An Oracle Solution Brief

July 2013

Managing Unpredictability using BPM for

Adaptive Case Management

Adaptive Case Management

Disclaimer
The following is intended to outline our general product direction. It is intended for information
purposes only, and may not be incorporated into any contract. It is not a commitment to deliver
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decisions. The development, release, and timing of any features or functionality described for
Oracles products remains at the sole discretion of Oracle.

Adaptive Case Management

Introduction ........................................................................................................................ 4
Managing Unpredictability ................................................................................................. 5
Adaptive Case Management ............................................................................................... 5
Use Case #1: Investigative cases: Claims Management...................................................... 5
Use Case #2: Service Requests: Loan Origination ............................................................... 6
Use Case #3: Long Running Services: Managed Health Care .............................................. 7
Applying Oracle BPM Suite for Adaptive Case Management ............................................. 8
Conclusion ......................................................................................................................... 10

Adaptive Case Management

Introduction
Businesses seldom follow a script. Managing change and unpredictability is an integral part of
doing business. Organizations, which have mastered this flexibility in their business processes
see more value and remain more competitive. They are able to provide better customer
experience and wider range of products and services to their customers. Not all business
processes require high flexibility, but many do. For example employee on-boarding processes
can be broken into a set of standard activities which are known ahead of time for what steps an
employee must take to join a company. This is commonly referred to as a structured business
process where everything about the process can be defined in advance. Whereas in
unstructured business processes, we may not be able to predetermine sequence of activities;
such processes need tools to manage flexibility and unpredictability. An example of an
unstructured business process is an insurance claim which may require different business
stakeholders to weigh in and make different decisions at different steps of the process depending
on each outcome.
Business process management suites traditionally have been extremely well suited to cater to
structured processes but fall short when the process needs flexible handling. For managing
unpredictability in processes, we need capabilities of adaptive case management.
Adaptive Case Management generally refers to long running processes that require coordination
of knowledge, content, correspondence and human resources to complete certain work. It
requires adherence to corporate and regulatory policies/rules to achieve decisions about rights,
entitlements or settlements. In such processes path of execution cannot completely be
predetermined.

Adaptive Case Management

Managing Unpredictability
To manage business processes that have unpredictable workflows which cannot be explicitly modeled at
design time we need flexibility to determine the course of the process at runtime. This requires BPM
solutions to meet the following requirements:
Flexibility in case flows: This means that the knowledge worker managing the case can add work or
process fragments or even link cases at the time of execution to provide the necessary flexibility for case
management.
Flexibility in user interfaces: Since each case could be different, the user interfaces that case worker
interact with also need to flexible. The contextual and dynamic user interfaces adjust with the scope and
provide case worker with the right UI elements that are required for that particular case.
Flexibility in work assignments: As the work in adaptive case management is flexible, so is the work
assignment. Case workers may need to add stakeholders to the case during the case processing and adjust
the work assignments as the case progresses.
Flexibility in enforcing business policies: Cases are typically long running processes and some may
even run for months. There may be a possibility that during the case processing the policies or the
regulation change. Business people can make those changes to the business rules and be sure that all
currently active cases are following the current set of policies.

With such flexibility at your disposal, you can adapt to changing business conditions much more
effectively. Being flexible and adaptive let you provide more contextual and personalized customer
experience as the experience is not dictated by rigid applications or processes. You can easily navigate
through the unforeseen condition that requires unique handling in the process.
Adaptive Case Management (ACM) offer such flexibility and ability to adapt to changing business
conditions.

Adaptive Case Management

A case is generally a long lived, collaborative process. Processing of a case requires coordination of
knowledge, content, correspondence and human tasks. Case as in most of the processes requires
adherence to organizations rules and policies and regulatory requirements. These policies may be about
entitlements, escalations, service level agreements or settlements. It is called adaptive because the path of
process execution cannot be fully predefined and may have to adapt to the specific requirements of every
case. Human judgment is required, at various milestones in the process, to determine the next step in the
case processing. External events and case types may alter the processing during the time of execution.
Lets review the use cases of adaptive case management.

