Healthcare Payer Solution: Grow Business Profitably. Presenter s Name Presenter s Title

Transcription

1 Healthcare Payer Solution: Grow Business Profitably Presenter s Name Presenter s Title

2 Safe Harbor Statement 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 any material, code, or functionality, and should not be relied upon in making purchasing decision. The development, release, and timing of any features or functionality described for Oracle s products remains at the sole discretion of Oracle. 2

3 Agenda Leadership in Healthcare Innovation in Healthcare Solutions Results Achieved by Oracle Customers 3

4 Oracle in Healthcare Did You Know? More than 80 Healthcare Payers run Oracle Applications 20 of the top 20 US Health Insurers run Oracle Applications More than 350 leading healthcare providers run Oracle Applications 10 of the top 12 Fortune Global 500 healthcare organizations run Oracle Applications 4

5 The Challenges We re Hearing Grow Business Profitably How do I respond rapidly to a dynamic market and improve profitability? Companies that operate in many different markets need to accurately address the profitability of members and adjust rates accordingly." Enable Consumerism How can I make healthcare information transparent through self-service channels so that customers are empowered to make the right health choices? The Blues are committed to developing long-term and thoughtful policy solutions to the challenges of rising healthcare costs and the growing number of uninsured Americans. Address Postmerger Integration and Governance How can my organization face industry consolidation and continue to meet increasing national and regional governance demands? Our enterprise applications are strategic, allowing Wellpoint to quickly integrate acquisitions and still meet regulatory requirements. 5

6 The Challenges We re Hearing Grow Business Profitably How do I respond rapidly to a dynamic market and improve profitability? Companies that operate in many different markets need to accurately address the profitability of members and adjust rates accordingly." Payers are evaluating and customizing product lines to improve profitability 6

8 Grow Business Profitably Requirement Oracle Capability The Oracle Difference Recruit, retain and increase market share with targeted distributors Distribution and Self Service Most comprehensive distributor relationship management solution Increase product innovation and speed to market Product Best-in-class product master with integrated marketing/sales solution Optimize provider networks Enhance visibility into profitability drivers Provider Relationship Business Intelligence for Healthcare Only insight-driven provider relationship management application within an SOA architecture Only enterprise business analytics solutions with pre-built healthcare profitability key performance indicators 8

10 Distribution and Self Service Drive Distribution Loyalty Recruit Execute agent recruitment programs Track and manage agent files Manage producer master Manage incentive compensation to accurately compensate agents and reward exceptional producers Gain insight into channel profitability through Partner Analytics Dashboards Retain Service Facilitate team selling Distribute leads and collaborate on RFQ process Enable channel with Partner Portal Service agent/broker requests utilizing call center capabilities Drive distribution loyalty Improve channel visibility Streamline sales process across channels 10

11 Distribution and Self Service Drive Distribution Loyalty Oracle s Siebel Insurance Oracle Siebel Call Center Oracle s Siebel Marketing Analytics Web Services Comprehensive Distribution Insight and Sales/Partner Automation Intelligent Marketing Call Center Analytics Sales Process Mgmt Rapid Product Rollout Sales/Partner Credentials Book of Business Customer Segmentation Program Channel Marketing Results Tracking Caller Profiles Customer Knowledge Automated Screen Channel Profitability Pops Product Profitability Interaction Logging Market Insight Task-based UI Insurance Manage Escalation Dashboards Managed Self-Service 11

12 Distribution and Self Service Drive Distribution Loyalty Partner Program Collaborative Marketing Collaborative Sales Collaborative B2B ecommerce Collaborative Service Partner Recruitment and Registration Literature Posting and Distribution Lead and Opportunity Dynamic Product Pricing Customer Service Requests Program Administration Marketing Resource Product and Price Lists Sales Tools Product Configuration Partner Self Service Partner Profile Joint Marketing Planning and Execution Catalog Syndication Dynamic Product Catalog Entitlements Verification Training and Certifications Joint Campaign Execution Pipeline and Forecast Quote and Shopping Cart Solutions and Problem Resolution Strategic Business Planning Market Development Fund Compensation and Commissions Order Inventory and Asset Partner Manager and Partner Portal Analytics Common CRM and PRM Infrastructure Front and Back Office Systems 12

