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July 28, 2006

Learning to love change - an article

I just had an article "Business rules cafe or how IT can stop worrying and learn to love change" published in SOA Web Services Journal. You can get a PDF of the whole issue my going to Sys-Con's site here and putting in your email address. No URL yet.

There's a lot more on the blog about agility (how to respond to change), business rules and requirements as well as a section on SOA.

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Posted by James Taylor at 2:24 PM | Comments (0)

Decision Yield - an overview

I just had an article "Business rules cafe or how IT can stop worrying and learn to love change" published in SOA Web Services Journal. You can get a PDF of the whole issue my going to Sys-Con's site here and putting in your email address. No URL yet.

There's a lot more on the blog about agility (how to respond to change), business rules and requirements as well as a section on SOA.

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Posted by James Taylor at 2:24 PM | Comments (0)

I just had an article "Business rules cafe or how IT can stop worrying and learn to love change" published in SOA Web Services Journal. You can get a PDF of the whole issue my going to Sys-Con's site here and putting in your email address. No URL yet.

There's a lot more on the blog about agility (how to respond to change), business rules and requirements as well as a section on SOA.

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Posted by James Taylor at 2:24 PM | Comments (0)

July 27, 2006

Decision Yield - an overview

What is Decision Yield

One of the challenges in adopting Enterprise Decision Management is measuring the ROI. Sometimes organizations find that a focus only on costs saved does not yield enough of a return to justify the investments required for EDM. By comparing organizations that have adopted EDM with those who have not it is possible to identify some clear differences in the way they make investment decisions. In particular there is a much greater focus on revenue improvement and on opportunity costs (those costs implicit in a delayedresponse to an opportunity). The challenge is how to turn this broader focus into something that can be used to justify EDM investments. Decision Yield is the approach that is recommended for this.

Decision Yield is a broad-based evaluation metric that reveals the quality of your current decisions and decision processes, and helps you plan, justify and measure improvements to these decision processes. It was first described by Frank Rohde in the Harvard Business Review. In it he says:

“We judge leaders by how well they make big, strategic decisions. But corporate success also depends on how well rank-and-file employees make thousands of small decisions. Do I give this customer a special price? How do I handle this customer's complaint? Should I offer a seat upgrade to this customer? By themselves, such daily calls – increasingly made with the help of enterprise decision management technology - have little impact on business performance. Taken together they influence everything from profitabilityto reputation.”

What constitutes a good decision? Is it the outcome alone? The cost of executing that decision? The speed? How about the coordination of multiple decisions across different parts of your organization? In reality all of these aspects are likely to be important. As noted, many organizations lack a consistent method for measuring the performance of high-volume, operational decisions. The result is that plans for improvements that are vital to an organization's growth are often made based on metrics that focus ononly one dimension of the decision process, such as cost savings alone. Organizations with such a narrow focus often miss the potential value of an EDM approach.

To determine what constitutes a “good” decision process and to measure the current state of your decision process, you must understand the different facets of an operational decision that contribute to business performance. This holistic way of evaluating decisions is what is known as “Decision Yield”.

While Decision Yield is a fairly general-purpose tool, it is designed specifically to evaluate automated decisions that are typically:

In other words, the kinds of decisions for which an EDM approach is ideal. Decision Yield, then, can be an effective tool for those evaluating EDM and trying to decide where best to apply it.

Decision Yield's holistic approach involves comparing five different dimensions of decision effectiveness, By considering all these aspects the Decision Yield approach allows you to make a comprehensive assessment of an operational decision. The five areas are:

Each of these aspects contributes to the overall effectiveness of a decision and the likely yield an organization will get from the decision – the Decision Yield. Let's consider each of these aspects in turn in a little more detail.

Measuring Decision Yield

The first step in measuring Decision Yield for a decision involves finding out the answers to a range of questions about the decision. These will be different for each decision but some typical questions can be identified:

To measure Decision Yield effectively you will need to develop a set of questions that are industry and decision-area specific. For instance, if you were working on establishing the Decision Yield for an underwriting decision, in place of the first question you might ask something like “How many tiers do you use in rating risk” or “How accurately do you predict the cost of claims for new customers”. These more specific questions drill into the precision, consistency, agility, speed and cost of the actual decisionyou are trying to improve.

By gathering answers to these questions you can come up with a measure of the current state of a decision in each of these five dimensions. The most effective way to track the effectiveness of EDM projects is to plot these dimensions for current state, future state and best practice. These are typically plotted on a radar graphic like this one:

Decision Yield

The outer boundary shows the current best practice for this decision while the inner one shows the current state. The middle layer shows where each proposed project is expected to “expand” the Decision Yield for this decision. One of the key concepts behind Decision Yield is this measurement against best practice. Decision management is a never ending process – even if you make it to industry best practice on all five dimensions, the reality is that the standard will change and more work will be required to keeppushing the envelope. Deciding how close to best practice your business strategy needs you to be on each dimension for each operational decision is a key element for successful EDM adoption. This also means you will need to constantly re-evaluate your Decision Yield as “best practice” will improve over time. If you improve your Decision Yield out to best practice and assume you are “done” then you may not notice that you are falling behind competitors as they meet and then exceed the standard you set.

