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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 OnboardingEn

rollm

ent

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 Carolina’s 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 Requirements

FunctionalRequirements

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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