healthcare payer solutions (emea)
TRANSCRIPT
Healthcare Payer Solutions (EMEA)
Chris IbellVP Oracle Consulting for Healthcare – Europe, Middle-East and Africa
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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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Did You Know?Oracle inHealthcare
More than 300 leading healthcare providers run Oracle Applications - Oracle
20 of the Top 20 US Health Insurers run Oracle Applications - S&P
10 of the top 12 Fortune Global 500 healthcare organizations run Oracle Apps
More than 80 Healthcare Payers run Oracle applications - Oracle
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The Challenges We’re Hearing
Reduce Healthcare Reduce Healthcare and Operating and Operating
CostsCosts
“How can I satisfy the big number of ever changing regulatory requirements in my country?”
Governments issuing Healthcare reform bills (structural changes)Governments issuing Healthcare reform bills (structural changes), introducing privatization, , introducing privatization, reducing/changing the coverage of public health plansreducing/changing the coverage of public health plans
Comply with Comply with Changing Changing
RegulationsRegulations
“How can I effectively use healthcare management /procurement? How can I have a benchmark cost for my operations?”
Retain and Retain and Grow Grow
MembershipMembership
“How can I grow by retaining my members and winning new ones? How can I satisfy today’s empowered consumers through (self-)service?”
Mergers and acquisitions are happening in various European countMergers and acquisitions are happening in various European countries, payer ries, payer organizations are becoming larger and larger and are struggling organizations are becoming larger and larger and are struggling with consolidationwith consolidation
Healthcare costs are unsustainably growing, driven by fundamentaHealthcare costs are unsustainably growing, driven by fundamental factors, e.g. aging population l factors, e.g. aging population and medical innovationand medical innovation
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• Leadership in Healthcare
• Innovation in Healthcare Solutions
• Results Achieved by Oracle Customers
Agenda
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Oracle Healthcare Payer Solutions
Retain and Grow
Health Plan
Membership
• Oracle Self-service Insurance, Oracle OpenBeleid and Customer Service Center
• Oracle Self-service Insurance, Oracle OpenZorg
Comply with Changing
Regulations
Comply with Changing
Regulations
• Oracle OpenZorg - Health Plan Definition and Healthcare Management
• Oracle OpenBeleid and Oracle Discoverer (or 3rd party reporting tool)
• Oracle OpenZorg, Oracle Financials
• Oracle OpenZorg Healthcare Procurement and Oracle OpenBeleid
• Oracle OpenZorg Claims Processing
• Oracle OpenZorg, Oracle OpenBeleid, Oracle Self-service Insurance and Customer Service Center
Reduce Healthcare and
Operating Costs
Reduce Healthcare and
Operating Costs
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Oracle Healthcare Payer Solutions
Retain and Grow
Health Plan
Membership
• Oracle Self-service Insurance, Oracle OpenBeleid and Customer Service Center
• Oracle Self-service Insurance and Oracle OpenZorg
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Retain and Grow MembershipRequirement
Retain individual and group membership
Oracle Capability
Customer Service CenterOracle Self-service Insurance
The Oracle Difference
Only payer-specific self service and off-the-shelf member intelligence for all channels
Consolidate systems as a result of mergers and acquisitions
Oracle OpenZorg and Oracle OpenBeleid
Only comprehensive off-the-shelf solution in Europe
Support recruitment and enrollment of new membership
Siebel Marketing, Oracle Self-service Insurance and OracleOpenZorg
Only payer-specific solution for recruitment and enrollment of new members
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Oracle Self-service Insurance
Provides customers with an easy to use self service application
Use of web and email channel for maximum convenience Ability to review and modify insurance policies at any timeAbility to review instant quotes and sign up onlineProvides lower costs for the insurerBetter quality
Provides customers with an easy to use self service application
Use of web and email channel for maximum convenience Ability to review and modify insurance policies at any timeAbility to review instant quotes and sign up onlineProvides lower costs for the insurerBetter quality
