Improving Consumer Service Operations Excellence

Transcription

1 Improving Consumer Service Operations Excellence Tom Ptashnik, Director, Consumer Strategies and Business Process Management Leslie Dickens, Vice President, Corporate and Product Strategy Suzie Bushart, NCompass Service Strategy Blue Cross Blue Shield of Michigan NASCO

2 Agenda Who is NASCO? What is NCompass NCompass Strategy BCBSM Service Operations Impacts 2

3 NASCO provides comprehensive core administration solutions exclusively to the Blues.

4 Products and services that can be customized to meet specific business needs and market challenges Innovation driven by Plan collaboration and shared investment A leveraged environment that provides a competitive cost advantage 4

5 5

6 What is NCompass 6

7 NCompass SM is everything a Customer Service Representative needs 7

8 8

9 What is NCompass NASCO Consumer Servicing Service Excellence (anticipate & navigate) Pega based & Blue Enabled NCompass leverages Pega s CSHC solution. NASCO has worked with our Plan customers to configure Blue capabilities that are available out of the box with the solution. NCompass Consumer Servicing Multi-tenant & Shared Asset Governed NCompass is a multi-tenant, shared Blue asset which lowers the total cost of ownership. NASCO works closely with our Plan customers to identify capabilities that are common for all Plans in our base layer while allowing unique Plan customizations in the Plan layer. Integration Capability NASCO s digital connector capabilities and the NCompass Common Information Model allows for data use from multiple sources NASCO and Plan solutions to provide real-time information, (e.g., enterprise service business, service tier, operational data stores, service events) 9

10 What Comprises NCompass Out of the box, NCompass is a fully realized Customer Servicing Platform for Blue business with Base Capabilities developed and deployed in a multi-tenant architecture hosting each Plan within their own environment stack allowing them the flexibility to customize where needed. Pre-packaged Blue Service Intents Product Architecture Integration Architecture NCompass Roadmap NCompass COE 10

11 Pega Applications Product Architecture NASCO, has designed the Pega based architecture to be a best-practice model that builds upon the Pega framework, utilizing a common product integration layer and common information model, and augmented by a Plan implementation layer to support Plan-specific requirements. Plan Impl. NASCO Base Product Layer MI NCompass Product (NASCO Customer Services) NASCO Enterprise Layer CS-HC (Customer Service Solution for Healthcare) CF HZ AN MA Michigan CareFirst Horizon Anthem Mass Admin Portal (User Driven Capabilities) CIM (Data Models) Navigator (NASCO Inventory/Workflow Mgmt Solution) INT (Integration Rules) Claims Repair WORK (UI, Flows, Activities, Cases, etc.) Claims Workstation NASCO ESB Michigan ESB CareFirst ESB Anthem ESB Pega Foundation Software Products CS (Customer Service Solution) HCIF (Healthcare Industry Framework) Pega Base Capabilities (BPM, BRE, Case Management, Decision Analytics, Mobile, Reporting, Integration, etc.) Massachusetts ESB 11

12 NCompass Blue Plan Adoption BCBSM Member Svc for large group BCBSM Member Svc for individual market & small group Provider Servicing CareFirst Member servicing for large group BCBSM Backlog enhancements BCBSMA Member servicing for all market segments Provider servicing Horizon BCBS Member servicing for all market segments Provider servicing 12

13 NCompass Strategy 13

14 Employers Expect/Demand a Positive Impact on Medical Cost Trend for their Employees Theme Description Examples Personalized Healthcare Care Models (PODS) & Member Centric Care Management Slice Vendors As members and patients take on more of the cost of care, they have greater demands to healthcare content to help them manage & improve their health. Employers desire care models that are catered to their employees. Payers must have strong member centric care & population health mgmt solutions to impact medical trend. Growth of niche players who offer concierge like service & care to employees. Disintermediates role of payer in the care & servicing of members. Integrated Care Teams 14

15 Demand & Needs for Concierge Servicing Range Across Employers & Providers National Accounts and individuals demand a service engagement that: Provides high-touch & high-tech capabilities. Provides care team models, POD models to focus on care management of the employees (stay healthy, manage chronic diseases, support acute care scenarios) Tighter, high performing networks Blue Challenges: Forming and administering narrow/tiered high performing networks Ability to bring the necessary data and information to bear to drive the necessary analytics & decision management required by employers Competition increase in venture funding drives more slice competitors which erodes Blue Plan membership and stickiness. Loss of consumer/member engagement risks long-term loss as employees age into Medicare products. Value Based Arrangements are proliferating as part of the BCBS Plan Healthcare Value Strategy As risk is being shifted, responsibilities traditionally held by the payer care coordination & management, referral management, etc. are transferred to the providers. Consumer/member engagement is a key strategy for Blue Plans Blue Plans must differentiate themselves from the providers through leveraging their data assets and developing analytic and decision management capabilities to prove out the value of their products and networks. 15

