Cigna
Cigna Uses Business Rules to Support Treatment Request Approval
What is the strategic issue?
CIGNA is a major health insurance company. Its CIGNA Behavioral Health covers 16 million Americans in all 50 states and internationally. In addition, it supports a network of more than 50,000 professionals who needed a system that quickly and automatically approved requests submitted by providers, such as therapists, for additional patient care. CIGNA Behavioral Health’s business processes for making approval determinations were supported in different locations using several different software applications. Certain rules in use sometimes conflicted with each other, and knowledge was lost due to employee turnover. In addition, the rules were in inflexible if-then statements. Accessing and changing the rules was a slow, cumbersome, and expensive process. To reduce the knowledge loss due to employee turnover and to increase consistency and efficiency of rule maintenance, CIGNA Behavioral Health decided to adopt rule-based intelligent systems that could automate decision-making situations. CIGNA chose Haley Authority knowledge management (KM) software and Haley Rules intelligent system to build a Web-based benefit management system named Provider eCare Online.
How does it relate to this week’s course concepts?
According to the book, this week we learn about long-term objectives and strategies, we also learn business strategies. It talks about generic strategies and grand strategies. Include in the grand strategies there is an innovation. Innovation is making some changes to increasing markets, this issue is like this. They build this system one reason is to reduce the cost and knowledge loss, the other reason is that it can give them more markets to sell their insurance, it is also convenience for people to use this.
At which conclusions do you arrive at from your analysis?
According to the book, some firms find it profitable to make innovation their grand strategy.
What is the strategic issue?
CIGNA is a major health insurance company. Its CIGNA Behavioral Health covers 16 million Americans in all 50 states and internationally. In addition, it supports a network of more than 50,000 professionals who needed a system that quickly and automatically approved requests submitted by providers, such as therapists, for additional patient care. CIGNA Behavioral Health’s business processes for making approval determinations were supported in different locations using several different software applications. Certain rules in use sometimes conflicted with each other, and knowledge was lost due to employee turnover. In addition, the rules were in inflexible if-then statements. Accessing and changing the rules was a slow, cumbersome, and expensive process. To reduce the knowledge loss due to employee turnover and to increase consistency and efficiency of rule maintenance, CIGNA Behavioral Health decided to adopt rule-based intelligent systems that could automate decision-making situations. CIGNA chose Haley Authority knowledge management (KM) software and Haley Rules intelligent system to build a Web-based benefit management system named Provider eCare Online.
How does it relate to this week’s course concepts?
According to the book, this week we learn about long-term objectives and strategies, we also learn business strategies. It talks about generic strategies and grand strategies. Include in the grand strategies there is an innovation. Innovation is making some changes to increasing markets, this issue is like this. They build this system one reason is to reduce the cost and knowledge loss, the other reason is that it can give them more markets to sell their insurance, it is also convenience for people to use this.
At which conclusions do you arrive at from your analysis?
According to the book, some firms find it profitable to make innovation their grand strategy.