Retain and Grow Health PlanMembership
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Oracle Self-service InsuranceComponents
Database
ApplicationServerOracle technology
DefTool™ Composer™eBilling Manager
Siebel edocs
Web application
Oracle Selfservice Insurance
Custom made solutions
Retain and Grow Health PlanMembership
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Oracle Self-service Insurance“Open” part
• Receive an instant quote• For individual insurances as well as for collective agreements• Confirmation email
• Sign-up online• For individual insurances as well as for collective agreements• Approval by groupadministrator in case of collective agreement
(configurable)• Confirmation email
• Login• Enrollment new user• Log in• Forgotten password
Retain and Grow Health PlanMembership
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Oracle Self-service Insurance“Closed”part - dashboard
• Dashboard policy owner• Profile => modify profile data• Overview policies => view policy details, modify policy• Raise service requests• Overview of statements => view statement details• Own Risk usage
• Dashboard Contractor• Profile• Service requests for validation• Overview of collective agreements and policies within agreement• Overview of statements => view statement details
Retain and Grow Health PlanMembership
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Retain and Grow Profitable Health PlanMembership
The Member-Centric ApproachCRM
PoliciesClaimsService
RequestsInteractions
Web & Email
Contact Centre
MemberInformation
MemberInformation
Back Office
Single secure repository of member interaction historyMulti-channel accessUnified platform for new “customer focused” services
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Oracle Healthcare Payer Solutions
Comply with Changing
Regulations
Comply with Changing
Regulations
• Oracle OpenZorg - Health Plan Definition and Healthcare Management
• Oracle OpenBeleid and Oracle Discoverer (or 3rd party reporting tool)
• Oracle OpenZorg, Oracle Financials
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Comply with Changing Regulations
Requirement Oracle Capability The Oracle Difference
Deliver adaptive and flexible back-office process support
Oracle OpenZorg - Health Plan Definition and Healthcare Management/Procurement
Only Oracle OpenZorgsupports user-defined and changing business rules, for both public, private and mixed environments
Support changing accounting needs
Oracle OpenZorg, Oracle Financials
Only payer solution where integration with the general ledger is supported via user-defined translation rules
Support mandatory reporting requirements
Oracle OpenBeleid and Oracle Discoverer (or 3rd
party reporting tool)
Only Oracle OpenBeleidoffers off-the-shelf star schema’s for claims and member data combined
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Oracle OpenZorg Payer Solution: Key Components•Policy Management – supports the entire process from enrollment to premium calculation, automatically producing customer documentation such as policy statements and healthcare entitlement cards, as well as invoices and financial transactions. Retroactive policy changes are supported with automatic premium recalculation.
•Claims Processing – provides an integrated claims solution where claims from policy holders or healthcare providers are automatically adjudicated based on configurable business rules, leading to straight-through processing and payment. Claims can be processed online or in batch and can be corrected automatically. Bi-directional exchange of claims information with healthcare providers is supported.
•Health Plan Definition – allows for the definition of an unlimited number of health insurance products for individually insured persons and collective contracts. Health plans defined by law and legislation can be created, and changes can be handled by adapting product definitions. Policy Management and Claims Processing can immediately use all new and modified product definitions.
•Healthcare Procurement – supports all levels of agreements with healthcare providers, ranging from professional group level to individual contracting. Agreements can be specified down to treatment level (also at DRG level). Claims Processing will directly check all types of agreements. The flexibility in Product Definition and Healthcare Procurement enables client-specific rule definitions to be entered without any programming effort.