13 Distribution and Self Service Drive Distribution Loyalty The current OSI solution offers the following feature capabilities: Request an online quote React to personal offers Sign-up for a policy View the status of pending transactions View, print, and download invoices or statements View and print policy documents Download policy terms & conditions View and print collective agreements Policy maintenance, allowing the insured to perform the following transactions: Add or delete new member(s) Add or delete insurance product(s) Change level of coverage (insured risk) Adjust bank details Terminate membership Provide information regarding status of coverage and claims 13

14 Blue Cross Blue Shield of Louisiana Reduces Cost of Sales and Enrollment COMPANY OVERVIEW Headquartered in Baton Rouge, Blue Cross and Blue Shield of Louisiana also has district offices in Alexandria, Houma, Lafayette, Lake Charles and Monroe. One out of every 4 Louisianans depend on Blue Cross for coverage. It is the state s largest health insurer with more than 1 million members statewide. $1.6B in premium revenues in The company s subsidiaries include HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc. CHALLENGES/OPPORTUNITIES Reduce the cost of sales and enrollment Reduce quote turnaround time SOLUTIONS Automated agent/broker sales solution supporting 1,700 distributors with application capture via the Internet CUSTOMER PERSPECTIVE eblue is now being used by preferred agents. We have accurate, clean, complete electronic applications. They were received in seconds with no stamps to buy and no envelopes to open.we have taken a huge step right here. Mike Reitz, Senior Vice President and Chief Marketing Officer RESULTS Reduced enrollment time for new members from 20 days to 6 days Reduced sales and enrollment costs by 50% 14

16 Universal Product Master Increase Product Innovation and Speed to Market Key Imperatives for Healthcare Insurance Rapidly Launch New Products & Services Support Emerging Markets Greater Customer Intimacy & Centricity Improve Operational Efficiencies 16

17 Universal Product Master Increase Product Innovation and Speed to Market Central administration of product and pricing rules Product Marketing Scenario Builder Rapidly Launch New Products & Services Support Emerging Markets Speed to market for new products Up-sell/cross-sell Recommendations Consistent product and pricing rules across channels Product Recommendation Greater Customer Intimacy & Centricity Improve Operational Efficiencies Product Eligibility Product Compatibility Composite Application Framework 17

18 Universal Product Master Increase Product Innovation and Speed to Market State Requirements Competitors Mandates Pressures Market Analysis Biz Level Product Definition Product Release Technical Product Creation

19 Universal Product Master Increase Product Innovation and Speed to Market Issues Requirements Complex Product Administration Both in terms of people and systems Lengthy Time to Market Launching a new product can take between 6-18 months Revenue leakage Sales product definition does not equal product definition in billing Absence of Coherent/Consistent Product Process Limits Cross Sell/Upsell Challenges in Servicing Customers Inconsistent eligibility responses Handling Billing Inquiries Product and Pricing Administration Consistent Product Creation and Lifecycle Product Administration Cross Referencing Capabilities/ Data Mapping to support claims system Simplify Billing for Groups Real-time access to product catalog Simplify the member reconciliation process Data Synchronization Enable product and pricing data to be distributed throughout the enterprise A Central Repository for Product and Pricing Data

20 Universal Product Master; Sales Automation Increase Product Innovation and Speed to Market Characteristics: > Improve speed to market > Simplify product administration > Enable product management process > Promote cross selling and up-selling > Reduce member reconciliation issues Call Center Agents ecustomer Product Data Approach Universal Product Master Services Product Pricing, Eligibility, Recommendations Quote & Order Master Product & Pricing Admin SOA-based Inside Sales SOAbased Other Front Office IVR / SMS > Limit updates, thus increase accuracy > Flexible Product Configuration Actuarial/ Underwriting Product Master > Provide access to data through services Broker Portal Partners Billing Billing Billing

