APQC Releases Healthcare Payer Process Classification Framework

Industry-specific business process framework facilitates improvement through process management and benchmarking for U.S. healthcare insurance companies

(Houston, Texas - October 22, 2013) - APQC, the nonprofit leader in benchmarking and best practices research, has introduced a business process framework for the healthcare payer industry. This version of APQC’s cross-industry Process Classification FrameworkSM (PCF) was developed by APQC in collaboration with KPMG. The healthcare payer PCF is intended to help US healthcare insurance companies, and other similarly-focused organizations, in their process definition, benchmarking, and content management activities.

The healthcare payer PCF may be downloaded for free at www.apqc.org/pcf.

“APQC is excited to provide the healthcare payer industry with the same benefits that others have received from industry-specific process classification frameworks,” said John Tesmer, senior program manager with APQC. “As in the automotive, banking, consumer products, telecommunications and other industries, APQC’s framework will enable healthcare payers to judge how they measure up to competitors in an objective and standardized format.”

“The U.S. healthcare industry is converging around shared economic interests and new business models, forcing healthcare payers to re-assess all of their key processes to determine the implications of operating in a B2C model through exchanges or collaborating with provider and life sciences organizations in new ways,” said Liam Walsh, KPMG Advisory’s Healthcare and Life Sciences leader.  “We believe that developing the process classification framework will assist our payer clients and, more broadly, the healthcare industry, assess the operational implications of this convergence of interests through a standardized way of evaluating performance.”

At its simplest level, APQC’s PCF is a list that organizations can utilize to define work processes comprehensively and without redundancies. The PCF identifies 12 high-level functional categories and contains more than 1,000 process elements that, when considered as a whole, represent the operations of an organization.

The PCF forms the foundation of the APQC Open Standards BenchmarkingSM (OSB) research program (www.apqc.org/osb). The OSB program allows organizations to directly compare their performance against other organizations for the detailed processes described in the PCF. In addition, the PCF enables organizations to understand their inner workings from a more customer-focused horizontal process viewpoint rather than a vertical functional viewpoint.

About APQC

APQC is a member-based nonprofit and one of the world’s leading proponents of knowledge management, benchmarking, and best practices business research. Working with more than 750 organizations worldwide in all industries, APQC provides organizations with the information they need to work smarter, faster, and with confidence. Visit www.apqc.org, call +1.713.681.4020 or follow @APQC and learn how to Make Best Practices Your PracticesSM.


KPMG LLP, the audit, tax and advisory firm (www.kpmg.com/us), is the U.S. member firm of KPMG International Cooperative (“KPMG International.”) KPMG International’s member firms have 145,000 people, including more than 8,000 partners, in 152 countries.

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