[HTML generated from Word using Textism's Word HTML Cleaner]

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Posted by James Taylor at 4:33 PM | Comments (0)

"Load balancing" decisions

Chatting with some colleagues yesterday, one of them used the phrase "load balancing" when talking about how you could combine computer-based and human-centric decisioning. The context was a discussion around Deep Blue, IBM's famous chess computer, and how much processing power it needed to win chess matches against the top human player - 256 processors and 200,000,000 positions evaluated a second. This led on to another discussion, onesomewhat inspired by my recent reading of Blink and by Larry Rosenberger's presentationon a similar topic, whatif we tried to build a computer to assist a player not replace them completely? In EDM terms, what if we:

How much processing power would this take? Is this kind of "load balancing" interesting or useful? It was a fascinating discussion, enriched by the wonderful concept of "load balancing" between people and computers.

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Posted by James Taylor at 1:57 PM | Comments (0)

July 25, 2006

The ART of (genetic) segmentation

I saw a post or two recently on genetic algorithms (including Alberto's and Walter's) and it made me want to post about a recent Fair Isaac use of genetic algorithms called "Adaptive Random Trees" or ART.

So how does ART work, how does it apply something as esoteric as genetic algorithms to something as practical as making cross-sell offers? Let's lay out a typical scenario. I have a population of customers and I want to predict something about them - say their likelihood of accepting a specific cross-sell offer. A typical predictive analytic approach is to develop a model that uses historical data about who has, and who has not, accepted offers to calculate some kind of score or measure of responsiveness - anequation if you will - that can be applied to each customer to calculate a value that represents their likely responsiveness. Often when developing these models an analyst discovers that different segments of the customer base behave differently. This means that more than one model is required - typically each segment will need its own model. For a given population this may quickly result in an unwieldy number of segments and hence models. Even though building a predictive model for each segment improve the accuracyof the prediction, and thus the likely precision of the targeting of that population, it costs too much and takes too long to do. Enter ART.

ART uses genetic algorithms to develop both the segments that should have their own models and the models themselves. It does this by:

The process continues until the new trees are not producing any better results than the previous generation. At this point you have both an optimal segmentation tree and initial models to calculate a prediction for the members of each segment. All of this without human intervention in the process - the process is initiated and bounded by someone with strong analytic skills and the final result is easy to modify and streamline to match production needs but the genetic algorithm does the work in between. The endresult is best expressed as a set of business rules representing a decision tree and a set of predictive models for each segment. A true EDM solution.

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Posted by James Taylor at 1:50 PM | Comments (0)

Book Review: Blink

This book has been a hot topic recently. I first heard about it at InterACT where Larry Rosenberger used it as part of his discussion on the future of analytics. The book is an easy read and full of wonderful stories and vignettes that illustrate Malcolm's points. Essentially the book is about how people make rapid decisions, often before consciously processing the available data, and the good and bad consequences of this. We are all familiar with some of the negative consequences - racial stereotyping for instance - but Malcolm discuses some of the positive ways this impacts effective decision-making. Using a relatively small case of characters and some richly described stories he leads us through an understanding of how rapid cognition works, why it is different from how we analyze things and how it can be more or less effective that any approaches to problem solving.

I particularly enjoyed the stores about people who had trained their snap judgments so that they could make quick and accurate assessments of situations while not being distracted by misplaced reactions and those about how hard it can be to describe a reaction, even if it is a good one.

Now you may be thinking that, if this book is about snap judgments, it is not obvious what it has to do with EDM. Well Larry talked about this some in his presentation at InterACT that was inspired in part by the book and there are a couple of examples that seem to me to be perfect illustrations of how an EDM approach can build on and reinforce the good aspects of our snap decision-making such as Malcolm's discussion of building a heart attack decision tree so as to focus the rapid cognition of doctors on the factors that matter statistically. He also discusses the problems of allowing snap judgments on the basis of how someone looks and this is another area where replacing or augmenting human judgment with analytics and rules can help. Indeed this was the basis for one of the first ad campaigns for the FICO score titled
"Good Credit Doesn't Necessarily Wear a Suit and Tie"

GoodCreditDoesntWearSuit

The full ad can be seen here.

This book is highly recommended for anyone interested in how people make decisions. There is a lot more on the blog about analytics as well as a set of analytic FAQs. Lastly you can buy the book here - it's a thought-provoking read.