22 Provider Relationship Business Challenges Process Control How can I standardize increasingly complex contracts and contract processes? How can I streamline approvals of non-standard agreements? Time to Contract How will I continually reduce contract cycle time and costs? How can I reduce paperwork and improve efficiency? Plan Network Network How can I minimize lengthy post-negotiation red lining? How can I avoid costly claims adjustments and disputes? Provider Compliance What is the best way to monitor provider performance to contract? How can I comply with increasing regulatory oversight? 22

23 Provider Relationship Insight-Driven Business Processes Business Insight SRM Dashboard Expanded KPIs for Provider Relations Summary metrics at business unit level Provider Relations performance analytics pagelet Business Processes Contract Network Optimization Provider Analysis Request to Provider for contract creation New reporting functions & flexibility Product to network comparisons SLA compliance tracking and noncompliance alerts Matching members with appropriate providers Group requirements 23

24 Provider Relationship SOA Environment Multi-channel Call Center Web Agents Independent Agents/ Brokers Employees Oracle Network Data Integration Service (SOA) Enterprise Service Bus Business Process Rules Workflow Engine Engine Process Orchestration Provider Contracting Claims Physician Profiling Network Mgmt 24

26 Business Intelligence Gain Insight Into Patient Conditions, Treatments and Outcomes Achieved Oracle s BI Product Strategy Integrated Business Intelligence Database Business Intelligence & Data Mining Functions Integrated in Database Integrated Business Intelligence Tools Best-of-Breed, Next Generation Business Intelligence Technology Platform Integrated Analytic Applications Enterprise Wide, Industry Specific Analytic and Corporate Performance Applications Fastest Time to Value & Lowest TCO Pre-packaged Performance & Analytic Applications Across Siebel, PeopleSoft, e-business Suite, JDEdwards, & other systems Utilizes Any Information Technology Environment 26

27 Business Intelligence Gain Insight Into Patient Conditions, Treatments and Outcomes Achieved From: Analysts only Historical data Fragmented view Reporting results Analytic tools Planning silos with limited BI To: Pervasive use Real-time, predictive data Unified, enterprise view Insight-driven business process optimization Unified infrastructure and prebuilt analytic solutions Enterprise Performance System 27

28 Business Intelligence Gain Insight Into Patient Conditions, Treatments and Outcomes Achieved Extended and Unified Clinical/Business Intelligence Infrastructure Data Integration Ad-hoc Analysis Interactive Dashboards Essbase Analytics Reporting & Publishing Proactive Detection and Alerts Disconnected & Mobile Analytics MS Office & Outlook Integration Oracle BI Server Common Enterprise Information Model Intelligent Caching Services Multidimensional Calculation and Integration Engine Intelligent Request Generation and Optimized Data Access Services OLTP & ODS Systems Data Warehouse Data Mart Essbase Oracle PeopleSoft, Siebel, Custom Apps Files Excel XML Business Process 28

29 Business Intelligence Gain Insight Into Patient Conditions, Treatments and Outcomes Achieved An Enterprise Performance System Reporting Scorecarding Operational BI Planning Modeling Planning Budgeting Financial Consolidation Scorecards Clinical Service & Contact Center Human Resources Order & Fulfillment Supply Chain Clinical Analytics Common Enterprise Information Model Oracle Business Intelligence Foundation OLTP & ODS Systems Data Warehouse Data Mart Essbase Oracle PeopleSoft, Siebel, Custom Apps Files Excel XML Business Process 29

