May 5-6, I'll be joined by my colleague, InRule Technology Chief Product Officer and co-rounder Rik Chomko and Healthcare Technology Strategist Jerry Kolosky at the Microsoft Enterprise Developer and Solutions Conference. Our session: Healthcare Rules! A Prescription for Pain Relief: Using Rule Technology in Healthcare Systems.

We're seeing growing success among healthcare companies using business rule technology to power key systems. This session will share what we and our customers have learned. Can't make it to NYC? Join remotely as we stream our presentation or view the content online.

The session description is below. For more information or to register, go to: http://entdevcon.istreamplanet.com/default.asp

Healthcare Rules! A Prescription for Pain Relief: Using Rule Technology in Healthcare Systems.
Healthcare payers and providers face myriad challenges, not the least of which is compliance with new and changing federal, state and local regulations, all while budgets for staff and systems are shrinking. Automating critical decisions with explicitly defined and centrally managed healthcare rules improves core processes ─ like inbound claim scrubbing, prior authorization, benefit verification, and cost estimation, among others ─ while reducing development and maintenance burdens. 

This session will include case studies and a technology demonstration featuring automated healthcare rules, using the premier .NET solution for authoring, managing, integrating and executing business rules. 

·         Learn how the largest provider of Medicaid and Medicare process management services­ uses .NET business rule technology for a state Medicaid processing system that reduces the timeframe for provider reimbursement by 81 percent.

·         Get an in-depth look at a flexible platform based on .NET and designed to validate healthcare rules and improve compliance throughout the revenue cycle, and beyond.

·         Additional case studies show how other healthcare leaders—including the largest US not-for-profit health plan and one of the top claims companies— have implemented .NET rule-based solutions that:

o   Identify, resolve, and prevent the occurrence of healthcare-associated infections

o   Quickly and cost effectively offer clients customized co-pay plans that comply with internal rules

o   Ensure compliance with CMS and commercial payer policies for implant support services

Rules are everywhere. Those of us in the business rules technology business tend to see rules everywhere and there are days when I think that automating and managing rules can improve just about any decision-making process.

Today, however, I am reminded that sometimes the “real” rules are not the ones that are in the rule book and that some rules cannot be automated. Monday was the first day of the 2009 baseball season, yesterday the home opener for my Chicago White Sox (beat Kansas City 4-2), and tonight my first game of the season. Baseball is a sport of warm summer days and cold malted beverages—and of rules. There is something very pleasing about explaining the nuances of baseball rules to a child or a friend at their first game, having pride in being able to identify a balk or being able to explain the infield fly rule.

In his very excellent essay “There Are No Ties at First Base,”  Ted Cohen—University of Chicago professor and baseball rule junkie—tells the tale of his quest to correct a contradiction in the baseball rule book. What Mr. Cohen understands at the end of his quest is what business rules practitioners remind us all the time—that sometimes the real rules aren’t the official rules. The foundation of any business rules strategy is understanding how decisions are actually being made, then ensuring a common understanding of those rules. Automation and management are important, but it’s making sure that stakeholders agree on the key rules that is the first step toward better business decision management.

As Mr. Cohen so simply states, “What good are the rules if no one knows them? What good is it to know the rules if no one believes you? And what if they believe you but just don’t care?” In the end, the baseball rulebook didn’t exactly define the rules and rules didn’t exactly define baseball. So while neither baseball nor rules is everything, they certainly do take up a lot of my waking, thinking time. I hope to use this space to share the thoughts and experiences of those of us who focus on business rules.

Mr. Cohen’s essay can be found in the collection Baseball and Philosophy: Thinking Outside the Batter’s Box, edited by Eric Bronson. As a White Sox fan, I can also recommend the essay, ”Should Cubs Fans Be Committed?” by Thomas D. Senor.