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Posted by James Taylor at 11:27 AM | Comments (0)

July 24, 2006

A refund story

Old Way:

The other night I had to return something to my local grocery store. I walked in with the goods, but without the receipt. The person working the customer service desk (a regular staffer not a dedicated customer service person) asked me for the receipt and, on learning that I did not have it told me I needed it for a refund. I said "oh" and waited and, after a few seconds, she told me that she would go ahead and refund it anyway but next time I should bring the receipt. Then she asked me for my loyalty card andrefunded the money. [True Story]

EDM Way:

The other night I had to return something to my local grocery store. I walked in with the goods, but without the receipt. The person working the customer service desk (a regular staffer not a dedicated customer service person) asked me for my loyalty card as this was the standard first-step in the refund process. She then scanned my returns. Using the barcodes on the returned goods and my identification the system:

Why is this a better process?

  1. It could tailor the need for a receipt based on the customer's past behavior and decide whether I should get a cash refund or a store credit
  2. It removed the need for her to make a judgment call on the spot and so risk offending a good customer or paying off a shoplifter ensuring that company policy and risk models were applied
  3. It created an opportunity for loyalty marketing and quality service

All the necessary data is in the system. The models and rules are easy to develop. The technology to deliver the interaction support to her till exists. None of this is hard.

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Posted by James Taylor at 9:30 PM | Comments (0)

July 20, 2006

Pay-As-You-Drive Insurance is Here! Well, Actually, Over There...

Posted by Guest Blogger Extraordinaire, Ian Turvill, of Fair Isaac

A description of an innovative insurance offering crossed my desk the other day, and I felt that I had to reflect on its EDM-related implications.&,nbsp, In a report issued on June 15, 2006, entitled &,quot,Pay-As-You-Drive: Dynamic Insurance Emerges in Europe&,quot,, written by Ricardo Arruda of Forrester Research.&,nbsp, In it, he describes the growing demand for technology-enabled methods of insurance pricing, which charge consumers according to the speed, location, and timing of their driving.

Ricardo summarizes it like this:

&,quot,Pay-as-you-drive schemes rely on GPS technology and mobile phone networks to track individual car usage and determine tailored motor insurance premiums.&,nbsp, Insurers were initially reluctant to launch this product, as it challenged establish pricing models and involved high implementation costs.&,nbsp, But pioneers like Progressive Casualty Insurance showed how pay-as-you-drive schemes could yield significant business and customer benefits.&,nbsp, Led by the largest insurers and government authorities, pay-as-you-drive schemes are now appearing in European insurance markets from UK to Italy.&,nbsp, These emerging pay-as-you-drive schemes will create a dynamic insurance market that gives consumers greater control of their own premiums and sets insurers powerful new challenges and opportunities.&,quot,

In many ways, &,quot,Pay-As-You-Drive&,quot, (PAYD) Insurance is the logical extension of the growing use of micro-segmentation that many US insurers are already offering.&,nbsp, This involves the use of a far broader range of variables, in conjunction with custom predictive analytics, to precisely rate the risk presented by individual consumers.&,nbsp, The difference here is that, in addition to the static measures of risk, such as the driver's age, driving history, or the commuting distance, they are using dynamic measures, such as speed, time of day, and location, to give the best possible overall assessment.&,nbsp, Under PAYD, insurers may not have 4 or 100, or even 4,000, underwriting bands: in effect, they have a band for every single policyholder they serve.

Ricardo argues that PAYD brings multiple benefits to drivers, insurance companies, and even to the public at large.

  • Drivers are likely to perceive the insurance rates as fairer, since their payments are tied directly to their usage, and because they now gain control over the amounts paid for insurance - just as they have some influence over the level of gasoline consumption.&,nbsp, Ricardo indicates that drivers operating under a PAYD scheme tend to drive less and pay up to 25% less in insurance than they did under a prior methods calculating rates.&,nbsp, He doesn't, however, explain the basic underlying economic rationale for this, which is that insurance changes from a &,quot,fixed expense&,quot,, all paid at the outset of the agreement, to a &,quot,variable expense&,quot,.&,nbsp, Thus, the cost of insurance becomes part of the &,quot,marginal cost&,quot, that driver faces when he/she sets out from their garage.&,nbsp, And if their marginal cost is higher, while the marginal value of a trip remains, then - on the margin - car owners will drive fewer miles.&,nbsp, See, Economics 101 was useful, after all!
  • European insurers, according to Ricardo, profess that their customers become much more loyal under a PAYD underwriting method, because they sense a far higher level of price transparency.&,nbsp, He also suggests that the data they collect on customers' driving patterns could be valuable in the development of new products or even in the creation of marketing and advertising programs.&,nbsp, He appears, however, to overlook the most fundamental tenet of insurance: for every risk, there is a price.&,nbsp, When insurers can more precisely charge premiums according to risk, they get a double whammy.&,nbsp, First, they can offer lower prices to the people who deserve them, and who might otherwise be charged higher prices elsewhere.&,nbsp, As a result, they can win greater share.&,nbsp, Second, they can charge higher prices to people who actually do present a higher risk.&,nbsp, Two things will then happen: either the customers attrite (which is fine, because the insurer was in reality losing money on them before), or the customers stay and make higher payments (which is, of course, also just dandy).
  • We have already noted that car usage tends to drop when insurance payments are made &,quot,as you drive&,quot,.&,nbsp, Some - particularly environmentalists - would say this is, of itself, a good thing.&,nbsp, But, in addition, PAYD systems can help governments better ration the use of the road.&,nbsp, Since the risk of accidents is correlated with the volume of traffic, and therefore PAYD-rates are set higher during those periods, there is a disincentive for PAYD-equipped customers to drive at times of heavy road usage.&,nbsp, Moreover, the very same system that powers PAYD insurance also makes PAYD road charges possible.&,nbsp, For governments, such as in the UK, which intends to enforce fees for every mile a motorist travels by 2010 (yes, really), this means that they could simply piggyback off commercial systems.

