healthcare payer solution: enable consumerism - oracle · merger integration ... “the blues are...

Healthcare Payer Solution: Enable ConsumerismPresenter’s NamePresenter’s Title

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The following is intended to outline our general product direction. It is intended for information purposes only, and may not be incorporated into any contract. It is not a commitment to deliver any material, code, or functionality, and should not be relied upon in making purchasing decision. The development, release, and timing of any features or functionality described for Oracle’s products remains at the sole discretion of Oracle.

Safe Harbor Statement

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• Leadership in Healthcare

• Innovation in Healthcare Solutions

• Results Achieved by Oracle Customers

Agenda

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Oracle inHealthcare

Did You Know?

20 of the top 20 US Health Insurers run Oracle Applications

10 of the top 12 Fortune Global 500 healthcare organizations run Oracle Applications

More than 350 leading healthcare providers run Oracle Applications

More than 80 Healthcare Payers run Oracle Applications

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Address Post-merger Integration and Governance

“How can my organization face industry consolidation and continue to meet increasing national and regional governance demands?”

“Our enterprise applications are strategic, allowing Wellpoint to quickly integrate acquisitions and still meet regulatory requirements.”

“How can I make healthcare information transparent through self-service channels so that customers are empowered to make the right health choices?”

“The Blues are committed to developing long-term and thoughtful policy solutions to the challenges of rising healthcare costs and the growing number of uninsured Americans.”

Enable Consumerism

Create An Agile Profitable Business

“How do I respond rapidly to a dynamic market and improve profitability?”

“Companies that operate in many different markets need to accurately address the profitability of members and adjust rates accordingly."

The Challenges We’re Hearing

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• “Consumerism in health care is based on the idea that individuals should have greater control over decisions affecting their health care”

• As consumers share less of the direct costs of healthcare they become less concerned about costs

“How can I make healthcare information transparent through self-service channels so that customers are empowered to make the right health choices?”

“The Blues are committed to developing long-term and thoughtful policy solutions to the challenges of rising healthcare costs and the growing number of uninsured Americans.”

Enable Consumerism

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40

50

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1960 1980 2000

Share of NationalHealthExpenditures Paidby Consumers

The Challenges We’re Hearing

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Enable Consumerism

Requirement Oracle Capability The Oracle Difference

Understand provider quality metrics to support pay for performance

Healthcare Business Intelligence

Most complete set of capabilities to support pay-for-performance initiatives

Support collaboration amongst the plan, providers and members

Healthcare Information Exchange (HIE)

Only next-generation, standards-based technology for meaningful healthcare information exchange

Create effective medical management programs

Claims Service,Member Outreach, Claims Intelligence

Most advanced analytics to target member populationsfor medical outreach

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Enable Consumerism











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Three Key Customer Challenges

Improving Customer SatisfactionIncreasingly, customer satisfaction is synonymous with the brandDissatisfaction with any channel causes higher costs A superior customer experience increases retention

Improving ProductivityLeveraging customer “Self-Service” claims via the webSupport online eligibility verificationManaging Health Savings Accounts

Reducing CostsReduce claims adjustmentLessen group administrative burdenEliminate claim re-work Minimize fraud and appeals

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Enable Consumerism Claims Service, Member Outreach

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Enable Consumerism Claims Service, Member Outreach, Claims IntelligenceClaims Service

Network ManagementEnterprise Analytics

BPELBPEL

Enterprise Integration

NetworkNetworkPlanPlan

Oracle Business Intelligence Foundation

ODSSystem

Data Mart

Custom Apps

FileEssbase

Common Enterprise Information Model

BPEL

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Enable Consumerism: Claims IntelligenceLeverage Claims Data

Mine claims data to understand utilization trendsImprove customer service through embedded analytical insightsEnsure network mix and geographic distribution match membership needs

HEALTHCARECLAIMSDATA

ACCOUNT MANAGEMENTUnderwritingPerformance Reporting

MEMBER SERVICESClaims inquiriesCDHP SupportPersonal Health Record

MEDICAL MANAGEMENTWellness ProgramsDisease ManagementCase ManagementUtilization Review

PROVIDER MANAGEMENTClaims InquiriesPerformance AssessmentContract NegotiationsPay-for-performanceNetwork Adequacy Evaluation

