1. Healthcare Payer CRM Solution Set 8.x
Deanne Branham

2. 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

3. Solution Set Definition

4. 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

5. Healthcare Payor CRM Solution Set Overview

6. 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

7. 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!!

8. Embedded Best Practices

9. Large Group Business Process

10. 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

11. Healthcare Payor: Opportunity to Proposal (Large Group)
Lead Management
Opportunity Management
Business
Insight
Review
Opportunity
Details
Research
Customer &
Broker
Conduct
Meetings,
update via
BlackBerry
Advance
Sales Stage
Assign work
to Team
Start Proposal Process
Generate
Quote, send to
Underwriting
Review
Acct
Structure
Research
Competitive
Situation
Assign/
Configure
Products
Geo
Access
Sales
Sales, TAS/Solution Sales
Underwriting
Assess
Claim
History
Perform Rating,
Submit
To Proposal
Team
Review
Actuarial
Reports
Eligibility
And
Exclusions
Sales, Group Policies, *Configurator
Sales, Extension to Rating Engine
Present Final Proposal
Review
Proposal
Proposal Generation
Review Work,
Generate
Send Proposal
To Sales
and/or
Broker
Enterprise Roles
Support/Proposal
Team
Sales Representative
Underwriter
Broker
Executive
Sales, Extension to Rating Engine
Proposal Presentation
Workflow, Sales

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

13. 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.

14. 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.

15. Drilling into the Quote takes Tom to the Group Policies screen
CLICK (2)
CLICK (1)
Tom can upload the initial census data and submit this application to Underwriting. He changes the substatus and clicks Submit.

16. After submitting the application, the fields are grayed out to prevent changes once the application is in Underwriting.
CLICK
Tom can click on the Inbox tab to view the handoff of work from himself to the Underwriting group.

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

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

19. 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.

20. 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.

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

22. 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.

23. 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.

24. 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).

25. Steve can perform final customizations on the proposed plan
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.
CLICK

26. Selection of product attributes triggers automated 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.

27. Integrate to rating engine
CLICK
After configuring the product attributes, Steve can view the Product Classes.

28. 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.)

29. 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.
CLICK (1)
Submit to proposal team

30. Indicators can be color-coded to quickly determine if work is moving according to WellPoint and/or customer objectives
To monitor Sold Case implementation, managers and executives can see how quickly work is progressing through the defined process
CLICK
Dashboard users can drill into data behind the chart to see specific cases that are in a specific stage and take action if necessary.

31. Complete Healthcare Solution Platform Leverage Applications as You Need Them
Siebel Healthcare Analytics
Siebel Executive Dashboards
Siebel Sales Dashboards
Siebel Service Dashboards
Siebel Marketing Dashboards
Siebel Healthcare Self-Service Solutions
Siebel Agent Portal
Siebel eCommerce
Siebel eBilling
Siebel Group Self-Service
Siebel Member Self-Service
Siebel Provider Self-Service
Siebel Healthcare Base Applications
Siebel Marketing:
Target Consumers, Groups, Agents/Brokers
Siebel Sales:
Individual, Small & Large Group
Siebel Service:
Members, Groups, Providers, Agents/Brokers
CRM HR
Products
Benefits
Membership
Claims
Integration

32. Q
& A