Use Case #1: Investigative cases: Claims Management

Many adaptive case management use cases are of investigative nature. This means, first of all, the case is
not one-and-done, it is long running. Secondly as in investigation it needs collection of evidence and
processing of evidence for making informed decisions. Depending on the type of evidence the next step
in the process is determined.

Adaptive Case Management

Take, for example, a car insurance claim. Car accidents can be of different types, and involving drivers
with different driving history. The car accident can be a minor fender-bender, or a serious accident with
bodily harm. It can be a case of accident with the loss of life, or even hit and run. For each of these cases
or even in case of the same type of incident, the sequence of actions taken to resolve the case may differ
depending on the nature of that particular incident.
Depending on the claim type, certain documentation is required and collected. It can be photos from the
incident, maps of incident, medical reports, police reports etc. All such documents are added to case and
are routed with case for processing.
The case worker may collaborate with peers to resolve the claim, or case worker may add new
stakeholders to work on the claim. A claim reviewer may need to verify policy holders eligibility
including deductibles, and allowed types of reimbursements or restorations. Depending on the claim
types, the claims officer needs to make decisions and determine the next steps in processing the case.
Adaptive case management provides them with such flexibility while ensuring the visibility and audit
tracking of each case.

Figure 1.Investigative claims need collaboration and flexibility

We can see such use cases across many other industries. Banks and credit unions face similar issues
during the investigation of fraudulent transactions. Credit card fraud may include a series of steps from
the time a customer disputes a credit card charge, all the way to reversal of charges and issuing a new
credit card. The processing varies depending on the type of card, customer, location, transaction type etc.
Adaptive case management is a right model to managing such cases.

Use Case #2: Service Requests: Loan Origination

Another use case for adaptive case management is a service request. Some service requests are quite
straight forward and can be done using straight through processing - this can include stopping a utility
service or requesting a replacement credit card. Some may need some more involvement and longer
processing times. Examples include loan origination, and benefits administration.

Adaptive Case Management

Such cases are triggered by customer request via web, phone or email. Then depending on customer type
or request type the processing is determined.
Take, for example, loan origination. It is extremely easy for customers to move from one bank to another
in response to highly attractive offers. So if the customer is dissatisfied, he or she might quickly defect.
Banks must accommodate customer demands by enforcing fast and accurate loan origination processes
while maintaining enough flexibility to react to market changes. How quickly can the bank respond when
the central bank changes its rates? How easily can it address new audit rules and generate compliance
reports? How efficiently can the banks underwriters and risk analysts adjust policies and calculate
necessary reserves? All this impacts the customer satisfaction as well as banks bottom line.
Many of above situations impact the loan application cycle. While common transactions in that cycle are
automated, the smallest variant can stall an application in the queue until a banker or loan officer can
address the issue. For example, what happens if the applicant has a change of status midstream, perhaps
losing a job or filing for bankruptcy? These dynamics put many banks into a quandary: on one hand,
increasing the use of electronic communication and enforcing online transactions simplifies the process.
However, once these electronic wheels are in motion, loan officers may need to intervene to address
unique issues.
Adaptive case management provides capabilities to manage all such situations while processing a loan.
With ACM, loan officers can determine the right documentation required to make a decision on the loan,
attach it to the loan and also gain the necessary flexibility to create custom tasks for any unique situation.
Loan officer can also change the tasks as the parameters that determine the loan eligibility or customers
situation change.