So now we've established that PAYD has some good things going for it, let's think a little about the technical implementation.&,nbsp, Ricardo emphasizes some of the basic sensing and tracking mechanisms that have to be used to make this approach work.

&,quot,A 'black box' is installed beneath the hood of a car and receives signals from global positioning system (GPS) technology to determine the vehicle's current position, speed, and time and direction driven.&,nbsp, The black box then acts as a wireless modem to transmit theses inputs through standard mobile phone networks to the insurer.&,nbsp, The insurer then processes the information in an operations center and can pass it on to the client via the Internet.&,quot,

Once the information reaches the insurer, there seems to be a little case of &,quot,And then the magic happens&,quot, to this description.&,nbsp, How exactly does the insurer process this information?

Well, I'll tell you: a Business Rules Management System.

The insurer can set up rules that define the level of risk a client presents, based on their speed, location, and time of day.&,nbsp, These can be further complemented by conventional rules and analytics that dictate the driver's &,quot,static&,quot, level of risk.

The insurer can apply the BRMS to the incoming stream of client data to generate exact calculations of payments due and communicate this to billing systems accordingly.

No existing rating engine or policy administration is equipped to do this.&,nbsp, Only a rules engine, with appropriate access to analytics and connections to the necessary data, has the flexibility and power to deal with rapidly evolving PAYD rules and the volume of calculations required.&,nbsp, Yet one more application for Enterprise Decision Management!

A postscript:&,nbsp, It's interesting that European consumers appear to be very much more amenable to this &,quot,Big Brother&,quot, kind of intrusion than those in the US.&,nbsp, I have two alternative hypotheses why this may be the case.

The first - which seems a little prejudiced - is that Europeans are simply more pliant than Americans, and that they are more willing to have someone watching over their shoulder.&,nbsp, While I have no doubt that Yanks are generally very sensitive to monitoring, I really don't think that Europeans are truly any less so.

The second hypothesis is more interesting from a public policy point-of-view, and it is that American companies may be shooting themselves in the foot by lobbying against stricter consumer data protection laws.&,nbsp, The European Union is known to have quite stringent rules for maintaining customer databases.&,nbsp, Did you know, for example, that in the UK even the local chapter of the Salvation Army would have to record its membership data with the country's database registrar in order to be fully compliant with their consumer data statutes?

Is it possible that &,quot,Old World&,quot, consumers are more willing to be monitored because they have a stronger belief that their data will not be misused.&,nbsp, By contrast, in the US, imagine what fears would go through consumers' heads when offered a GPS unit to sit in their cars and track their every move?

It will be interesting to see Pay-As-You-Drive Insurance remains primarily a non-US phenomenon, or if it also takes off in the States, because the fundamental appeal should be the same, even if the policy and cultural environments differ.

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Posted by James Taylor at 11:31 PM | Comments (0)

Pay-As-You-Drive Insurance is Here! Well, Actually, Over There...

Posted by Guest Blogger Extraordinaire, Ian Turvill, of Fair Isaac

A description of an innovative insurance offering crossed my desk the other day, and I felt that I had to reflect on its EDM-related implications.&,nbsp, In a report issued on June 15, 2006, entitled &,quot,Pay-As-You-Drive: Dynamic Insurance Emerges in Europe&,quot,, written by Ricardo Arruda of Forrester Research.&,nbsp, In it, he describes the growing demand for technology-enabled methods of insurance pricing, which charge consumers according to the speed, location, and timing of their driving.