PRODUCT MANAGEMENTProfitability by LOB, etc.Benefit Change ImpactPricing

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Case Management / Medical & Utilization Management

Handle Complex Case Management• Multiple distinct case stages• Case Serialization• Case / Sub-Case Management• OOTB support for many case types

Simplify forms processing• Integration to Adobe Form Server• Automatically output Siebel information to

standardized Adobe (PDF) formats

Improve case management and utilization review through Siebel UCM

First and Only Enterprise Case Management Solution

Case management for: fraud and abuse; benefits; adjudication; appeals and grievances

Enable ConsumerismClaims Intelligence

Horizon Significantly Reduces Business Costs and Improves Customer Service

CUSTOMER PERSPECTIVE“We’ve added 200,000 new members while reducing call wait times 20%.”Bill Marino, CEO

COMPANY OVERVIEWIn business for over sixty years, Blue Cross Blue Shield of New Jersey is the largest health care provider in New Jersey. Blue Cross Blue Shield of New Jersey has won many awards, including an award for having the top ranking in the New Jersey HMO Performance Report in 2004 and the 2004 Brand Excellence Award from the Blue Cross Blue Shield Association.As New Jersey’s largest health insurer, Horizon Healthcare Services, Inc. provides coverage to more than 2.9 million people throughout the state.

CHALLENGES/OPPORTUNITIESNeeded to upgrade call center and sales force system to better serve its customersNeeded to reduce administrative costs

SOLUTIONSOracle’s Siebel Call Center

Siebel Sales

Siebel Service

RESULTS• Reduced training for new hires from 20 to

4 weeks• Improved representative productivity by

15%• Reduced call times by 20%• Reduced call wait times by 20%

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Horizon Healthcare Services is #1 with Oracle CRM

March 2005Horizon Blue Cross Blue Shield Of New

Jersey Wins Brand Excellence Award For The Second Consecutive Year

(Newark, NJ, March 17, 2005) – Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) has received a Brand Excellence Award from the Blue Cross and Blue Shield Association for the second consecutive year. Horizon BCBSNJ was selected based on its brand awareness as well as its member experience in its market. Horizon BCBSNJ ranked first among all Blue Cross Blue Shield plans nationwide in member experience, a composite measure of overall customer satisfaction, likelihood to recommend the plan, and likelihood to renew with the plan. Horizon BCBSNJ ranked third in member experience last year.

Horizon Healthcare Services, Inc. Leverages Siebel Healthcare [Oracle] to Earn Number One Ranking for Member Experience; New Jersey's Largest Health Insurer Uses Siebel Healthcare to Provide World-Class Service to 3.1 Million Members

SAN MATEO, Calif. --(Business Wire)-- May 16, 2005 --Siebel Systems, Inc. [now Oracle], the leading provider of customer-facing solutions, today announced that Horizon Healthcare Services, Inc. was ranked number one for Member Experience by independent research firm Synovate. The survey evaluated 62 healthcare markets, and Horizon's performance advantage over its New Jersey competitors was the widest margin of any plan in Synovate's national market research. Horizon is a long-time Siebel Systems customer, and since deploying Siebel Healthcare in 2002, Horizon has achieved year-over-year improvement in its ranking by Synovate, this year earning the number one spot. Siebel Healthcare is designed to integrate member and provider communications channels, consolidate member and provider information across claims systems, and reduce plan administration costs.

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Enable Consumerism











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Pharma and Med Products

RHIO Utility

Provider Citizen

Payer

National and Local Public Health Authorities

• Disease/Bio Surveillance• Outbreak & Countermeasure

Response• Health Alerts• Drug Surveillance• Medical Research• Registries

Concept: Integrated Data Across the Healthcare Ecosystem

•ePrescribing•Referral generation•E.H.R.•Universal scheduling•Cohort ID for research•Clinical quality programs

•PHR•Provider transparency•Treatment options•Disease education•Wellness orientation

•Translational research•Drug surveillance•Clinical data from providers•Post trial surveillance

•Claims processing and payment•Coordination of Benefits•Care management•Provider Management

Information GovernancePrivacy & Security Management

Data Retrieval andData Management

Data Manipulation Services

Data Analytics

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The Challenges and Benefits of Information Sharing

ChallengesMultiple disparate clinical systems resulting in inability to gain clear understanding of care delivered and required across the continuum of care

