the burndown items in a given sprint.

“Agile marketing [is] about staying focused on specific goals and moving quickly and easily to accomplish marketing goals efficiently,” said Alex Kehr, global growth manager at lead generation platform LeadBoxer. “

Software quality tools vendor SmartBear Software Inc. has used Agile marketing since 2012 and, today, its entire team of 25-plus marketing professionals uses it. Agile marketing’s focus helped SmartBear go from completing just 55% to 65% of requested tasks to 95%, with a well-oiled, Agile marketing machine, according to senior manager of digital marketing and brand Gary DeAsi.

“Agile marketing has allowed us to focus on what’s most important, plus achieve [our] content production goals,” added John Cass, contributing author of the Agile Marketing Manifesto and director of marketing at remote photo inspection firm OnSource LLC.

Transparency and collaboration with other functions

Unlike other approaches that are more internally focused, Agile marketing provides opportunities for transparency and collaboration throughout your company. Everyone on the marketing team can provide input. DeAsi advised marketing leaders to get ideas and feedback from the people who will actually be following the Agile process day to day to help with adoption and enthusiasm.

Agile marketing is also transparent for other teams, such as sales. These teams can see the marketing backlog, may be invited to attend the daily standup/scrum meeting and are typically invited to see what’s been completed during the periodic sprint review.

“Everyone in our marketing organization has complete transparency to see what everyone is working on at any given time, from our CMO to the co-ops,” DeAsi said.

Email marketing automation firm Vision6 integrated Agile marketing into their existing Agile development framework to increase the voice of the customer in development, said Zoe Beath, head of marketing.

“To Vision6, Agile marketing means embracing change, collaborating across cross-functional groups and keeping customer needs at the heart of all our marketing efforts,” he said. 

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Amex Global Business Travel pools data lake to bolster ‘duty of care’

Business travel is seldom an unalloyed pleasure. Nor is it a trivial cost for corporate organisations. New American Express Global Travel (Amex GBT) president Philippe Chérèque, formerly the firm’s chief commercial and technology officer, says some customers are close to spending $ 1bn on travel each year.

Chérèque, who was American Express Global Travel’s CIO as well as its commercial head before becoming president, joined the firm two years ago. He has been putting $ 1bn into modernising the firm’s IT – in the direction of cloud computing, and capitalising on analytics.

“Traditionally, travel management companies have been satisfying the chief procurement officer rather than the business traveller,” he says.

Chérèque speaks of the need for more proactive care: “If there is fog at Heathrow, we call the passenger to say, ‘We have booked you on the Eurostar and you can fly from Paris.’

“The traveller is the key. If your engineer is stuck in the middle of India, that costs more to the company than saving 10% on the cost of the ticket.”

Chérèque says Amex GBT’s corporate customers are placing increasing importance on duty of care in the light of terrorist incidents and other misfortunes. When Brussels Airport was bombed in March 2016, Amex GBT could tell where travellers were because it had their Amex card data.

The company built an application that automatically sends an SMS text message to travellers when an incident happens: those who respond immediately show as green, then travellers not responding go orange then red. For example, it could immediately tell that there was one passenger on board the EgyptAir flight that crashed in May 2016.

The company is a joint venture between Amex and a private equity group headed by investment firm Certares. It has a treasure chest of $ 1bn in cash to put into IT, and has taken a comprehensively cloud approach.

“In the past two years, we have migrated not only from the data warehouse of Amex, but moved away from its HR system, its finance system and so on,” says Chérèque.

It is using Workday for HR, NetSuite for finance, and Coupa for procurement.

Data lake and visualisation

Christophe Tcheng, vice-president of core products and platform architecture, joined Chérèque from travel company Amadeus, which is the business alma mater for both men. Tcheng was head of research and development services at Amadeus, while Chérèque was executive vice-president. He was at the company for nearly 25 years.

Tcheng designed Amex GBT’s data architecture. He confirms it has 300 data people, with a small group of “around four” hardcore data scientists and developers.

Of choosing Hortonworks as the Hadoop distribution to build a data lake, which has been operative from 2016, he says: “It was a conscious choice to go for open source; it’s very robust and efficient. It’s not rocket science, but the trick is to make it work.

“In the past two years, we have migrated not only from the data warehouse of Amex, but moved away from its HR system, its finance system and so on” Philippe Chérèque, Amex GBT

“The idea emerged at the back end of 2014. We had an enterprise data warehouse, from Microstrategy. It was good technology, but it is technology from the 1990s. The industry is moving to Hadoop plus visualisation layers”.

For the latter, Amex GBT partnered with cloud business information (BI) and analytics company Birst to build a product called Premier Insight for corporate clients. This launched in November 2015, and Chérèque says dozens of corporations are using it.

Tcheng says on choosing Birst: “It is cloud enabled, and also because of its roadmap – with embedded BI, vision and investment. We didn’t want to choose the best platform for today if, in two years’ time, it is behind the pack.”

Amex can provide analytics into customers’ spend levels and so indicate where additional costs are being incurred, or where there are opportunities to make use of better buying power to improve efficiency of spend. It has card data from MasterCard and Citibank, among others, through application programming interfaces (APIs), as well as the Amex card data.

The analytics relies on having all the data sources together in one place, and then being able to visualise it for people to use through a browser. Birst provides the analytics platform and the data visualisation. 

Chérèque gives such examples as its customers being able to easily see where employees are not compliant – and so not using negotiated deals with hotel chains – and calibrating their airline spend.

“With the airlines it can be a cliff system – if you buy 100% [of the negotiated deal] you get a bonus back, if you spend 99% you get nothing. And if you spend more than 100% you could spend that money elsewhere. Airlines have had better statistics than the corporations, but now [the latter] have the information in advance – getting the data afterwards is no use.”

Chérèque also points to the sector possibilities in the firm’s use of a data lake with analytics. “We take care of most of the travel meeting and events for the pharmaceutical industry. We organise 40,000 meetings per year for them. With Birst, we can provide information about what is the average spend per trip in the industry. Someone in the pharmaceutical industry is not very interested in being benchmarked against Cisco or IBM.”

For individual travellers, Amex GBT is using the data lake to develop personalisation. “We know what kind of restaurants you like to go to, so when you make the booking we can make recommendations. Also we draw on people who have the same behaviour as you, who are in your cohort – which kind of restaurants, which kinds of hotel they go to.

“The booking is the tip of the iceberg. There are a lot of things happening below,” he concludes.……..    ……………… ……. ………

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