Ricardo summarizes it like this:

&,quot,Pay-as-you-drive schemes rely on GPS technology and mobile phone networks to track individual car usage and determine tailored motor insurance premiums.&,nbsp, Insurers were initially reluctant to launch this product, as it challenged establish pricing models and involved high implementation costs.&,nbsp, But pioneers like Progressive Casualty Insurance showed how pay-as-you-drive schemes could yield significant business and customer benefits.&,nbsp, Led by the largest insurers and government authorities, pay-as-you-drive schemes are now appearing in European insurance markets from UK to Italy.&,nbsp, These emerging pay-as-you-drive schemes will create a dynamic insurance market that gives consumers greater control of their own premiums and sets insurers powerful new challenges and opportunities.&,quot,

In many ways, &,quot,Pay-As-You-Drive&,quot, (PAYD) Insurance is the logical extension of the growing use of micro-segmentation that many US insurers are already offering.&,nbsp, This involves the use of a far broader range of variables, in conjunction with custom predictive analytics, to precisely rate the risk presented by individual consumers.&,nbsp, The difference here is that, in addition to the static measures of risk, such as the driver's age, driving history, or the commuting distance, they are using dynamic measures, such as speed, time of day, and location, to give the best possible overall assessment.&,nbsp, Under PAYD, insurers may not have 4 or 100, or even 4,000, underwriting bands: in effect, they have a band for every single policyholder they serve.

Ricardo argues that PAYD brings multiple benefits to drivers, insurance companies, and even to the public at large.

  • Drivers are likely to perceive the insurance rates as fairer, since their payments are tied directly to their usage, and because they now gain control over the amounts paid for insurance - just as they have some influence over the level of gasoline consumption.&,nbsp, Ricardo indicates that drivers operating under a PAYD scheme tend to drive less and pay up to 25% less in insurance than they did under a prior methods calculating rates.&,nbsp, He doesn't, however, explain the basic underlying economic rationale for this, which is that insurance changes from a &,quot,fixed expense&,quot,, all paid at the outset of the agreement, to a &,quot,variable expense&,quot,.&,nbsp, Thus, the cost of insurance becomes part of the &,quot,marginal cost&,quot, that driver faces when he/she sets out from their garage.&,nbsp, And if their marginal cost is higher, while the marginal value of a trip remains, then - on the margin - car owners will drive fewer miles.&,nbsp, See, Economics 101 was useful, after all!
  • European insurers, according to Ricardo, profess that their customers become much more loyal under a PAYD underwriting method, because they sense a far higher level of price transparency.&,nbsp, He also suggests that the data they collect on customers' driving patterns could be valuable in the development of new products or even in the creation of marketing and advertising programs.&,nbsp, He appears, however, to overlook the most fundamental tenet of insurance: for every risk, there is a price.&,nbsp, When insurers can more precisely charge premiums according to risk, they get a double whammy.&,nbsp, First, they can offer lower prices to the people who deserve them, and who might otherwise be charged higher prices elsewhere.&,nbsp, As a result, they can win greater share.&,nbsp, Second, they can charge higher prices to people who actually do present a higher risk.&,nbsp, Two things will then happen: either the customers attrite (which is fine, because the insurer was in reality losing money on them before), or the customers stay and make higher payments (which is, of course, also just dandy).
  • We have already noted that car usage tends to drop when insurance payments are made &,quot,as you drive&,quot,.&,nbsp, Some - particularly environmentalists - would say this is, of itself, a good thing.&,nbsp, But, in addition, PAYD systems can help governments better ration the use of the road.&,nbsp, Since the risk of accidents is correlated with the volume of traffic, and therefore PAYD-rates are set higher during those periods, there is a disincentive for PAYD-equipped customers to drive at times of heavy road usage.&,nbsp, Moreover, the very same system that powers PAYD insurance also makes PAYD road charges possible.&,nbsp, For governments, such as in the UK, which intends to enforce fees for every mile a motorist travels by 2010 (yes, really), this means that they could simply piggyback off commercial systems.

So now we've established that PAYD has some good things going for it, let's think a little about the technical implementation.&,nbsp, Ricardo emphasizes some of the basic sensing and tracking mechanisms that have to be used to make this approach work.

&,quot,A 'black box' is installed beneath the hood of a car and receives signals from global positioning system (GPS) technology to determine the vehicle's current position, speed, and time and direction driven.&,nbsp, The black box then acts as a wireless modem to transmit theses inputs through standard mobile phone networks to the insurer.&,nbsp, The insurer then processes the information in an operations center and can pass it on to the client via the Internet.&,quot,

Once the information reaches the insurer, there seems to be a little case of &,quot,And then the magic happens&,quot, to this description.&,nbsp, How exactly does the insurer process this information?

Well, I'll tell you: a Business Rules Management System.

The insurer can set up rules that define the level of risk a client presents, based on their speed, location, and time of day.&,nbsp, These can be further complemented by conventional rules and analytics that dictate the driver's &,quot,static&,quot, level of risk.

The insurer can apply the BRMS to the incoming stream of client data to generate exact calculations of payments due and communicate this to billing systems accordingly.

No existing rating engine or policy administration is equipped to do this.&,nbsp, Only a rules engine, with appropriate access to analytics and connections to the necessary data, has the flexibility and power to deal with rapidly evolving PAYD rules and the volume of calculations required.&,nbsp, Yet one more application for Enterprise Decision Management!

A postscript:&,nbsp, It's interesting that European consumers appear to be very much more amenable to this &,quot,Big Brother&,quot, kind of intrusion than those in the US.&,nbsp, I have two alternative hypotheses why this may be the case.