Cost and complexity of reporting quality metrics due to lack of interoperability

Shrinking workforce and growing patient requirements with potential to adversely impact quality of care

SolutionsDevelop an interoperability platform that supports continuity of care across the continuum, knowledge bases, and evidence based clinical practice

Provide users with business intelligence tools that are able to collate data from across the enterprise/community/globe

Provide clinical decision support tools to ensure patient safety and best practice outcomes

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Oracle’s: Health Information Exchange (HIE)Improve the Accuracy and Availability of Secure Clinical Information

MessageNormalization

(RIM or IHE) Clinical DataWarehouse

TransformMessages

into aCommonFormat &

Route

Normalized Clinical DataRepository

TerminologyNormalization

TranslateDisparate

Vocabularies& Concepts

Clinical Information Reuse

Custom or 3rd PartyApplications

Handheld Support

Regional Health Networks

Message Services

Person Services

Security & Auditing

Healthcare Transaction BaseFMW/SOA Suite DW/SOA Suite/FMW

Security, Access & Identity Management

Clinical Decision Support

Business Intelligence

SourceSystems

Pharmacy

Labs

CIS

KnowledgeBases

Clinics

DataModel

Healthcare Portal / MPI / Knowledge Bases (ISV Partners)

Healthcare specific services architectureStandards based (meaningful clinical data)Web access for patient centered care

MD Office

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Stockholm County Delivers Clinical IT Services using SOA

CUSTOMER PERSPECTIVE“Stockholm County has chosen to implement a Service Oriented Architecture to support future Healthcare IT development because …"Jack Robinson, IT Manager Stockholm County

COMPANY OVERVIEW

Largest county in Sweden, serving 1.9m citizens, namely 20% of the population. Consists of 26 municipalities spread over 6’500 km2 with total Healthcare IT spend of $200m per annumProvide Healthcare services to citizens including 22’000 GP visits, 7’000 hospital admissions, 500 operations, 60 births and 6’000 dental visits per day

CHALLENGES / OPPORTUNITIESComputerised islands of Electronic Medical Record information with over fifteen systems in the county

Many systems developed in the 1970’s and lacking in flexibility

Strong IT departments at each hospital with limited coordination of budgets, developments, projects and procurements

GOALS / SOLUTIONSPatient centered common lifetime medical recordActive self care by the patient (“The Internet Patient”)SOA approach to future systems developmentCommon storage, web services, clinical applications, presentation and security services for Healthcare IT

RESULTS• Basic infrastructural building blocks,

including common storage, services, application and portal layers developed

• First pilot rollout to group of GPs underway, with live patient data

• SOA platform will enable consolidation of existing applications with increased quality of service and enable the vision for ‘One Person, One Health Record’

• <Plus quantifiable business benefits>

Stockholms läns landsting

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Son Dureta Delivers Meaningful Clinical Data to Clinicians

CUSTOMER PERSPECTIVE“Hospital Son Dureta has chosen to implement a normalized clinical database combined with web-based clinical applications with technology from Oracle Healthcare and Orion Health because we believe that this offers the most solid IT platform to assist our clinicians in their work.”Joan Marquès Faner, CIO, Son Dureta

COMPANY OVERVIEWLargest health facility in Spain’s Balearic Islands, operating 900 beds and employing 3600 people across 5 facilities, hosting the islands’ reference laboratory, used for specialist tests that cannot be performed elsewhere.

Generates over $6 B in yearly revenue and employs over 26,000 people

CHALLENGES/OPPORTUNITIESDifferent IT systems (LIS, RIS, HIS) operate independently; clinical data is stored in a multitude of formats and terminologies vary between departmentsDoctors in emergency room only receive information onpaper from triage zone, orders are made on paper andhanded to lab and radiology, doctors need to wait for testresults to arrive on paperThe current systems cannot be adapted to store new typesof information such as imaging

SOLUTIONSOrion Health and Oracle Solution

Oracle Healthcare Transaction BaseOrion Health Rhapsody Integration Engine and ConcertoClinical apps portal (including CPOE)CDRED apps with integrated clinical data

RESULTS• Integrated and relevant clinical data is

stored in a comprehensive standards-based repository

• Clinicians can search and view information and order tests electronically through a clinical web portal

