In a fast-changing environment, organizations need the agility to make changes quickly, while still efficiently automating their business rules and logic.
We all make mistakes—it’s one of the things that makes us human. It’s also one of the things that makes automation so tempting from an efficiency standpoint. If we could just implement the appropriate business logic that would apply rules correctly in every situation, much human error would be eliminated. Not only would the rules prevent many mistakes, but their automatic application would also free up employees to work on other business critical tasks.
Of course, this idea isn’t new, and many industries have attempted to simplify their operations through the use of defined business logic within their applications. However, traditional approaches required rules to be hard-coded into core systems through IT, a time-consuming process that required heavy use of scarce technical resources. In industries where the rules change rapidly, by the time a change was implemented it could already be outdated.
Today, organizations are required to move at a faster pace and can’t afford to wait for IT to hard code rules changes. Not only that, but customer expectations are rising, requiring a quicker response time. Businesses must deliver more information to more people—and make fewer mistakes along the way. In a climate demanding high levels of business agility, the cost of using legacy systems is expensive in terms of time, resources and performance.
Japan has provided universal health insurance coverage to all its residents since 1961, at a cost of roughly half of what the US currently spends on healthcare. The system is widely praised for its efficiency and quality, as Japan boasts the longest life expectancy in the world, and medical fees are strictly regulated by the government.
That does not mean the healthcare system in Japan is simple. Every two years the fees for all services are set by the government in a lengthy negotiation covering more than 4,000 reimbursement rules. Once implemented, all providers submit reimbursements through the statement of Japanese medical expenses and details, Rezept, but payments are often delayed or reduced due to insufficient data.
These reimbursement issues were critical for small medial practices that relied on those payments for their day-to-day operations. ISB, a leading provider of IT solutions in Japan, knew there had to be a better way. To increase the efficiency of the reimbursement process, they researched several Business Rules Engine (BRE) solutions.
In comparing a trio of solutions, ISB found one solution required a complete rebuild from scratch, and another lacked the flexibility needed to effectively address the complexities of the reimbursement process. A third option, Progress Corticon, was both easily customized and could be quickly implemented, and presented as the clear solution.
As Mr. Takuya Miyagi, Manager/Consultant of TMMC (a partner of ISB) put it, “we compared the other solutions but they were not fast enough or flexible enough.” He went on to add, “we also concluded that Corticon would significantly reduce our cost and development time.”
Corticon’s flexibility not only makes it ideally suited to fast-changing and complex environments, but the simplicity of the system helps keep costs down as well, allowing business users to create rule changes and not have to wait for IT. ISB and TMMC were able to build a cloud-based reimbursement solution called Fine Rezept 30% faster than they would have with other rules engines, and without IT involvement in the rules management, there was a 20% savings in overall maintenance costs.
Using Corticon, ISB was able to implement a flexible system that automates reimbursement, validating invoices and flagging inaccurately recorded items, making sure providers submit the right data and are paid faster. With the support of the Corticon team, they were able to meet an aggressive timeline and stay on schedule.
You can learn more about ISB’s story here. To find out more about how we can help you too, feel free to contact us any time.
Ning Lim loves technology and how it enables possibilities. She's excited about the innovation at Progress, and how its technology empowers customers to achieve real business realities.
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