The first - which seems a little prejudiced - is that Europeans are simply more pliant than Americans, and that they are more willing to have someone watching over their shoulder.&,nbsp, While I have no doubt that Yanks are generally very sensitive to monitoring, I really don't think that Europeans are truly any less so.

The second hypothesis is more interesting from a public policy point-of-view, and it is that American companies may be shooting themselves in the foot by lobbying against stricter consumer data protection laws.&,nbsp, The European Union is known to have quite stringent rules for maintaining customer databases.&,nbsp, Did you know, for example, that in the UK even the local chapter of the Salvation Army would have to record its membership data with the country's database registrar in order to be fully compliant with their consumer data statutes?

Is it possible that &,quot,Old World&,quot, consumers are more willing to be monitored because they have a stronger belief that their data will not be misused.&,nbsp, By contrast, in the US, imagine what fears would go through consumers' heads when offered a GPS unit to sit in their cars and track their every move?

It will be interesting to see Pay-As-You-Drive Insurance remains primarily a non-US phenomenon, or if it also takes off in the States, because the fundamental appeal should be the same, even if the policy and cultural environments differ.

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Posted by James Taylor at 11:31 PM | Comments (0)

Medical errors and decisioning

Interesting article on USA Today Report finds drug errors injure more than 1.5 million. The article estimated more than $3.5B in unecessary costs. It gave a list of things you can do as a consumer to help. It made me think of things you can do if you are part of the healthcare system to make it work better. For each recommendation made to consumers I have tried to make recommendations to those working in healthcare- wise and effective use of decisioning technology can address some of these issues.

  • Maintain a list of prescription and nonprescription drugs, vitamins and other dietary supplements you use. Take that list with you whenever you visit a health care provider.
    • Healthcare providers could use the web and other channels to make it easier for consumers to provide this information directly using smart forms, for instance, to collect the right data efficiently
    • Obviously an electronic medical record would help but only if it is actually used
  • Ask your doctor to write down the drug's name, dose and how to take it. At the pharmacy, make sure those instructions match what's on the bottle you're given.
    • Electronic prescriptions help with this a lot
  • You can ask both the doctor and pharmacist about side effects and how to use the drug.
    • Using a rules-based approach to manage side effect description allows medical staff to manage the rules, makes it easy to change as soon as something new comes out or new information emerges
    • Automation of this check means that potential side effects can be highlighted when it is prescribed, when it is filled and, potentially, when the patient uses an online medication management system
  • Pharmacies often maintain computer records that can flag drugs that will interact dangerously, if you fill all your prescriptions at the same chain
    • At least one of these is a Fair Isaac customer using business rules to do exactly this
    • Some forward-thinking hospitals, like Parkview Health, are also doing this at a hospital level
  • If your pills look different when they're refilled, don't assume the maker changed the size or color&,nbsp,- ask the pharmacist why. You could have been given the wrong drug or dose.
    • Use rules to generate "scripts" for nurses administering and patients taking drugs that say things like "take 2 of the small blue pills" to help double check
    • Use rules so that you can easily change them when a maker does, in fact, change it
  • At the hospital, ask the doctor and nurse what drugs you're being given, why and what effects to expect.
    • See above
  • Before surgery, ask if there are any medicines you should avoid or stop taking beforehand.
    • Integration of rules-based alerting across drugs and procedures is something hosptials should be managing
    • Admission rules for surgeries should, for instance, trigger checks against drugs being taken so that admitting staff can confirm the patient has already stopped the medication to avoid admitting someone who can't be operated on anyway
  • Prior to hospital discharge, ask for a list of medications you should be taking at home and how to take them.
    • A good hospital management system should be able to apply the discharge rules and post-discharge care rules and generate instructions and advice for consumers

Beyond all this rules-based checking there is growing interest in using predictive analytics to identify patients in specific segments or who should have specific treatment. Forward-looking providers should be checking into that too. One thing to note - it's not as easy as all that to inject rules into medical processes - two many alerts and doctorsand nurses start to get "alert fatique". Check out this white paper by Mark Clare and Mark Pierce at Parkview Health.

Today is turning into a healthcare day...

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Posted by James Taylor at 2:26 PM | Comments (0)

Healthcare Podcast

Nice little podcast by a colleague on the topic of healthcare and using business rules to improve its delivery.

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Posted by James Taylor at 2:23 PM | Comments (0) | TrackBack

Eliminating fraud (in healthcare) with EDM

Bill Briggs over at Health Data Management wrote a nice little piece on how I.T. Helps Payer Smoke Out Fraud. This article brings up what is a huge issue -&,nbsp,healthcare payers are paying tens of billions in erroneous, abusive and fraudulent claims that look just fine in editing and adjudication systems. As the article points out, even rules-driven fraud detection systems won't catch all thiskind of fraud as they rely on the payer knowing, at some level, what rules to apply. In reality, while the majority of fraudulent claims appear legitimate when viewed in isolation, they actually shouldn't be paid in full, and many of them should not be paid at all. Once they are, only a tiny fraction of the dispersed funds will ever be recovered.