• An electronic display shows up-to-date information about patients currently in the emergency department

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Biobank Will Improve Clinical Research with Oracle Applications

COMPANY OVERVIEWThe UK Biobank project is set to become one of the world’s largest resources for studying the role of nature and nurture inhealth and disease It involves collecting biological samples and data on the medical history and lifestyles of up to half a million participants ages 40-65 and monitoring their health changes over a 30-year periodThe results will help researchers understand the biology of health and disease and could lead to the prevention and cure of many later-life disorders

CHALLENGES/OPPORTUNITIESBuild a secure repository to protect the confidential medical, health, and lifestyle data collected on participant and ensure that access to it is restricted to authorized parties

SOLUTIONSHealthcare Transaction Base (HTB)Oracle Access, Security and Identity ManagementOracle DatabaseOracle partner JoraPh Consulting

EXPECTED RESULTS• Scalable healthcare information

repository• Integrated and comprehensive view of

patient information• Integration of clinical record data with

30 year research study• Best of class data access, identity

management and security• On time and on budget implementation

February 2007

CUSTOMER PERSPECTIVE“We chose Oracle Healthcare Transaction Base for its robust, high performance infrastructure, proven functionality, compliance with national an international protocols, and adherence to the strictest, globally recognized data access and security standards.”Steve Walker, Chief Information Officer UK Biobank

http://www.ukbiobank.ac.uk/

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Centers for Medicare and Medicaid Services

COMPANY OVERVIEW• The Medicare and Medicaid programs were signed into law

on July 30, 1965. The most significant legislative change to Medicare--called the Medicare Modernization Act or MMA--was signed into law on December 8, 2003. This historic legislation added an outpatient prescription drug benefit to Medicare. Medicaid provides health care services to low-income children and families, caretakers, elderly, the blind and individuals with disabilities. It includes numerous servicesincluding periodic screening, pregnant women and infant care and a prescription drug rebate program.

CHALLENGES / OPPORTUNITIES• Provide a “document” centric view of the data in Oracle COTS

financial modules• Trace a source document form initiation to completion and

track all related financial and non-financial activity• Automate manual processes to facilitate customer service

support• Improve technology performance• Enhance functionality• Meet Federal mandates

SOLUTIONS• Oracle eBusiness Suite• Oracle Application Server 10g

CUSTOMER PERSPECTIVE“Under John Stanley’s direction (Oracle) the custom HTB ETL component was re-architected and fortified to meet rigid operational standards and guidelines required by CMS for production implementation. This effort culminated in the recent production go love of the HTB solution for HIGLAS on May 1, 2007 for one of the Medicare contractors. The remaining contractors are targeted to be transitioned to the HTB production solution by September 30, 2007 which coincides with the end of FY07 for CMS.”

RESULTS• Achieved an additional $9 million of interest earned

in trust funds during first seven months utilizing Oracle Financials General Ledger

• Document centric view of transactions• Faster access to history of claims• First contractor was implemented smoothly• There was a dedicated Oracle and IBM team

focused on jointly resolving issues; therefore, debugging and fixes were turned around quickly

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Sample Oracle’s Health Information Exchange Customers

COMPANY PROFILE CHALLENGES & SOLUTIONS RESULTSOPPORTUNITIES

Clinical data exchange for lab orders, results, and payment between providers and payers.

Aggregate disparate clinical data from multiple health entities normalized to make it comparable for point of care info and bio-surveillance

Longitudinal EHR & Physician Portal

Dated integration solutions

FMWLive, processing data . Competed against all major IE vendors

HTBBPELOBI

HTBFMW

FMW

Standards based integration platform for M&A growth , modernization, efficiencies

Integrated and normalized clinical data stored in a standards-based repository for clinician search and viewing of lab results, bio-surveillance and consumer empowerment

Better information at the point of care for better quality of care. Just completed User Acceptance Test

Clinical data exchange within and across disparate entities.

