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Deanne Branham

Healthcare Payer CRM Solution Set 8.x

Objectives

• Understand what a solution set is and why it is important

• Understand the Contents of the Healthcare Payor CRM Solution Set

• Embedded Best Practices in the Healthcare Payor CRM Solution Set

Solution Set Definition

What is a Solution Set?• What we sell (customer-centric solution, not Oracle-centric product)• Along with tools to help us sell, including:

• Positioning slides, including market drivers, corporate initiatives, and solution set alignment

• Discovery questions• Solution pre-configured demo, demo guide, slides, and script• Executive dashboards• ROI/TCO models• Value proposition• Reference architecture / solution map• Customer references

• Solution Set functionality consists of some combination of industry specific sales, service, marketing, analytics, and master data management, along with typical integration definitions

• Positions Embedded Best Practices and Out of Box Functionality to Avoid the “What do you want Siebel to do?” Implementations

Healthcare Payor CRM Solution Set

Overview

What is the Healthcare Payor CRM Solution Set 8.x?

• History• Created in version 7.8

• Created Embedded Best Practices for:

• Sales and Broker Portal• Service and Analytics • Enhanced with New

Functionality Over Time• Contains ABSOLUTELY

No Scripting (VB or Java)• All Scripts

Encapsulated in Business Services

• Technical Content• User Interface (Form Applets

and Web Templates)

• 237 applets• 48 business components• 144 views

• 4 SmartScripts

• Claim Appeal• Small Group Quote• Individual Quote• Individual Application

• 39 Workflows

What is the Healthcare Payor CRM Solution Set 8.x?• How many business flows/Best Practices does it contain?

• Marketing• List Import• Campaign Management• Campaign Execution

• Sales• Hybrid solution with OnDemand• Large Group Sales business process with Product Configuration• Small Group Sales business process• Telesales Individual Sales Process• Renewals• Agent Portal

• Service• Member Services (6 Transactions) with AUTO NOTE GENERATION• Claims Adjustment• Member/Provider Portal

• Healthcare Analytics• How often it has been shown

• BCBSND, Humana, IBC, CBC, Premera, First Care, Assurrant, etc…….• Sales Revenue achieved from solution set

!!Over 10M in License Revenue with Q4 projection!!

Embedded Best Practices

Large Group Business Process

Demo Scenario 1: Large Group Flow

Profile of Prospect (Bayside Trading Company):• Large Group• 5500 Employees• Lost to competitor 2 years ago because of no online enrollment• Just Received RFP

Objectives :• Manage all activities from opportunity to implementation

Opportunity ManagementLead Management

Start Proposal Process

GenerateQuote, send toUnderwriting

GenerateQuote, send toUnderwriting

Review Acct

Structure

Review Acct

Structure

ResearchCompetitive

Situation

ResearchCompetitive

Situation

Assign/ConfigureProducts

Assign/ConfigureProducts

GeoAccess

GeoAccess

BusinessInsight

BusinessInsight

ReviewOpportunity

Details

ReviewOpportunity

Details

ResearchCustomer &

Broker

ResearchCustomer &

Broker

ConductMeetings, update viaBlackBerry

ConductMeetings, update viaBlackBerry

AdvanceSales Stage

AdvanceSales Stage

Assign workto Team

Assign workto Team

Underwriting

AssessClaim

History

AssessClaim

History

Perform Rating,Submit

To ProposalTeam

Perform Rating,Submit

To ProposalTeam

ReviewActuarialReports

ReviewActuarialReports

Underwriting

EligibilityAnd

Exclusions

EligibilityAnd

Exclusions

Present Final Proposal

Review ProposalReview Proposal

Proposal Generation

Review Work,Generate Proposal

Review Work,Generate Proposal

Send ProposalTo Salesand/orBroker

Send ProposalTo Salesand/orBroker

Enterprise Roles

Support/Proposal Team

Sales Representative

Underwriter

Broker

Executive

Sales Sales, TAS/Solution Sales

Sales, Group Policies, *Configurator Sales, Extension to Rating Engine

Sales, Extension to Rating Engine Proposal Presentation

Workflow, Sales

Healthcare Payor: Opportunity to Proposal (Large Group)

CLICK

Tom can run a Geo Access report to assess the WellPoint network coverage for the proposed account’s employees.