Use Case #3: Long Running Services: Managed Health Care

Some processes are long running with no particular end state. Such types of processes are quite common
in while managing social services and health care. Many health care organizations provide long term
managed health program for conditions that need continuous assessment by the care provider. It can be
managing diabetes or chronic back pain. In such situations, care provider sets up a care plan and,
depending on results of ongoing evaluations, may need to modify the plan.
Adaptive case management can be used quite effectively in such situations. Take chronic back pain as an
example. The primary care provider, the knowledge worker in this case, creates a treatment plan for a
patient. The plan may include diagnostics, medication, physiotherapy, weight loss program and nutritional
evaluations. After a certain period, the condition of the patient is reevaluated and plan adjusted. Care
provider may want to add x-ray results to the process, may want to add new sports medicine specialists to
the case and may need to attach documents, pictures and x-rays to the case. Adaptive case management
provides capabilities to handle such kind of flexible process.
ACM has all the capabilities that lets the care provider manage and monitor the patients well being and
adapt the care plan as per the patients progress. This plan may continue for few months, years or for the
life of the patient, but this provides the essential tracking and visibility to care provider and to the patient
so that best possible and tailored service can be offered.

Adaptive Case Management

Applying Oracle BPM Suite for Adaptive Case Management

Oracle BPM suite has built-in Adaptive Case Management capabilities to manage unstructured processes.
In Oracle BPM suite Case is a pre-built, first class entity and can be used to associate all case related
artifacts like documents, data, history, and discussions with it. You can create and manage all case related
work activities within BPM workspace.
Often Adaptive Case Management scenarios require document routing and content management, so
those capabilities are also well integrated into Oracle BPM. While working on the case you may check-out
documents from a document management system or attach various documents and create the document
workflow. Oracle BPM Suite has integration with WebCenter Content that allows managing all file types
like Word, Excel, Acrobat and even supports digital asset management including pictures, photos, audio
and video content.

Figure 2. Oracle BPM Suite supports robust content management

To work with a case, knowledge worker has accesses to the case workspace that includes all case related
objects including documents, data, case history, etc. Knowledge worker may work on a case activity, may
add documents to it, collaborate with other workers or SMEs to gain more input. Depending on the
context and situation, knowledge worker may create more tasks or add others users to the case. There
may also be certain rules and policies associated with the case that determine necessary actions based on
certain conditions, or to enforce constraints within which the knowledge worker needs to work. Analytics
capabilities in Oracle BPM Suite provide business manager an insight into case processing and can also
recommend actions to the knowledge worker.

Adaptive Case Management

Figure 3. Adaptive Case Management in Oracle BPM Suite.

Once the knowledge workers pick a case instance to work on, they open a case overview screen (Figure
4) that includes all the information about the case and provides a detailed overview of status of the case.
Case overview provides visibility into which case milestones (1) are in progress or are completed. Case
worker can see all the case stakeholders (2) that may include employees, customers, and partners. They
can add additional stakeholders if needed. They can review the thread of case activities (3) that have been
completed or in progress and can also review the discussion threads from the collaboration activities (4).
Another prominent feature is activity ratings (5). Unlike structured and repeatable processes, in ACM the
importance and priority of activities can change from case to case and here you can do that.

Figure 4. Case Overview in Oracle BPM Suite.

Adaptive Case Management

Conclusion
Todays organizations need information systems that can adapt to market changes, and deliver an
improved customer experience. Customer demands are evolving and they demand more personalized
service, more products and service types. To serve their customers, organizations need flexible tools for
creating, deploying, and managing business processes. Oracle BPM Suite helps organizations to
transform the fundamental processes surrounding investigative or service request case management
providing a flexible way to define and execute the adaptive processes.
Oracle BPM Suite includes built-in Adaptive Case Management and offers:

Management of Case Activities, Events, Stakeholders and Permissions

User driven task decomposition

Run-time addition of work and case stakeholders

Integrated Content Management

Adaptive Case Management

Managing Unpredictability using

Copyright 2013, Oracle and/or its affiliates. All rights reserved. This document is provided

BPM for Adaptive Case

for information purposes only and the contents hereof are subject to change without notice.

Management

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Author: Ajay Khanna

July 2013

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