AmeriPath

ONC/NHIN Prototype

Louisiana HIE

Military Health System

Children's Health System (Alabama)

Mississippi Medicaid

Data aggregation and content normalization for longitudinal EHR for patient identification, allergies, meds, labs and clinical documentation

Aggregate disparate claims and clinical data; Normalized to make it comparable

Oracle HTBFMWIdentity Management

Oracle HTBFMWAnalytics

Fraud and abuse detection

Aggregation of clinical data

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Enable Consumerism



Healthcare Business Intelligence and Provider Billing








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Strategy Development

Capital Allocation

Revenue Cycle Management

• What services do I make money? Lose money? Why?• In which services should I invest? Divest? Improve financial performance? • How do my hospitals services compare across the health system?• How can I optimize service location? Should I consolidate services?• How can I influence physician behavior to affect quality and efficiency?

• What is my profitability across service lines by hospital?• Where should I focus my cost reduction initiatives? How do I track success?• Why are costs for X service increasing, is it labor, supplies or physician practices? How can we decrease

these costs?• Are patient care processes following protocols? Why not? Is it physician or patient complexity driven?• What physician should set standards for others?

• What impact to my bottom line will a rate change create? Can I afford to sign this managed care contract? Can I afford not to?

• What types, how much and where are my denials originating?• How relative is my pricing to cost? Comparatively throughout my system?• Are my payors paying correctly? Timely?• Can I compare my payors profitability and score them?• Am I charging for all the services I am performing?

Operations Improvement

• What services should I invest capital? What financial return can I expect?• What is the ROI for a capital purchase?• What incremental ancillary capacity will be affected by additional capital purchases?

Hospitals must have reliable information to address strategic decisions as well as daily operational insights in running the business

Copyright © 2007 Deloitte Development LLC. All rights reserved.

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Source System(s)

Excel,Various Report Writers

ERP / Supply Chain

Source System(s)

Revenue Cycle

Source System(s)

CIS

Source System(s)

DSS

End UsersEnd Users

End Users End Users

Decision Makers

End Users

Decision Makers

Decision Makers

Datawatch MonarchReports

CrystalReports

Excel, Proclarity, Others

Ad Hoc Analyses: • Clinical outcomes analysis• Case-mix analysis• Denials management reporting• Expense variance analysis

• Clinical pathway variance analysis

• Medical claims analysis• Financial planning analysis

• Purchasing analysis• Market share analysis and

forecasting• Patient satisfaction analysis

Multiple Audiences Have Resulted in Multiple Reporting Systems and Inconsistent Data


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• Reduction in surgical site Infection rates

• Reduction in inpatient mortality associated with AMI

• Reduction in nosocomial infection rates

• Reduction in ventilator associated pneumonia (VAP)

Clinical Outcomes

Operational Quality

Surgical Patients• Antibiotics administered 1 hour prior to surgical

incision• Appropriate pre-operative hair removal through

clipping• Glucose levels at or below 200mg.dl

AMI• Aspirin at arrival• Beta-blockers at arrival• Thrombolytics within 90 minutes of arrival• Smoking cessation counseling prior to discharge

Patient Safety

• Reduction in adverse events/ 1000 patient days

• Reduction in ADE/ 1000 doses

• Reduction in patient falls/ 1000 days

• Reduction in Type III & IV pressure ulcers/ 1000 days

Service Excellence

• Overall Patient Satisfaction

• Staff and departments worked together as team

• Staff’s efforts to include you in decisions about your treatment

• Overall cheerfulness of staff

• Staff Satisfaction

• RN Turnover rate

Metrics that MatterA Few Representative Examples


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End Users ExecutiveTeam

Information

Quality Management Information

Physician/Clinical Management Information

FinancialInformation

Managed CareInformation

Data Integration(Comprises the processing engine to collect, cleanse,transform, and aggregate data from diffferent sources)

Enterprise Portal(Provides a single, secure and integrated point of access to reports, content, and applications)

Data Aggregation and Storage(Comprises the data repository of historical details and summary transaction data)

Access / AuthorizationPresentation, Personalization

Views Views Views Views Views Value Delivered

Business Intelligence(Provides reporting and analytic capabilities across varying levels of granularity and timeliness (e.g., historical, operational, predictive and what-if analysis) CI

S

Supp

ly C

hain

DSS

Reve

nue

Cycl

e

Infrastructure(Comprises the infrastructure platformto host, maintain and operate the BI solution)

Online Analytical ProcessingPre-Defined Data CubesPre-Defined Reporting

Data ConsolidationHistorical data

Data ExtractionData CleansingData Loading

Data Sources, Real time dataCertain operational reports

Data Acquisition(Comprises internal, external, reference,and shared sources of data)

