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

    AuthorTitle

    Cognizant & BCBSNC: Leveraging Pega Platform to Deliver Innovative Quote to Card Solution Using Six Sigma Techniques

    2016 Pegasystems Inc.

    Jim FultonDirector, IT Delivery, BCBSNC Harish DwarkanhalliVice President, CognizantDev VictorienEngagement Leader, Cognizant

  • Pega & Cognizant HealthCare Journey:

    2

    Yesterday

    Tomorrow

    Today

    Business Process Management (BPM)Business Rules Management (BRM)Case Management (CM)

    Customer Relationship Management (CRM)Customer Experience Management

    DigitizationAutomation

    New Horizons

    PRPC & Frameworks

    Decision Hub

    CHANGED How Process & Rules

    are Managed

    CHANGING How Relationship & Experience

    are Managed

    WILL CHANGEHow Business is

    Automated & DigitizedYesterday-Today-Tomorrow

  • Clai

    ms

    Claims Intake

    Pre-Processing

    Benefit Adjudication

    Post-Processing

    Pega & Cognizant HealthCare Journey

    3

    Member Data Input

    Group Setup

    Member Setup

    Member OnboardingE

    nrol

    lmen

    t

    Prospecting

    Provider Data Maint

    Credentialing

    Contracting

    Prov

    ider

    Net

    wor

    k M

    anag

    emen

    t

    Utilization Management

    Disease Management

    Case Management

    WellnessCare

    Man

    agem

    ent

    Core PRPC FoundationHealthCare Industry Framework (HCIF)

    Additional Frameworks GSPM, ISPM, PCS, CW, CR, SCE, CMF

    Yesterday (BPM, BRM, CM) Heat Map

  • Core PRPC FoundationHealthCare Industry Framework (HCIF)

    Decision Hub DSM, PAD, ADM, VBD, ESM

    Pega & Cognizant HealthCare Journey

    4

    Mar

    ketin

    g

    Market Study

    Plan Creation

    Marketing Collateral Management

    Campaign Management

    Census Management

    Lead Management

    Quote Generation

    Negotiation & Closure

    Sale

    s

    Cus

    tom

    er S

    ervi

    ce

    Contact Center

    Appeals and Grievance

    Member Portal

    Member Communication

    Today (CRM, CX) Heat Map

  • Pega & Cognizant HealthCare Journey

    5A

    utom

    atio

    n

    Dig

    itiza

    tion

    New

    Hor

    izon

    s

    Cog

    nitiv

    e B

    PM

    Workforce Intelligence

    Robotic Process Automation

    Robotic DesktopAutomation

    Mac

    hine

    Lea

    rnin

    g

    Tomorrow

  • Pega & Cognizant HealthCare Journey

    6

    Clai

    ms

    Reduction in processing time80%

    Reduction in claims

    processing time75%

    Reduction in IT cost for claims

    processing10%

    Reduction intime for duplicate

    claims check98%

    CMS Compliance100%

    Reduction in time for

    User Training71%

    Reductionin TAT80%

    CallAdherence 100%

    Care

    Man

    agem

    ent

    Enro

    llmen

    t

    Reduction in Onboarding Time50%

    End to End Traceability100%

    Prov

    ider

    Net

    wor

    k M

    anag

    emen

    t

    Reduction in Process Step

    Count66%

    Reduction in Turn Around Time90%

    Reduction in Average Call

    Handling Time35%

    Increase in Number of

    Requests Handled 24%

    Cust

    omer

    Ser

    vice

    Delivered Benefits

  • + North Carolinas largest health insurer

    + Founded in 1933

    + Employ more then 4,700 North Carolinians

    + Serve more than 3.89 million members

    Blue Cross Blue Shield of North Carolina

    7

  • Culture of Continuous Process Improvement

    8

    Business Process Excellence Department

  • Business Process Improvement

    9

    Input Measures Output / Outcome MeasuresProcess Measures

    What gets measured gets managed. Peter Drucker

  • Value Stream Management

    10

    Alignment of Process Hierarchy and Process Measures

  • Account Implementation Fulfillment (ID) Fulfillment (Booklet)

    Renewal Sales MembershipNew Sales

    Sign Me Up Value Stream

    11

    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 activities.

  • Account Implementation Member Enrollment (AIME)

    12

    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

    AIME Project Objectives

  • Transition from Process / Measures to Pega / SLA

    13

    Planning Business RequirementsFunctional

    Requirements

    Tech Design &

    DevelopmentTesting Go-Live

    Assignment

    TopCase

    Sub-Case

    SystemSetup

    Business Process Consultants and IT Systems Analyst Partnership

  • AIME Architecture

    14

  • Assignmentq Individual SLA

    (Cycle Time)q User Interface

    AIME Case Management

    1515

    Case / Sub Caseq Process SLA

    (Lead Time)

    AIME

    Pre Sale Post Sale Enrollment Custom ID Custom Booklet

    Pre SaleCGS

    Submit GEO

    Discovery Call

    Complete Group Level

    Submit ID Card Request

    Build Custom Booklet Template

    Top CaseSub CaseAssignment

    Legend

  • AIME Screenshot SLA Configured by Business

    16

    SLA Measures: Goal / Deadline, Unit & NotifySLA Dynamic RulesSLA DirectionSub-Case / Assignment

  • AIME Screenshot Workbasket Assignments

    1717

    SLA Deadlines Set Assignment PriorityBusiness Can Also Set Priority

    Case, Sub-Case and Assignment Deadlines Drive Priority

  • AIME Screenshot Search Group Implementation Status

    18

  • AIME Screenshot Enrollment Tracking

    19

  • AIME Dashboard Real Time Six Sigma

    20

    Real Time Tracking: Lead Time Cycle Time Resource Utilization SLA

  • AIME Outcome

    21

    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

  • IT and BPE Joint Assessment Methodology

    22

    Observation & Data Collection

    As-Is Process Mapping

    Data Analysis

    Process & Technology Proposals

    SolutionRecommendation

    Business Benefits & Roadmap

  • THANK YOU

    QUESTIONS?


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