Toward a Healthcare Business-Process Reference Model

Standardizing processes in an effort to develop a full-scale healthcare business-process reference model could enable flexible business models without requiring custom interfaces and help track transactions to improve response times and quality of care. The structure of the healthcare industry is in flux. In seeking more cost-effective solutions, enterprises are constantly experimenting with different business models and trying various combinations of roles: risk holder, care provider, plan manager, and plan administrator. Health plans are also becoming more complex. Comprehensive plans often aggregate smaller plans, each covering a different benefits category with a different business model for providing and administering care. From both a business and information systems perspective, the result is expensive and chaotic.