Hardware, SoftwareNetwork Operations

ERPCISRevenue Cycle Decision Support

Information Management Eco-System


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Acquisition, Integration and TransformationETL, HL7, X12, XML, BPEL, BAM, Workflow, Data Hubs, Terminology Services

Presentation ToolsStandard/Ad Hoc Reports, Dashboards, Event Driven, Balanced Scorecards

Infrastructure ManagementConfiguration, Security, Backup, Scheduling, Identity Management

Actionable IntelligenceIndividualized AccessAccountability

Multiple Tools/ProtocolsCommon FrameworkEnterprise Enabled

Reduced ComplexityImproved PerformanceIncremental Updates

Reduced CostsIncreased SecurityImproved Compliance

Less Integration EffortImproved AccuracyReduced Latency

Virtual Single Instance Scalable, Robust, SecureDICOM Support

Business Intelligence and AnalyticsBusiness Rules, Transactional Processing, OLAP

DatabaseReal Applications Clusters

Content DeliveryAccess Unification, Personalized Portals, Un/Structured, Notifications(Email)

End UsersExecutive

TeamInformation

Quality Management Information

Physician/Clinical Management Information

FinancialInformation

Managed CareInformation

Views Views Views Views Views Value Delivered

Oracle Infrastructure for B.I.Comprehensive Solution from a Single Vendor


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Impact of Having Provider Performance Data

Impact on Payers

• Transparency to stimulate provider accountability and improvement

• Improve compliance with guidelines, evidence-based practice and reduce variation

• Direct members to high performing providers

• Continued refinement of reliable, defensible measures supported by sufficient sample size, available data, and balanced framework

Impact on Employers

• Consumer cost, efficiency and quality awareness

• Informed purchasing and selection of services

• High performing provider networks that reduce medical costs and improve outcomes

• Meaningful measures that differentiate performance

• Measure individual providers to differentiate performance


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Oracle Business Intelligence–What is it?

• Comprehensive Suite of Enterprise Analytic Applications across Front and Back Office

• Actionable Information for All Users

• Rich, Real-time Insights from All Enterprise Data

• Next Generation BI Platform

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Business IntelligenceGain Insight Into Patient Conditions, Treatments and Outcomes Achieved

OracleBI Server

OLTP & ODSSystems

Data WarehouseData Mart

OraclePeopleSoft, Siebel,

Custom Apps

FilesExcelXML

BusinessProcessEssbase

Multidimensional Calculation and Integration Engine

Intelligent Caching Services

Intelligent Request Generation and Optimized Data Access Services


Ad-hoc Analysis

Interactive Dashboards

ProactiveDetectionand Alerts

MS Office& OutlookIntegration

Reporting & Publishing

Disconnected& MobileAnalytics

Data Integration

Essbase Analytics

Extended and Unified Clinical/Business Intelligence Infrastructure

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Oracle’s BI Product Strategy• Integrated Business Intelligence Database

• Business Intelligence & Data Mining Functions Integrated in Database• Integrated Business Intelligence Tools

• Best-of-Breed, Next Generation Business Intelligence Technology Platform• Integrated Analytic Applications

• Enterprise Wide, Industry Specific Analytic and Corporate Performance Management Applications

• Fastest Time to Value & Lowest TCO• Pre-packaged Performance Management & Analytic Applications• Across Siebel, PeopleSoft, e-Business Suite, JDEdwards, & other systems

Utilizes Any Information Technology Environment

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An Enterprise Performance Management System

Oracle Business Intelligence Foundation

OLTP & ODSSystems

Data WarehouseData Mart

OraclePeopleSoft, Siebel,

Custom Apps

FilesExcelXML

BusinessProcessEssbase


Reporting

Modeling Planning Budgeting FinancialManagement Consolidation Scorecards

PlanningOperational BI

Clinical ClinicalAnalytics

HumanResources

Order Management& Fulfillment

SupplyChain

Service &ContactCenter

Scorecarding


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BI Accelerator Defined

What is the B.I. Accelerator?

