85 million individuals UnitedHealthcare Optum 50 states No. 14 Named World s Most Admired Company Member, Dow Jones Industrial Average

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3 About UHG Serving more than 85 million individuals worldwide with health benefits and services UnitedHealthcare and Optum serve members in all 50 states in the United States and more than 125 other countries 2013 revenues of $122.5 billion Fortune 500 ranking: No. 14 Named World s Most Admired Company in the Insurance and Managed Care sector, 2011, 2012, 2013, and 2014, by Fortune Member, Dow Jones Industrial Average 3 3

4 UHG Operating Model Helping People Live Healthier Lives Employer & Individual Medicare & Retirement Community & State Military & Veterans Health Benefits Collaboration Health Services Benefits OptumHealth OptumInsight OptumRx Foundational Competencies Expertise in clinical care management and access Advanced, enabling technology Health data with actionable health intelligence 4

5 Process Complexity 1 Hard to access Too many system of records. End-to-End visibility constrained 2 Too many features Scope creep (or feature creep) to business solutions 5 Bad usability Lacked being intuitive, engaging, and overall user-friendly 3 Inconsistent design Lacked reusable components repository 4 More Tools Multiple tools used across the enterprise 5 5

6 Organizational Transformation Organization Alignment Socialization Cost Capital Training Centre of Excellence (CoE) Why not try Pega? 6

7 Pega Journey Jointly working with Pega on a new initiative using Pega Mobile product 2015 ~ 150K Users* 100K Users 2014 Enterprise contact renewed Strengthened the relationship through value based programs Doubled the user base 100, Established a strategic partnership with Pega 120 Users 2011 Established BPM Center of Excellence (CoE) Established BPM focused program 20K Users 2012 Socialized and evangelized BPM as a discipline across UHG Created an End to End workflow ecosystem for Medicare & Retirement business 50K Users 2013 Successfully implemented 30+ programs with substantial ROI Increased Pega user base to 50,000 Large multiyear programs initiated to improve the provider experience * - Internal & External Users 7

8 What was our Journey to Maturity? The BPM CoE roadmap was laid out in 3 phases with clearly identified goals for each phase which helped us to demonstrate tangible value at quick intervals, prioritize the resources on hand and improve continuously. Wave-1 Wave-2 Wave-3 Ships at Sea Skin in the Game Lessons Learned BPM CoE Foundation 2011 BPM Maturity Optimize BPM delivery Create enterprise vision and roadmap 2. Invest in core team of experts and engagement model 3. Develop core assets and services 4. Engage with key programs 5. Establish H/W & S/W infrastructure 1. Engage with key programs and demonstrate value through business outcomes 2. Establish governance 3. Measure return on assets and services Improve 4. Assess BPM maturity 5. Build scalable delivery model 1. Measure BPM ROI at enterprise level 2. Align BPM programs to enterprise Blue chip initiatives 3. Build enterprise models for next generation UHG 4. Optimize cost of delivery and infrastructure 8

9 Lessons Learned (Top Three) Risk Lesson Learned Comments Parallel future state process technology and business change implementation Begin to implement the business process changes prior to engaging IT development resources and technology delivery The business change program was not able to accelerate to meet the future state process at the same time the technology was ready Agile delivery methodology poses significant learning opportunities for business and IT organizations End users to work within the guardrails of the defined process flow End users adoption of the future state process is challenged by the limitations presented to them by the defined guardrails Iterative application development mythology requires unique skills & training that program teams (IT and Business) need to obtain prior to the engagement Organizations where adoption risk of the new process is high, future state change management becomes increasingly important to foster adoption of the increase monitoring and decreased opportunity for process deviation Limited exposure to the new methodology (Agile) Interaction between the development team & business was not as frequent as most agile programs BPM guardrails for process flows are essential to increase quality, efficiency and accuracy of the work performed. High resistance by the user community on adoption. Missed a focused change management initiative 9

10 End 2 End Issue Management Salient Features Add capabilities to M&R Issue Tracking System including time stamps and modifications Adopt an end-to-end Interaction and Issue Management approach to handling and resolving issues, including visibility downstream Demonstrate resolution and closed loop with the member when the issue is resolved Ability to track all actions and update category universe reporting in a single case file Business Opportunity The objective of MIIM is to consolidate issue tracking, systematically flag date and time on every record, and provide an end to end single source for case management. This solution ensures a more consistent member experience as well as improved CMS compliance

11 Improving Provider Payer Collaboration in the cloud Business Opportunity Eliminate complexity, through strategic collaboration, to simplify business interactions for our Care Providers. Simplify administrative processes and increase self-service for care providers and reducing operational costs Salient Features Provider-Payer interaction in the cloud Member eligibility check Member benefits lookup Claims reconsideration Extendible to other provider-payer interaction point Backend benefits platform agnostic Personalized provider portal experience Improved operational efficiency Multi-tenancy capabilities 11 11

12 BPM Results - Pega Benefits Adoption Rate Capital Programs $ Significant Benefits on programs delivered 200K Increase in User base in Programs Delivered across Enterprise 9x IMPROVEMENT in physician contracting cycle time ~100% GROWTH YOY New and improved capabilities enhancing the relationship with our members in every interaction BPM ENTERPRISE STANDARD Discipline across Enterprise 700+ PEGA TRAINED FTE s EXPANDING USER BASE CAPITAL ENABLEMENT People/Process/VoC Delivered critical programs to improve provider experience 12

13 Key Programs Delivered Member Track member and provider appeals, grievances and disputes across multiple business segments(icare) Increased auto-adjudication for complex claims (EAS) Improve TRICARE referral /utilization management efficiency through workflow automation and streamlined processes Provider Provider Self Service Journey (PTP/LINK) End-to-end workflow tool to support physician contracting operations and provider demographic maintenance (Phycon) Prior Authorization System used by pharmacist and technician help desk for Prior Authorization request processing. This system captures approve, denial and appeal Prior Authorization (PAS) Fulfillment Modernize and Simplify the M&R electronic enrollment experience for consumers and sales agents through creating a uniform front-end, product agnostic enrollment solution (LEAP) Contact and case management application to track Medicare & Retirement Sales Producer service and sales oversight activity (PCL) Call Center End-to-End issue management system(miim) Integrated customer service application that allows users to access relevant information from multiple sources through a single, consistent, and simple tool encompassing workflow and case management for the purpose of delivering quality service to constituents and addressing callers needs. (APEX)

14 Q & A