Last month at FICO World 2016 in Washington, DC, I had the pleasure of delivering a keynote address. Over the past few years of working with customers in a wide variety of industries and business challenges, we at FICO have uncovered the following five critical areas where organizations need to improve their operational decision making to help reduce complexity and create competitive advantage:

1. Capturing subject matter expertise
2. Intelligent solution creation
3. Faster insight to execution
4. Building institutional memory
5. Greater analytic accessibility

Over the next few weeks I’ll blog about each of these principles, starting here with the most basic tenet of decision management: capturing subject matter expertise.

Capturing Subject Matter Expertise

From decades of experience in working with customers around the world, FICO has learned that the codification of operational and solution-specific knowledge—by gathering and writing down subject matter experts’ experience on the decision process—is critical, yet at most companies is sorely neglected.

The two main issues with capturing that knowledge have been the lack of a consistent format and process to capture it. FICO has been working very closely with the Object Management Group, a standards body, to create a standard for documenting decisions. That work is the basis for the new Decision Model and Notation (DMN) standard. The DMN standard includes notation initially proposed by Dr. Alan Fish, a member of FICO’s technology consulting team, in his book Knowledge Automation: How to Implement Decision Management in Business Processes. DMN helps organizations articulate decisions, making them more transparent and improving collaboration.

FICO developed a process for capturing decision requirements in the DMN standard, a top-down methodology for decision modeling, called DRAW: Decision Requirements Analysis Workshop. A DRAW session brings all key stakeholders in a process together to understand the subject matter expertise they hold and to document it. DRAW is fundamentally a scoping exercise; it defines the extent and structure of a domain of decision-making and documents it with DMN.

In this way, the expertise that is held in the collective minds of multiple people is codified in a clear, visual representation. Notably, these DMN diagrams tend to fit on one page, even when the associated decisions require tens of thousands of rules to be made. This high-level summary helps everyone involved — now and in the future — clearly understand the decision being made. The DRAW process translates into more innovation, delivered faster, and a quicker improvement cycle.

MedScheme DRAWs down complexity

For an example of how this works, let’s look at the work we did with Medscheme, South Africa’s largest health risk management services provider. Medscheme came to FICO for help in re-engineering their healthcare claims assessment system, which had thousands of rules, and hundreds of thousands of data reference records. The goal at this stage of the project was to document the entire process, simplify it, and create an RFP for a complete system redesign.

Medscheme has an extremely complex set of decisions and data to get the outcome they desire. They need to assess claims, and determine who should be paid and how much for any given set of treatment. Criteria include:

• Is the claimant covered (e.g., is their policy current)?
• Is the claim valid?
• Is the treatment eligible (e.g., is it appropriate to the condition)?
• What is the nominal price for the treatment?
• What benefit can actually be paid, based on limits, utilizations to date, etc.?
• Who should be paid?

Working together with Medscheme, FICO conducted a DRAW session, the ultimate product of which was a DMN diagram. The DMN documents decision requirements, making them easily understandable by both business and technical users. An elegantly simple, graphical model, it contains deep understanding of the business issues at hand and the details of the key elements behind those decisions.

The decision models were highly complex and the notation language helped the team to visualize all the key elements and scope the RFP process. DMN makes it far easier for vendors to provide accurate bids, since scoping and pricing a decision automation project requires a deep understanding of the complexity of the business knowledge to be encapsulated in the system (rules, calculations, etc.).

Because DMN is an open, international standard, Medscheme could provide the results to all potential vendors as the specification of scope. It also allows the domain to be broken down into partitions for planning a phased project. FICO identified three reusable decision services (adjudication, pricing and benefits), which will be used in different combinations in three different processes (claim, pre-approval and quotation).
As a footnote, I am delighted that FICO has been selected to help with the next phase of the claims re-engineering project.

In my next blog I’ll talk about the principle of intelligent solution creation.

To learn more about DMN:

• Access FICO® DMN Modeler  – a tool for creating DMN models offered at no cost via the FICO Analytic Cloud.
• Watch this short video about using DMN.

Let’s block ads! (Why?)

FICO