• Business Intelligence accelerator for Healthcare Providers – “Provider BI IndustryPrint”

• Pre-built toolkit containing 1. Preconfigured Data Model in Oracle DW2. Templates for 40+ Reports/Dashboards 3. Repository of over 250 KPIs

• Encompasses four subject areas• Clinical Quality and Patient Safety• Revenue Cycle• Supply Chain• Decision Support

• Built on Oracle utilizing• Data warehouse technology• Business Intelligence• Portal presentation layer

• A demo to see an example of the end game

What does the B.I. Accelerator enable?

• Integrated Performance Management across Healthcare operations

• Granular data analytics for decision making by hospital administrators

• Performance Measurement by service lines, DRG, departments, payors, physicians, etc.

• Extensibility for future expansion of metrics and subject areas

• Scalability across the health system and “one-stop” solution for all business intelligence needs

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Blue Cross Blue Shield of Florida Reduces Time and Cost of Data Analysis

CUSTOMER PERSPECTIVE“Before we installed [Oracle] Siebel Analytics, .. we had to hire consultants to do the job, at a cost of $1,000 per report…Now we’re generating the reports on our own and saving about $4 million a year – the turnaround time is down to approximately three days.”Lisa Davis, Manager of Enterprise

Business Intelligence

COMPANY OVERVIEWBlue Cross and Blue Shield of Florida (BCBSFL), a leader

in the state’s health industry, serves more than 8.3 million people and holds a 29 percent market share, more than double the nearest competitor. BCBSF reported in 2005 consolidated total revenue of $6.97 billion and a profit margin of 4.9 percent. Statewide, the company provides employment for approximately 8,400 individuals in Jacksonville, Miami, Ft. Lauderdale, Orlando, Tampa and Pensacola.

CHALLENGES/OPPORTUNITIESStreamline the labor-intensive, costly and slow data analysis processAccess and analyze data stored in a number of legacy systemsDeliver reports in a timely manner; reduce turnaround time

SOLUTIONSOracle’s Siebel Analytics used by 2,000+ internal employees across the enterpriseIntegrated real-time and historical data from 15+ different database platformsLive after 45 days

RESULTS• Reduced costs of reporting/consultants

by $4 million in the first year• Reduced time for reporting and analysis

from 30-60 days to approximately 3 days or less

• Improved group medical loss ratio • Reduced time for complex security

parameter requirements for HIPAA compliance from 1,000 hours to 20 hours

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The Only Complete Healthcare Solution

PlatformPlatform

PeoplePeopleProcessesProcesses

PartnersPartners

CustomerResults

CustomerResults

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Healthcare Payer Solution Footprint

Partners

Oracle

Most ComprehensiveHighest RatedOnly vendor in Gartner and Forrester leader quadrants for all Middleware components.

Best-Selling••32,000+ Customers Deployed 32,000+ Customers Deployed

••70% of World70% of World’’s 50 Largest Firmss 50 Largest Firms

••$1B+ Business $1B+ Business

SOA Vendor of Choice

Source: Forrester Research ranking of Application Platform Servers, April 2005

Market-Leading Middleware Platform

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950 customers participating in Customer Advisory Boards

500 Industry & Product strategy council members

35 Fusion strategy council members

1,300 participants in early customer adoption programs

425 user groups

30,000 applications customers

220,000 database customers

5,000 middleware ISVs

1,700 application ISVs

9,000 database ISVs

30,000 middleware customers

29,000 developers, support engineers and consultants

Oracle’s People Advantage

275,000 customers

benefiting from shared innovation

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• Leadership in Healthcare• Innovation in Healthcare Solutions• Results Achieved by Oracle Customers

Agenda

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What Customers are Achieving…

increased enrollment by 200% with on-line quoting

added 200,000 new members while simultaneously reducing both member services call duration and wait times by 20% utilizing Oracle Siebel Contact Center

reduced sales and enrollment costs by 50% utilizing Oracle Siebel Healthcare Sales

reduced costs of reporting/consultants by $4 million in first year of Oracle Siebel implementation

achieved an additional $9 million of interest earned in trust funds during first seven months utilizing Oracle Financials General Ledger

http://www.cms.hhs.gov/

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The Oracle Difference

Only Oracle Provides…

• Most advanced analytics to target member populations for medical outreach

• Next-generation, standards-based technology for meaningful healthcare information exchange

• Most complete set of capabilities to support pay-for-performance initiatives

healthcare payer solution: enable consumerism - oracle · merger integration ... “the blues are...

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