Business process management (BPM) software tools promise to streamline the way health care organizations do their work.

A number of companies offer products designed to support BPM, a structured approach for optimizing the business activities needed to perform a particular task. BPM software lets customers design, execute and monitor processes.

BPM suites, meanwhile, go beyond those essential process management chores to provide additional features, such as collaboration and simulation. The latter feature lets users test a new process before putting it into action.

BPM vendors are reporting an increased interest in their wares. "A year ago"¦most of the companies that are in the BPM space spent most of their time trying to educate their customers on the basics of BPM," said Marc Wilson, vice president of professional services at Appian, a BPM software and services provider.

BPM is now "starting to enter the phase where [customers] large and small realize this is not just something nice to have but something they really need," he said.

Health care organizations figure prominently among BPM adopters, with many suite vendors specifically targeting the sector. Industry executives generally view privatesector health care providers and payers as a bit ahead of their public-sector counterparts in BPM use. But the products have started to catch on among government-related health care institutions.

Overall, the market for BPM suites is ready to grow. Forrester Research predicts that the worldwide market will expand at a compound annual growth rate of more than 21 percent through 2009 when the market is expected to reach $2.7 billion.

Wide applicability BPM can play a role in multiple areas within health care, industry executives say. The Veterans Health Administration, for example, plans to use BPM to improve the benefit eligibility process. The agency will use HandySoft Global's BizFlow BPM suite to implement an automated workflow in conjunction with its Enrollment System Redesign (ESR).

The workflow project will follow next year's ESR deployment, which will form the agency's enrollment and eligibility backbone.

Veteran income verification will be the initial process that the VHA automates via BizFlow. That workflow thread will mark the first big enhancement to the ESR, said Lynne Harbin, associate director of the Project Management Division at the VHA's Health Eligibility Center. She said the current income verification process is manual and requires considerable employee involvement.

ESR, however, will provide a rules-based engine to automate business decisions. That system, combined with BizFlow's workflow engine, is expected to minimize the time it takes VHA employees to resolve an eligibility issue. The VHA's aim is to boost process efficiency and reduce the costs associated with verification, Harbin said. The agency plans to incorporate additional workflow threads after the income verification deployment, she added.

The VHA has specialized requirements, but hospitals pursue BPM in the more general area of revenue cycle management, which involves assessing a patient's insurance coverage and ability to pay for services.

"Hospitals are very interested in revenue cycle management," said Brian Boxman, chief operating officer of HandySoft. He said hospitals face risks when they admit patients without verifying that they have insurance and the means to pay for treatment.

Revenue cycle management calls for hospitals to check factors such as insurance availability, deductible levels and available credit before admitting a patient. Once the patient checks into a hospital, the emphasis shifts to the proper coding of health care services for billing purposes. "That is a very workflow-intensive process" and one that lends itself to BPM, Boxman said.

Hospital HR
BPM also plays a role in human resources. Boxman said BPM can deliver self-service applications. Those Web-based applications let health care professionals view documents and payroll information, initiate leave requests, and handle other chores. To make that happen, BizFlow integrates with a health care organization's existing Web portals, databases, human resources systems and electronic document management systems, Boxman said.

Some hospitals use BPM to streamline the process of recruiting and hiring new employees.

Gaston Memorial Hospital, in Gastonia, N.C., tapped Metastorm's BPM suite to retool the process of posting job openings. The procedures for obtaining approvals and publishing job opportunities took days in the past, said Tom Parnelle, a project manager at the hospital.With BPM, a job posting goes from the requesting manager to a Web database in as little as seven minutes, he said.

Getting the word out about jobs is critical, given the competition for nurses, pharmacists and other health care professionals, Parnelle said. "The quicker we can get things out there, the better chance we have of getting a quality person," he said.

The human resources department was the first user of BPM at Gaston Memorial, a nonprofit facility that has obtained state financing. The hospital has since employed BPM in other areas such as patient incident reporting. Such expanded uses are typical for BPM adopters.

"That's a characteristic of just about all of our customers," said Laura Mooney, senior director of corporate and product marketing at Metastorm. "Some customers have close to 50 different processes deployed on the software," she added.

A compelling business process problem typically drives an initial BPM purchase,Mooney said.

Once an organization solves the initial problem, other divisions will see the benefits, and the use of BPM proliferates, she said.

While providers find more uses for BPM, payers also put the technology to the test. In claims processing, for example, BPM can extend beyond the fundamentals of process design.Wilson said the products can dynamically assign worker responsibilities throughout the claims cycle. The technology can determine which claims reviewer should process the next claim, based on workload.

In Appian's case, the company's Process Modeler defines roles and responsibilities.An organization can explicitly assign responsibilities to people or groups or dynamically assign them according to business rules, policies, skills or workload balancing algorithms, said Michael Beckley, vice president of product strategy and co-founder of Appian.

Similarly,Mooney said, a Metastorm vision insurance customer uses BPM to "make sure call centers are efficient and balance the workload across services reps."

Calculating costs and payoffs
The cost of implementing BPM varies based on ambition. Mooney said average start-up costs for a single process deployment range from $130,000 to $150,000, depending on the amount of services required to field a solution. Enterprise deployments can hit the $1 million mark, she added.

"Broadly speaking, deployments can range from $100,000 to $4 million," Boxman added. Variables include the number of processes, professional services required for specification/prototype work and the number of users, he said.

Mooney said customers report returns on investment from 10 percent to 300 percent,with the bigger returns associated with broader deployments. Those deployments can take a couple of weeks to several months, depending on their complexity.

But the BPM journey doesn't end with software installation. Processes need continual tweaking to keep up with organizational directives and external events, such as new regulations. Vendor executives said they aim to empower customers to readily amend their processes. "We come from a perspective of