This document discusses how digital transformation can help achieve operational efficiency and effectiveness in healthcare payers. It describes how legacy systems, manual processes, and rising costs are driving the need for digital transformation. New approaches like workflow automation, integrating clinical and financial data on new software platforms, and low-code application development can help drive cost savings and efficiencies. However, two-thirds of digital transformations fail due to barriers like outdated culture and skills in IT organizations. The document advocates using a low-code platform approach to accelerate digital transformation across various functions like provider data management, utilization review, and claims modernization.

1. Achieving Operational Efficiency and
Effectiveness with Digital Transformation
Technology
Scott Polansky | Practice Lead, Healthcare Payers
AHIP Institute | June 8, 2017

2. About Appian
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• Appian provides a leading low-code software development
platform that enables organizations to rapidly develop powerful
and unique applications. The applications created on our
platform help companies drive digital transformation (DT) and
competitive differentiation
• Headquartered in Reston, VA
• 18 year history

3. To succeed, every company must become a software company.
“Software is eating the world.”
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4. What’s Driving DT for Healthcare?
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• Reliance on legacy systems requiring significant
customization
• Prevalence of manual processes
• Member expectations for mobile capabilities
• Growth of IoT
• Rapid pace of regulatory change

5. What’s Driving DT for Healthcare?
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• Unsustainable cost increases
• Administrative complexity
• Need to gain a competitive edge
• Division between IT and business owners

6. Historical Drivers of Cost Reduction and Operating
Efficiency
• Provider owned payers
• Plan mergers and consolidation
• Contracting strategies and reimbursement models
• Pricing and underwriting strategies
• Traditional Business Process Redesign
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7. New Approaches to Achieve Cost Savings and
Operating Efficiencies
• Enhanced workflow automation
• Technologies to integrate clinical and financial
information
• New software platforms – PaaS, SaaS
• Low-code application development
• Cloud computing
• AI and Robotic Process Automation
= DIGITAL TRANSFORMATION
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8. Existing systems consume
80% of IT resources
Insufficient
agility
Silos
Scarce developer
resources
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9. Two-thirds of digital
transformation projects
end in failure.
Harvard Business Review, July 2016.
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10. IT Organizations Face Significant Barriers -
They are on their own journey of transformation
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COMMON IT ORGANIZATION BARRIERS TO LEADING DIGITAL TRANSFORMATION
People
We do not have
enough people
with the right
skills
Culture
We do not have a
risk taking,
innovation culture
Legacy
Systems
We have legacy
systems to support
that consumer our
efforts
Incentive
Systems
Our current
evaluation system
does not measure
us on innovation
32%
25%
27%
Source: IDC IT Executive Survey, Jan, 2016, n=103
Partnerships
Our LOB peers do
not perceive us as
adding value in DX
Leadership
Our IT leadership
does not have the
right vision
8% 5% 2%

11. Digital Transformation is not Single Threaded
Case Management
Business Process
Management
Low-Code
Digital
Transformation
Platform

12. Accelerating Digital Transformation
Governance, Risk
& Compliance
Master complex
compliance requirements
and manage global risk.
Customer
Journey
Deliver superior
customer engagement
in sales, marketing,
and support.
Business
Operations
Drive operational efficiency,
maximize employee
productivity, and optimize
business decisions.
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13. Functionality Requirements
Monitor
Complex event
processing for real-
time tracking,
analysis, and
response
Report
Comprehensive
visibility into
business
operations
Optimize
Self-optimizing
processes eliminate
bottlenecks and
inefficiencies
Audit
Complete audit
trails instantly
available for all
system activities
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14. Managing Journeys
TIME
Changes
Actions
customer
contract
trial
sku
prospect
franchise
facility
employee
opportunity
vehicle
agency
claim
patient
regulation
account
manager
invoice
inquiry
case
product
location
asset
milestone
partner
department
lease
Enterprise
Applications
Cloud-based
Data
Databases
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15. 15
Challenge
Improve ability to manage provider information and accommodate continued growth
– Provider data stored in multiple systems
– Disconnected standalone contract management system
– Arduous credentialing process
– Challenging manual on-site auditing process
– Poor visibility into provider/member relationships
Appian’s Solution
Creation of new core systems using Appian’s platform
– A single UI to on-board, access and update Provider data
– Automated scheduling, task and reporting
– A more professional and streamlined process to reduce time to credential new Providers
Leverage existing investments, unite
disconnected processes & data and
deliver Provider Data Management
with Appian
Case Study: Provider Data Management
One of USA’s largest organizations of government-sponsored
managed care plans with 6 million beneficiaries

16. PwC | BPM Services | page 16

17. PwC | BPM Services | page 17

18. 18
Challenge
Minimize dollars paid out in error due to false approvals, even though they felt they were roughly 98.5%
accurate.
➢ Care coordinators took down notes in notepad review on spreadsheets to interpret the rules
➢ Rules in the spreadsheets may not be up to date and differ by geography and plan
➢ Months needed to set up customized accounts
Appian’s Solution
Reduce handling times and increase quality of decisions using Appian’s platform
➢ Authorization rules automated
➢ Escalations were automatically created and routed
➢ Follow up activities were created for case managers to review cases
Case Study: Utilization Management
Large multi-state insurer serving 10M+ members
Savings of ~$1M/mo 30% increase in productivity and 5% increase in quality

19. • Care Management
• Encounter Reporting
• FW&A
• Appeals & Grievances
• Claims Modernization
• Product Lifecyle Management
• Member and Account On-boarding
• Legacy Systems & Technical Debt
Other Potential Applications
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20. Faster More Agile More Innovative
(We make it easy for you to build and run enterprise-grade software.)
Appian is the platform for digital transformation.
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21. The Digital Transformation Platform.™
The Digital Transformation Platform.™