16 Continuum of Customer Servicing Today s Customer Service Limited Self Service options (Chat, web/self service) Performance measured via traditional metrics: Average Speed to Answer (ASA) Average Handle Time (AHT) Service Level Occupancy~70% - 90% of requests require voice support Legacy Call center technologies Responsive Customer Service Ability to drive consistent guided processes for CSRs Ability to have all needed information at the CSRs fingertips. Ability to service members across all channels text, chat, phone, mobile, social. Ability to track & report Group s SLAs NCompass, including chat, Social, co-browse + Consumer Servicing Hub + AskBen + Pega Marketing Proactive Customer Service Multiple channels of engagement Ability to support speech analytics Ability to launch & manage campaigns Integrated servicing teams POD models High touch; community support models, POD models for points that require it High tech self service Concierge Servicing More holistic view of member during care journeys Data to plug into Plan s population health mgmt and care mgmt Integration & availability of must be solid Innovation, Automation and artificial intelligence at the core Rich analytics & decision management to support proactive care Self Service options to enable 24x7 resolution Modern channels of support Enhanced Operational metrics Plug into patient experience solutions and portals Availability to Data Strong Analytics Care Mgmt Decision Support 16

17 Consumer Servicing Hub Create experiences that add mutual value Customer Interaction History Data About Customer Customer Identification & Matching Next Best Actions Proactive / Reactive Customer Profiles & Journeys Propensities, Scoring & Modeling Information Insight Action Orchestrate Across Channels Design Actions, Offers, & Triggers Centralize Strategies & Rules 17

18 Consumer Servicing Hub Platform: Balancing Every Engagement, In Real-time HTTP Channels Customer Needs Modern channels of communication & support Relevant Timely Contextual NCompass Servicing Hub AskBen Sales Service Retention Business Objectives Leveraging customer context - to deliver preemptive service in real-time. Am I covered Consistent Risk 18

19 NASCO Consumer Roadmap Objectives Member Servicing Provider Servicing Support Plan implementations Complete Upgrades Grow Adoption Conduct Proofs of Concept Support Plan deployments at BCBSM, BCBSMA, Horizon, and CareFirst Initiate NCompass discussions with at least one additional Plan NCompass fully deployed at BCBSM Research AskBen (real-time claims estimation) deployment options Finish Current Plan Implementations Pilot New Features Grow Adoption Consumer Servicing Hub Support Plan deployments at BCBSMA, Horizon, and CareFirst Support Steady State model with BCBSM and CareFirst Pilot deployment with one additional Plan Expand to NCompass to BCBSMA and CareFirst Partner with Plan to develop processes for self service with AskBen Plan Implementations Consumer Servicing Hub Automation Support Plan deployments at BCBSMA and Horizon Support Steady State model across all Plans Support Growth Office activities to add additional Plans Expand NCompass to Horizon Expand AskBen capabilities OMNI-channel Partner with Plans on SMS Text and Chat initiatives Research Portal integration capabilities Evaluate POC for SMS Text functionality & Portal integration POC Deploy Portal integration to additional Plans Reporting Complete Informatica extracts for BIX reporting Expand Informatica extracts for other Plan customers Expand Informatica extracts to BCBSM Base Env. & Pega Upgrades Marketsegment Specific Capabilities Concierge Servicing Upgrade CareFirst BCBS to the Pega platform Maintain Base environment Research Medicare Advantage Service needs Consumer Servicing Hub (CSH) POC Planning Research Concierge capability requirements Upgrade BCBSM to the Pega platform Maintain Base environment Assess future Pega versions for upgrade path Develop and deploy Medicare Advantage capabilities at BCBSMA and Horizon Develop and deploy CSH POC at partner Plan Enable servicing capabilities to support Concierge servicing in NCompass Upgrade NCompass Base to new Pega version Maintain Base environment Expand Medicare Advantage capabilities to other Plans Expand CSH models and to additional Plans Expand Concierge servicing to other Plans Robotics Pilot Workforce Intelligence (WI) with a Plan customer. Deploy WI at partner Plan and develop Robotics plan based on results Develop and deploy initial robotics models Expand WI to other Plans Expand Robotics capability models 19

20 BCBSM Service Operations Impacts 20

21 BCBSM NCompass Roadmap BCBSM is closing a multi-year journey to develop NCompass, a next generation customer service desktop application built on the Pega platform. 21

22 BCBSM Pre/Post NCompass Servicing Improving consistency in customer engagements, reduced quality concerns, reduced rework, improved efficiencies Disparate processes across mult. service centers System driven processes force standardization of inquiry handling High complexity to accurately handle less common work paths Misrouted work & inefficient manual screening process to back office areas High complexity in appropriately handling SLAs based on work type & different customer groups System driven processes lead user through less common work paths Pega automated work routing rules ensures user cannot incorrectly send assignments to unintended recipients Pega automated work routing rules replace previous manual screening/routing process Pega assignment level SLAs and urgency rules systematically identify how to prioritize work to ensure customer expectations are met Low visibility/reporting into multiple work types Pega audit trail/history provides data at any step in process determined to be relevant 22

23