Comply with Changing RegulationsOracle OpenZorg
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Oracle OpenBeleid: Understanding Your Business
•Solution for reporting and analysis• mandatory (external) reporting • claims analysis for cost control• provider comparisons for benchmarking• product/health plan profitability, also premium calculation input• member analytics• influx, outflux• financial reporting
•Directly suitable for end users (no IT staff needed)•Separate Data Warehouse with Discoverer query tool
• end user layer included
•Solution for reporting and analysis• mandatory (external) reporting • claims analysis for cost control• provider comparisons for benchmarking• product/health plan profitability, also premium calculation input• member analytics• influx, outflux• financial reporting
•Directly suitable for end users (no IT staff needed)•Separate Data Warehouse with Discoverer query tool
• end user layer included
Comply with Changing Regulations
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OpenBeleid Star Schemas (Datasets)
• Claims/Declined claims• Premiums• Insured persons• Financial flow• Influx – Outflux• Medical Authorizations
Comply with Changing Regulations
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US GAAPUS GAAPUS GAAPFrench FiscalFrench FiscalFrench Fiscal
Flexible Accounting Solution
Payables InvoicePayables InvoicePayables Invoice
Centralized AccountingCentralized Centralized AccountingAccounting
DrDr CrCr
• Flexible Chart of Accounts
• User-editable accounting rules
• Translation rules from Oracle OpenZorg
• Multiple accounting and currency representations
• Subledger daybooks (journals)• Flexible reporting and inquiries
Description
Comply with Changing Regulations
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Oracle Healthcare Payer Solutions
Reduce Healthcare
And Operating Costs
Reduce Healthcare
And Operating Costs
• Oracle OpenZorg Healthcare Procurement and Oracle OpenBeleid
• Oracle OpenZorg Claims Processing
• Oracle OpenZorg, Oracle OpenBeleid, Oracle Self-service Insurance and Siebel Call Center
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Reduce Healthcare and Operating CostsRequirement Oracle Capability The Oracle Difference
Drive effective care purchasing through advanced analytics
Oracle OpenZorg Healthcare Procurement and Oracle OpenBeleid
Most advanced functionality for managing agreements and supporting negotiations with all healthcare providers
Streamline operations, minimize manual processes, reduce errors and paper output
Oracle Self-service Insurance and Customer Service Center
Only integrated off-the-shelf modular solution from front to back office with analytics
Optimize claims auto-adjudication in compliance with the health plan rules and provider agreements
Oracle OpenZorg Claims Processing
Only fully automated claims adjudication engine checking all health plan definitions and provider agreements
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Oracle OpenZorg Comprehensive Back Office Solution for Healthcare Payers
Both public and privateCovers all primary processes and many supporting processesMulti-organization and multi-brand supportBoth direct and intermediary channelsBoth individual and collective marketFlexible products- and healthcare procurement engine
Reusable data components -> efficient maintenanceConnective, Robust and ScalableSeparate, but fully integrated Data Warehouse (Oracle OpenBeleid)Separate, but fully integrated Self-service solution (OSI)
Both public and privateCovers all primary processes and many supporting processesMulti-organization and multi-brand supportBoth direct and intermediary channelsBoth individual and collective marketFlexible products- and healthcare procurement engine
Reusable data components -> efficient maintenanceConnective, Robust and ScalableSeparate, but fully integrated Data Warehouse (Oracle OpenBeleid)Separate, but fully integrated Self-service solution (OSI)
Reduce Healthcare and Operating Costs
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Oracle Support for Healthcare is Complete
• Healthcare applications capabilities• Database technology to support small to large and
multiple healthcare organizations• Access, Identity management and security that is world
reknown • Only complete standards-based, semantically
interoperable Health Information Exchange (HIE)• Most out-of-the-box self-service transactions (100s) to
reduce HR costs• Only integrated contracting, procurement, and payment
for materials and contingent nursing staff solution• #1 enterprise software vendor
• ERP, CRM, HCM and more• Most scalable, reliable, secure infrastructure• Most complete range of on-demand and on-premise
deployment options• Largest development, consulting and support team
• 29,000+ across 145+ countriesOperating System
Database
FusionMiddleware
Tools / J2EE
Applications/Business
Intelligence
Consulting
HTB
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Summary
• Retain and grow health plan membership• Comply with changing regulations• Reduces healthcare and operating costs
Oracle Self-service InsuranceSiebel CRMOracle OpenZorgOracle OpenBeleidOracle FinancialsOracle Technology platform
Oracle Healthcare Payer Solutions
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• Leadership in Healthcare
• Innovation in Healthcare Solutions
• Results Achieved by Oracle Customers
Agenda
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Delta Lloyd Group Consolidates Back-Office using Oracle Payer Solutions
CUSTOMER PERSPECTIVE“Oracle enables the combination of forces in the market. In the turbulent healthcare market with many changes in law and legislation, costs are an important issue. Therefore re-inventing the wheel is undesirable. With Oracle we work with state-of-the-art technology and with people who are solution-oriented and available when needed.”- Ingrid Visscher, chairman of the board of Delta Lloyd Healthcare.