The problem is that claims data, in and of itself, only goes so far in revealing billing problems. Claims edit and adjudication systems, as well as fraud detection systems that rely on rules alone, do not go much beyond examining the data on the claim—something like looking at just one leaf on a tree. These systems do not recognize that claims which are correct in isolation may actually be part of a larger pattern of fraudulent activity, repeated error or systemic weakness. They do not notice providers manipulatingthe system by upcoding or those billing for services that are unrealistic and for amounts that are out of alignment with their peers. Focusing on the leaves, they cannot see the trees—much less the vast forest of costly billing problems.

Nevertheless, claims data is the key to detecting and stopping these problems. It contains rich data on providers, patients and other healthcare participants. A detection system with powerful predictive analytics extracts data from all payer claims on an ongoing basis. It should capture meaningful information from this vast quantity of data and mathematically distill it down into a highly compressed and efficient form, analyzing each incoming claim against this rich context. The results of this complex multidimensionalanalysis—which enables predictive analytics-based solutions to minimize losses and even prevent them before payment—should be output in simple, actionable form:

  • Scores and rankings to focus analysts on the most problematic claims and providers
  • Explanations, with links to evidence, to enable analysts to rapidly understand the source of a problem
  • Correcting errors on the spot through integration of the fraud decision with the claims process
  • Opening and referring investigative cases and recommending policy changes to address systemic issues where a simple action is not sufficient

Healthcare payers stepping up to this level of decision management can achieve real savings. They can detect fraud in prepayment to prevent funds from being dispersed unnecessarily. They can get weekly rankings of problematic providers that enable early investigation. They can conduct comprehensive post-payment analyses that reveal large-scale fraud. And so on. Fair Isaac's experience is that customers using such predictive analytics-based detection systems consistently produce savings that add up to as muchas 10:1 ROI or more.

Thanks to Teri Kim for some extra information here and for reminding me I blogged about this before - Predictive analytics can detect growing fraud in Healthcare Claims

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Posted by James Taylor at 1:23 PM | Comments (0)

July 19, 2006

Robots, AI and decisioning

A colleague sent me a link to this article in the NY Times - Brainy Robots Start Stepping Into Daily Life&,nbsp,- which talks both about the robot cars of the DARPA grand challenge and other AI like projects. For those interested, check out previous posts by me on the topic of robots and decisioning - CongratulationsTommy!&,nbsp,and Robotics - the next frontier for decisioning?&,nbsp,- or Robert Hecht-Nielsen's page (the reprints page includes details on the session mentioned in the NY Times article).

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Posted by James Taylor at 9:36 AM | Comments (0)

July 17, 2006

Srategic, top to bottom alignment with EDM

One of the (many) advantages to an Enterprise Decision Management or EDM approach is the opportunity for real strategic alignment, top to bottom. At first sight this may seem contradictory with the ruthless focus on operational, high-volume decisions regular readers will know me for. If EDM is focused, and it is, on operational decisions how can it contribute to strategic alignment.

Many organizations are challenged to keep their operational execution – the way front-line staff operate and the way self-service applications behave - synchronized with their strategic plans. For instance

  • You might want to treat all gold customers a certain way but have a self-service application that does not differentiate between customers.&,nbsp,
  • You might want to get more aggressive about retaining a certain class of customer but have call center representatives who have too many campaigns to remember and so treat everyone the same.
  • You might want to offer demand-based pricing but have a website disconnected from the demand algorithms used by sales representatives.

And so on. Divergent agendas and miscommunication between those working on an organization's strategy and those executing it operationally are chronic problems. These disconnects can hinder executive leadership's access to information about what's really going on and their ability to effect change in organizational behavior when they see the need. All the performance management infrastructure in the world won't solve this - you will just have a real-time, accurate view of how badly it is going.

Using EDM to align strategy and operational decisions you can reduce inefficiencies and improve effectiveness. For example, an EDM system can help brand managers assess and improve the alignment between the promotional campaigns executed in the call center, the mailing house and over the website and their overall marketing strategy. An EDM application that managed customer retention decisions could ensure that the right retention offers were made to the right customers regardless of channel (call center, store,agent, website) and that these offers changed as quickly as the strategy did. By focusing on the operational decisions that implement the strategy at the front-line, by automating that and by giving the business leaders control over how those decisions are taken you dramatically improve the likelihood that there is alignment between strategic intent and operational reality.

