Cognizant & BCBSNC: Presentation Title Presentation Title

Transcription

1 Cognizant & BCBSNC: Presentation Title Presentation Title Leveraging Pega Platform to Deliver Innovative Quote Second to Card LineSolution Using Six Sigma Techniques Jim Fulton Director, IT Delivery, BCBSNC Harish Dwarkanhalli Author Title Vice President, Cognizant Dev Victorien Engagement Leader, Cognizant 2016 Pegasystems Inc.

2 Pega & Cognizant HealthCare Journey: Yesterday-Today-Tomorrow WILL CHANGE How Business is Automated & Digitized Digitization Automation New Horizons Tomorrow CHANGING How Relationship & Experience are Managed Today Yesterday CHANGED How Process & Rules are Managed Business Process Management (BPM) Business Rules Management (BRM) Case Management (CM) Decision Hub Customer Relationship Management (CRM) Customer Experience Management PRPC & Frameworks 2

3 Pega & Cognizant HealthCare Journey Yesterday (BPM, BRM, CM) Heat Map Provider Network Management Prospecting Provider Data Maint Credentialing Contracting Enrollment Member Data Input Group Setup Member Setup Member Onboarding Claims Claims Intake Pre-Processing Benefit Adjudication Post-Processing Care Management Utilization Management Disease Management Case Management Wellness Additional Frameworks GSPM, ISPM, PCS, CW, CR, SCE, CMF HealthCare Industry Framework (HCIF) Core PRPC Foundation 3

4 Pega & Cognizant HealthCare Journey Today (CRM, CX) Heat Map Marketing Market Study Plan Creation Marketing Collateral Management Campaign Management Sales Census Management Lead Management Quote Generation Negotiation & Closure Customer Service Contact Center Appeals and Grievance Member Portal Member Communication Decision Hub DSM, PAD, ADM, VBD, ESM HealthCare Industry Framework (HCIF) Core PRPC Foundation 4

5 Pega & Cognizant HealthCare Journey Tomorrow Digitization New Horizons Cognitive BPM Machine Learning Automation Workforce Intelligence Robotic Desktop Automation Robotic Process Automation 5

6 Pega & Cognizant HealthCare Journey Delivered Benefits Claims 80% 75% Reduction in processing time Reduction in claims processing time 10% 98% Reduction in IT cost for claims processing Reduction in time for duplicate claims check Care Management 100% 71% CMS Compliance Reduction in time for User Training 80% 100% Reduction in TAT Call Adherence Enrollment Reduction in 50% Onboarding Time 100% End to End Traceability Provider Network Management 66% Reduction in Process Step Count Reduction in 90% Turn Around Time Customer Service 35% Reduction in Average Call Handling Time Increase in Number of 24% Requests Handled 6

7 Blue Cross Blue Shield of North Carolina + North Carolina s largest health insurer + Founded in Employ more then 4,700 North Carolinians + Serve more than 3.89 million members 7

8 Culture of Continuous Process Improvement Business Process Excellence Department 8

9 Business Process Improvement What gets measured gets managed. Peter Drucker Input Measures Process Measures Output / Outcome Measures 9

10 Value Stream Management Alignment of Process Hierarchy and Process Measures 10

11 Sign Me Up Value Stream New Sales Renewal Sales Membership Operations personnel update their status in multiple locations using various systems and spreadsheets so Sales Representatives and Operations Management can keep track of group and member enrollment Account Implementation activities. Fulfillment (ID) Fulfillment (Booklet) 11

12 Account Implementation Member Enrollment (AIME) AIME Project Objectives Eliminate the need to perform manual work in multiple systems and various desktop tools used to track and report work progress Provide Executive Dashboards for Key Performance Indicator tracking and Operational Metrics Streamline the end to end process and use data captured during the process to dynamically change the step assignments in real time to maximize efficiency Integrate our SFDC and PEGA technologies to manage hundreds of steps performed by over 165 users across the Enterprise 12

13 Transition from Process / Measures to Pega / SLA Business Process Consultants and IT Systems Analyst Partnership Top Case Assignment Sub- Case System Setup Planning Business Requirements Functional Requirements Tech Design & Development Testing Go- Live 13

14 AIME Architecture 14

15 AIME Case Management AIME Pre Sale Post Sale Enrollment Custom ID Custom Booklet Legend Top Case Sub Case Assignment Pre Sale CGS Submit GEO Discovery Call Complete Group Level Submit ID Card Request Build Custom Booklet Template Case / Sub Case q Process SLA (Lead Time) Assignment q Individual SLA (Cycle Time) q User Interface 1515

16 AIME Screenshot SLA Configured by Business Sub-Case / Assignment SLA Direction SLA Dynamic Rules SLA Measures: Goal / Deadline, Unit & Notify 16

17 AIME Screenshot Workbasket Assignments Case, Sub-Case and Assignment Deadlines Drive Priority Business Can Also Set Priority SLA Deadlines Set Assignment Priority 1717

18 AIME Screenshot Search Group Implementation Status 18

19 AIME Screenshot Enrollment Tracking 19

20 AIME Dashboard Real Time Six Sigma Real Time Tracking: Lead Time Cycle Time Resource Utilization SLA 20

21 AIME Outcome AIME was delivered in 6 months with BCBSNC resources and Cognizant onshore and offshore resources AIME consist of seven sub-cases with over 50 assignments and tracks activities of over 165 users across the Enterprise AIME delivered $1.1M cost savings by eliminating waste Sales staff spent over $500K worth of their time checking on status Operations staff spent over $600K of their time manually reporting status 21

22 IT and BPE Joint Assessment Methodology As-Is Process Mapping Observation & Data Collection Data Analysis Process & Technology Proposals Business Benefits & Roadmap Solution Recommendation 22

23 THANK YOU QUESTIONS?