COMPANY OVERVIEWDelta Lloyd Group is a banking and insurance group employing approximately 6,500 staff (in FTEs). The Group consists of eight divisions active in four countries, with the following core activities: Delta Lloyd Insurance; insurance and pension services via independent intermediaries in the Netherlands OHRA Insurance; insurance and pension services sold direct to personal and business customers in the Netherlands ABN AMRO Insurance; insurance and pension services via the distribution network af ABN AMRO Bank in the Netherlands Delta Lloyd Asset Management; Delta Lloyd Banking; Delta Lloyd Property; Delta Lloyd Germany; Delta Lloyd Life Belgium
CHALLENGES OPPORTUNITIES•Pursued consolidation of back office systems to achieve cost reductions (uniform processes, one application, system)
SOLUTIONSOracle OpenZorgOracle Database 10g, Oracle Fusion Middleware 10gCurrent implementation:The last part of Ohra insured persons are migrated to Oracle OpenZorgleading to an implementation with all 800.000 insured persons
RESULTS• Multi brand, multi organization
implementation• Consolidated back-office across different
organisational units and implemented standard processes
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Azivo Implements Efficient Back-Office Payer Solutions
CUSTOMER PERSPECTIVE“With a multi-year contract for OracleOpenZorg, Azivo created certainty for a stable and efficient execution of its Healthcare Insurance back-office. To us OpenZorgmeans a flexible and customisable back-office.”Aad de Groot, General Manager
COMPANY OVERVIEWAzivo is a regional mutuality with 150.000 insured persons. It’s customer base is a combination of public (largest part) and private.
CHALLENGES/OPPORTUNITIES•Replacement of old claims application•Need to gain efficiencies in the back office •Needed timely management information support to support externalreporting requirements and provider network comparative analyses
SOLUTIONSOracle OpenZorg, Oracle OpenBeleidOracle General LedgerOracle Database 10g, Oracle Fusion Middleware 10g
RESULTS• One of the lowest number of FTEs for claims
processing by electronic exchange with Healthcare Providers
• Azivo was awarded as being the fastest (mandatory) reporting Healthcare Payer in the Netherlands. Before implementing Oracle OpenBeleid it was one of the slowest in reporting.
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Unive-VGZ-IZA-Trias (UVIT)Largest Dutch Healthcare Payer
CUSTOMER PERSPECTIVE”Oracle OpenZorg is of strategic importance to VGZ-IZA. The multi-year contract reflects our confidence in the continuity Oracle can offer us.”Chris Driessen, Board member
COMPANY OVERVIEWThe Netherlands’ largest Healthcare Payer, Unive-VGZ-IZA-Trias insures more than 4 million people and manages an average of 200,000 claim lines every single calendar day.
CHALLENGES/OPPORTUNITIES•Needed the agility to respond rapidly to frequent, complex changes in Dutch healthcare insurance law•Operate industry best-practice policy and claims management processes within an integrated IT environment •Analyze costs of providing healthcare insurance and assess profitability of individual and collective policies in portfolio •Streamline mandatory reporting to external regulatory bodies •Cut IT management costs by eliminating the need to build and maintain interfaces between more than 100 applications
SOLUTIONSOracle OpenZorg Oracle OpenBeleidOracle Self-service Insurance (based on Siebel edocs)Siebel CRM for call center Oracle Database 10gOracle Fusion Middleware 10g
RESULTS• Before implementation of Oracle OpenZorg
VGZ could not handle the increasing volumes anymore. Afterwards it has reached unlimited scalability in order to enable its Merger and Acquisition strategy
• Implemented business processes from head to tail; Oracle web application, backoffice, analytics and call center
• VGZ reduced the number of applications and interfaces significantly
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The Oracle Difference
•Only Oracle Self-service Insurance complete off the shelf payer-specific solution for recruitment and enrollment of new members•Only Siebel CRM offers payer-specific call center and off-the-shelf payer intelligence for all channels•Only Oracle OpenZorg offers fully automated claims adjudication engine checking all health plan definitions and provider agreements•Only Oracle OpenBeleid offers off-the-shelf analytics for claims and member data combined
Only integrated off-the-shelf modular solution from front- to back-office with analytics
Only Oracle…
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