This need for strategic alignment brings us into the area of business agility - you must be able to change the way your organization behaves more quickly than ever before. You need to be able to respond to competitive pressures, regulations, legal rulings, product introductions and more. Communicating and supporting both strategic and tactical course corrections organization-wide is a competitive requirement, not an option. The growth in real-time or right-time business intelligence systems means that organizationshave more visibility into how well (or poorly) they are doing than ever before. Yet if they are to respond effectively to this new understanding, then delivering new processes, skills and expertise rapidly to front-line workers and information systems is essential. The time it takes to update these operational activities is likely to be the key factor in how fast an organization can respond – the determinant of its business agility. If your analysis of last week's sales shows that a competitor is eating intoyour sales and you decide that a new pricing model is required, how long it takes to implement that pricing model in your call center system, your website, your stores or the systems your agents use will determine how quickly you can respond. An EDM approach would ensure that the way you make pricing decisions was automated once, consistently across all these channels and would mean you only had one place to go to make a change. Further that place would be implemented so as to make the change easy.

An EDM approach would ensure your systems had the agility they need and were not the bottleneck for a change in strategic direction.

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Posted by James Taylor at 2:10 PM | Comments (0)

Srategic, top to bottom alignment with EDM

One of the (many) advantages to an Enterprise Decision Management or EDM approach is the opportunity for real strategic alignment, top to bottom. At first sight this may seem contradictory with the ruthless focus on operational, high-volume decisions regular readers will know me for. If EDM is focused, and it is, on operational decisions how can it contribute to strategic alignment.

Many organizations are challenged to keep their operational execution – the way front-line staff operate and the way self-service applications behave - synchronized with their strategic plans. For instance

  • You might want to treat all gold customers a certain way but have a self-service application that does not differentiate between customers.&,nbsp,
  • You might want to get more aggressive about retaining a certain class of customer but have call center representatives who have too many campaigns to remember and so treat everyone the same.
  • You might want to offer demand-based pricing but have a website disconnected from the demand algorithms used by sales representatives.

And so on. Divergent agendas and miscommunication between those working on an organization's strategy and those executing it operationally are chronic problems. These disconnects can hinder executive leadership's access to information about what's really going on and their ability to effect change in organizational behavior when they see the need. All the performance management infrastructure in the world won't solve this - you will just have a real-time, accurate view of how badly it is going.

Using EDM to align strategy and operational decisions you can reduce inefficiencies and improve effectiveness. For example, an EDM system can help brand managers assess and improve the alignment between the promotional campaigns executed in the call center, the mailing house and over the website and their overall marketing strategy. An EDM application that managed customer retention decisions could ensure that the right retention offers were made to the right customers regardless of channel (call center, store,agent, website) and that these offers changed as quickly as the strategy did. By focusing on the operational decisions that implement the strategy at the front-line, by automating that and by giving the business leaders control over how those decisions are taken you dramatically improve the likelihood that there is alignment between strategic intent and operational reality.

This need for strategic alignment brings us into the area of business agility - you must be able to change the way your organization behaves more quickly than ever before. You need to be able to respond to competitive pressures, regulations, legal rulings, product introductions and more. Communicating and supporting both strategic and tactical course corrections organization-wide is a competitive requirement, not an option. The growth in real-time or right-time business intelligence systems means that organizationshave more visibility into how well (or poorly) they are doing than ever before. Yet if they are to respond effectively to this new understanding, then delivering new processes, skills and expertise rapidly to front-line workers and information systems is essential. The time it takes to update these operational activities is likely to be the key factor in how fast an organization can respond – the determinant of its business agility. If your analysis of last week's sales shows that a competitor is eating intoyour sales and you decide that a new pricing model is required, how long it takes to implement that pricing model in your call center system, your website, your stores or the systems your agents use will determine how quickly you can respond. An EDM approach would ensure that the way you make pricing decisions was automated once, consistently across all these channels and would mean you only had one place to go to make a change. Further that place would be implemented so as to make the change easy.

An EDM approach would ensure your systems had the agility they need and were not the bottleneck for a change in strategic direction.

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Posted by James Taylor at 2:10 PM | Comments (0)

Enterprise Applications and decisioning

To quote Butler Group "Enterprise Applications tend to be pretty dumb. They collect data, store it and product reports on it". So if your enterprise application(s) is/are dumb, what can you do about it?

  • Look at the reports you generate. Talk to the people who read them (assuming someone does). Find out what prompts ACTION on their part and see if you could figure out the rules for taking the action and have the system use the data to take the action for them - automate the decision that is taken when the report is reviewed.
  • Look at the data you have. Talk to someone who understands data mining or predictive analytics. See what they think they could PREDICT based on your data. Decide if any of this would be useful in running the business. Better yet, talk to your business users and see if they think it would be useful. See if you could improve a decision being taken by leveraging your data.
  • While you are talking to your business users, ask them what they wish they knew. Maybe you can find a way to derive it from the data you have. Ask them what they would do if they knew that and see if you can automate the ACTION too (see above)
  • Look at the way you collect data. Talk to someone who uses the data. Do they get all the data they need the first time or do they have to go back and ask for more? What other data do they want and why/when do they want it (different circumstances are likely to make them want different data). See if you can figure out the rules that would let you collect the data they need (but no other data) the first time.
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