Transparency & Automation for Prescription-Based Order in Healthcare

Company in medical supply & healthcare industry is a firm that provides healthcare services in Germany. The company specializes in rehabilitation, orthopedics, child care, and prosthetics. In addition, the firm offers various products, from wheelchairs to foot prostheses. As a partner to insurances, hospitals, doctors, care services, and care facilities, they aim to bring the right product to the customer. With multiple different medical supply stores, they have a strong presence in West Germany (especially Nordrhein-Westfalen) and are one of the leading medical suppliers in their area.

Challenge

One of the most critical aspects of conducting their business is that the customer’s order experience flows smoothly from a customer perspective and the company’s perspective. Their order process is a little bit different from a classical Order-to-Cash process. In a perfect world, the process would start with the customer arriving at one of their medical supply stores and requesting one of their products. Ideally, the customer has a prescription ready to show that the product is well suited for the person. An employee from the company helps the customer select the right product and usually provides the customer with the product. In some cases (depending on the product), they have to give the customer’s insurance a cost estimate, which ideally will be accepted. Afterwards, they can send the invoice and receive the payment from either the customer or the insurance.
However, as described in the text, this scenario is the optimal process, which most of the time does not reflect reality. One of the main issues for our customer was that currently, management was not aware of what was happening in the real-time process. Due to having many different medical supply stores and not having a tool yet to fully represent the process in real-time. Therefore they reached out to Celonis and Apolix to aid in getting a complete visualization and analysis of their ‘personalized’ Prescription-Based Order Excellence process.

Project Methodology

We decided to follow the process flow of all sales orders that customers issued at their medical supply stores for the given process. All information regarding the sales orders is captured in the company’s Microsoft Navision system. However, one of the problems we faced early on was that currently, the company was not tracking the event logs of the sales orders, which are the basis for process mining. Therefore, they activated the Change table, and we started the timeline for our project from the beginning of September 2021. In addition, after consultation with their team, we decided to track the status of the sales orders. As a result, we concluded more than 50 different statuses defining the sales orders’ position in the process. As a result, our customer can understand the next steps for every sales orders based on the statuses. Besides, we focused on several contextual variables to further link our findings to root causes, including insurance or prescription type.
The project’s main goal was to create more transparency in understanding what was happening and create a complete visualization of the process. Before this project, no one in the company knew exactly how this process looked in real life. Creating full transparency is vital as the firm aims to standardize the order process across all products. Besides, we decided to focus on analyzing rework activities that prolong the throughput time of the project. It was vital to understand which undesired steps occur often.
Allowing the company to take appropriate actions since the throughput time for their sales orders can be processed in a single day in the optimal scenario.

General Findings

The most important finding of this project was the complete transparent overview of the process. Together with these findings, we were able to create a happy path. The assumption that most sales orders do not follow the optimal path was further confirmed as more than 90% of the cases do not follow the best-case scenario. In addition, defining such a happy path allows the firm to benchmark its current sales orders and aim to standardize the process. To standardize a process, process mining further helped to identify potential RPA opportunities.

Clarifications when advising the Customer

One of the idle process steps that we identified as quite impactful is the clarifications that employees need from the sales representatives while advising the customer. These actions are because, in some cases, employees want to have a customizable product or information from the customer’s side is missing. Besides, we identified several product groups where these clarifications occur more often than the average. As a result, several action points from their side can be drawn, such as training that ensures that employees advising the customer have more information regarding the products. Moreover, Celonis can further help in the future to accelerate the process by sending immediate notifications to the sales representative when their help is needed. This can be done by utilizing the Celonis “Action Flow” feature.

Cost Estimate Declined by the Insurance

Another undesired activity that frequently occurs in the process is the rejection of the cost estimate by the insurance. This can happen because the cost estimate does not align with the pre-negotiated pricing with the insurance. Another reason can be that information regarding the product, or the customer is missing. Again, in this case, we connected such activity with contextual information. We identified that several insurances are more likely to decline the cost estimate. For the company, this means investigating the reason behind these observations and aiming to decrease the number of such instances.

Action Flow for Automating Reports

The findings before will not immediately affect the firm but rather help them understand inefficiencies and position themselves to ensure that such instances decrease. However, another feature that we utilized for the current project is the ‘Action Flow’ feature by Celonis. Such a feature allows users to create automatic reports or notifications based on the real-time databases’ information. For example, at the moment, every week, a designated employee creates a manual report to identify all modifications users whether a certain field is not filled out. With the help of the ‘Action Flow,’ we enabled this report to be created automatically.

Next Steps

Together with Apolix, the company wants to explore the world of automation and aims to create immediate value with Action Flows and Action Engines for the following steps. First, the goal will be to create more automation reports to increase efficiency in the overall Order to Cash process.