CLICK

Tom can enter the set of products the customer is interested in. He can then click the Create Quote button at the top of the screen start the Quoting process.

CLICK

Based on the information entered in the Opportunity record, a Group Policy record is created in the status of “Application”. Tom can drill directly into this quote.

CLICK (2)

CLICK (1)

Drilling into the Quote takes Tom to the Group Policies screen

Tom can upload the initial census data and submit this application to Underwriting. He changes the substatus and clicks Submit.

CLICK

After submitting the application, the fields are grayed out to prevent changes once the application is in Underwriting.

Tom can click on the Inbox tab to view the handoff of work from himself to the Underwriting group.

Tom can see the work item now assigned to SWALTERS; he can enter comments to make sure Steve processes the work quickly.

Underwriting Submit

Underwriting Submit

CLICK

Steve Walters in Underwriting has this new Policy application delivered to his Inbox. Steve can drill directly through to the work item.

CLICK

Steve can review the proposed products for the customer. If needed, Steve can receive guided assistance by clicking on the iHelp button at the top.

CLICK

iHelp provides inline assistance for complex processing. iHelp also allows users to see where they are in the current process. Hyperlinked items in the iHelp pane guide the user to the next step in the process. In this case, Steve clicks on the Exclusions item in step 4 to go directly to this tab.

CLICK

Steve can capture any applicable exclusions, then click through to capture Eligibility requirements.

CLICK

Steve clicks on the drop-down arrow to expose more available tabs for the Underwriting process. He clicks on the Group History tab to view claims history.

CLICK

Steve sees Large Claimant History information to further assess risk. He can then click again on the arrow to expose the Underwriting Reports tab and attach any relevant report.

CLICK

Once Steve attaches the Loss History Report, he can perform a final Rating. He clicks back on the Plan Design tab to access rates and the interface to WellPoint’s Rating engine(s).

CLICK

Steve can perform final customizations on the proposed plan. This brings up a set of guided screens that allow Steve to select product/plan attributes with guided assistance and automated enforcement of WellPoint business rules.

Selection of product attributes triggers automated rules. In this case, selection of a $500 In-Network deductible ensures that the Non-network deductible is higher than $500.

CLICK

After configuring the product attributes, Steve can view the Product Classes.

CLICK

Scrolling down further on the page, Steve can enter information about each Class, along with prices for each Rate Band. These rates can be entered manually, by spreadsheet import, or automatically by direct interface into a Rating engine. Siebel also maintains each category of rate (Bid, Sold, etc.)

CLICK (1)

CLICK (2)

Steve changes the status to Proposal Submit. This sends the work to the Proposal team; the fields are grayed out, allowing only the Proposal team to change any values.

To monitor Sold Case implementation, managers and executives can see how quickly work is progressing through the defined process

Indicators can be color-coded to quickly determine if work is moving according to WellPoint and/or customer objectives

Dashboard users can drill into data behind the chart to see specific cases that are in a specific stage and take action if necessary.

CLICK

Complete Healthcare Solution PlatformLeverage Applications as You Need Them

Siebel Healthcare Base Applications

Siebel Sales: Individual, Small & Large

Group

Siebel Marketing: Target Consumers, Groups,

Agents/Brokers

Siebel Service: Members, Groups, Providers,

Agents/Brokers

Siebel Healthcare Self-Service Solutions

• Siebel Agent Portal• Siebel eCommerce• Siebel eBilling

• Siebel Group Self-Service • Siebel Member Self-Service• Siebel Provider Self-Service

CRM HR Products Benefits Membership Claims

IntegrationIntegration

Siebel Healthcare Analytics

•Siebel Executive Dashboards•Siebel Sales Dashboards

•Siebel Service Dashboards•Siebel Marketing Dashboards

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