30 Blue Cross Blue Shield of Florida Reduces Time and Cost of Data Analysis COMPANY OVERVIEW Blue Cross and Blue Shield of Florida (BCBSFL), a leader in the state s health industry, serves more than 8.3 million people and holds a 29 percent market share, more than double the nearest competitor. In 2005 BCBSF reported consolidated total revenue of $6.97 billion and a profit margin of 4.9 percent. Statewide, the company provides employment for approximately 8,400 individuals in Jacksonville, Miami, Ft. Lauderdale, Orlando, Tampa and Pensacola. CHALLENGES/OPPORTUNITIES Streamline the labor-intensive, costly and slow data analysis process Access and analyze data stored in a number of legacy systems Deliver reports in a timely manner; reduce turnaround time SOLUTIONS Oracle s Siebel Analytics used by 2,000+ internal employees across the enterprise Integrated real-time and historical data from 15+ different database platforms Live after 45 days CUSTOMER PERSPECTIVE Before we installed [Oracle] Siebel Analytics,.. we had to hire consultants to do the job, at a cost of $1,000 per report Now we re generating the reports on our own and saving about $4 million a year the turnaround time is down to approximately three days. Lisa Davis, Manager of Enterprise Business Intelligence RESULTS Reduced costs of reporting/consultants by $4 million in the first year Reduced time for reporting and analysis from days to approximately 3 days or less Improved group medical-loss ratio Reduced time for complex security parameter requirements for HIPAA compliance from 1,000 hours to 20 hours 30

31 Grow Business Profitably Solution Summary Distribution and Self Service Most comprehensive distributor relationship management solution Product Best-in-class product master with integrated marketing/sales solution Provider Relationship Business Intelligence for Healthcare Only insight-driven provider relationship management application within an SOA architecture Only enterprise business analytics solutions with pre-built healthcare profitability key performance indicators 31

32 The Only Complete Healthcare Solution Platform Processes Customer Results People Partners 32

33 Healthcare Payer Solution Footprint Partners Oracle 33

34 Market-Leading Middleware Platform Best-Selling 32,000+ Customers Deployed 70% of World s s 50 Largest Firms $1B+ Business Highest Rated Only vendor in Gartner and Forrester leader quadrants for all Middleware components. Most Comprehensive Source: Forrester Research ranking of Application Platform Servers, April 2005 SOA Vendor of Choice 34

35 Oracle s People Advantage 220,000 database customers 1,700 application ISVs 30,000 applications customers 275,000 customers benefiting from shared innovation 30,000 middleware customers 29,000 developers, support engineers and consultants 1,300 participants in early customer adoption programs 5,000 middleware ISVs 950 customers participating in Customer Advisory Boards 9,000 database ISVs 35 Fusion strategy council members 425 user groups 500 Industry & Product strategy council members 35

37 What Customers are Achieving increased enrollment by 200% with on-line quoting added 200,000 new members while simultaneously reducing both member services call duration and wait times by 20% utilizing Oracle Siebel Contact Center reduced sales and enrollment costs by 50% utilizing Oracle Siebel Healthcare Sales achieved an additional $9 million of interest earned in trust funds during first seven months utilizing Oracle Financials General Ledger reduced costs of reporting/consultants by $4 million in first year of Oracle Siebel implementation 37

38 The Oracle Difference Only Oracle Most comprehensive distributor relationship management solution Best-in-class product master with integrated marketing/sales solution Only insight-driven provider relationship management application within an SOA architecture Only enterprise business analytics solutions with pre-built healthcare profitability key performance indicators 38

39 <Insert Picture Here> Appendix 39

40 Blue Cross and Blue Shield of Kansas City Expands Human Resources Capabilities COMPANY OVERVIEW Largest not-for-profit health insurer in Missouri Only not-for-profit health insurer in Kansas City In operation since 1938 Provides health coverage to more than 886,000 residents in the greater Kansas City area and Northwest Missouri Independent licensee of the Blue Cross and Blue Shield Association Industry: Healthcare Employees: 1,700 Revenue: US$1.4 Billion CHALLENGES/OPPORTUNITIES Eliminate redundancy between multiple databases and human resources system Automate processes ; minimize paper-based processes Increase scalability and functionality with a more robust application platform SOLUTIONS PeopleSoft Enterprise Human Capital PeopleSoft Enterprise Learning PeopleSoft Enterprise Financial PeopleSoft Enterprise Portal CUSTOMER PERSPECTIVE Expanding self-service options for our employees was a big priority the new Oracle applications have helped us address this need, enabling our staff to focus on other responsibilities. Kevin Sparks, VP, CIO RESULTS Eliminated data redundancies Improved reporting accuracy Provided self-service capabilities to employees for personnel updating and course enrollments Enabled visibility into critical business information Improved operational efficiency 40