As one of the largest associations of Statutory Health Insurance Physicians in Germany, KVWL based in Dortmund provides local, outpatient care with family and specialist doctors for around 8.5 million insured persons in Westphalia-Lippe, guarantees the legally compliant billing of medical services worth around 3.2 billion euros per year to payers and represents the interests of around 14,000 established doctors and psychotherapists.
Aeneis creates transparency, orientation and enables control.
Especially as a public corporation, in an increasingly complex world of work, it is imperative to use an intelligent tool for process documentation that supports process-oriented risk management across all areas of action of the organization and thus offers the necessary transparency, orientation and control options.
The Kassenärztliche Vereinigung Westfalen-Lippe (Westphalia-Lippe Association of Statutory Health Insurance Physicians) uses the basic functionalities of Aeneis to provide managers at every hierarchical level with consolidated information about the risk potential of their processes in terms of “reputation,” “efficiency and quality,” and “compliance.” In conjunction with an individually tailored CIP workflow, risks can not only be identified, analyzed and assessed via so-called risk control points, but necessary improvements can also be initiated with associated measures and their effectiveness monitored.
KVWL executives receive concentrated information about the risk potential of their processes
Identify, analyze, evaluate and initiate measures, report to managers
Identify risks along the processes
Using graphical process documentation in the form of BPMN diagrams, process owners, employees and the QM team identify risks and document them directly during the process in so-called risk control points. It is possible to make use of predefined risks from a risk library in Aeneis or to create process-specific risks directly.
Analyze, evaluate and initiate measures
After identification, the parties involved check to what extent countermeasures have already been taken in the process. These can be taken from a pool within Aeneis and offset against the risk. Only these are to be considered in the evaluation. The evaluation is based on the categories
• reputation and satisfaction of stakeholders,
• quality and efficiency, and
• compliance
The evaluation is supplemented by an assessment of the probability of occurrence and discovery. If it is now clear that measures must be introduced to mitigate the risk, these can be initiated, documented and followed up directly via the CIP workflow.
Report managers at all hierarchical levels
Once the risks have been identified, analyzed and assessed, the individual risks for each process, including their assessment, can be presented in the BPMN portal. Based on the assessments, Aeneis automatically determines two overall risk indicators for each process, which managers can use to deduce the urgency of action. The key figures can be aggregated across the various nodes in Aeneis, so that managers at all levels get a quick overview of the entire risk potential of their area of responsibility.
Outlook for further expansion of the system
Risks can be avoided in a public corporation in particular by making the necessary know-how and sources of information available. For this purpose, the
• relevant legal bases and
• further information
from various sources are constantly linked to the process.. These sources may include, for example, the Internet, the Intranet, collections and libraries in SharePoint®, etc.
