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Bary Bailey EVP, Chief Strategic Officer PowerPoint Presentation
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Bary Bailey EVP, Chief Strategic Officer

Bary Bailey EVP, Chief Strategic Officer

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Bary Bailey EVP, Chief Strategic Officer

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  1. .…a health and consumer services company making people’s lives better Systems & IT Outsourcing Bary Bailey EVP, Chief Strategic Officer

  2. .…a health and consumer services company making people’s lives better PacifiCare’s Future State • PacifiCare’s Future State is a measured, programmatic set of business and technology projects that enable our competitive product leadership strategy • The company requires business and technology change and investment

  3. Key Requirements Objectives .…a health and consumer services company making people’s lives better This is what our business users want... • Rapid product deployment • Increased operating efficiency • Flexible and scalable systems • Customer and member product flexibility and choice • On-time, one-time and, eventually, real-time claims processing • Robust medical management • Consistent and complete customer interaction • Information managed and used as a strategic business asset • Standard business practices

  4. Ancillary Internet Sites Ancillary Ancillary Ancillary Ancillary Internet Site #3 Internet Site #2 Internet Site #1 EDI EDI VRU Ancillary Ancillary Ancillary Ancillary Ancillary User Interface User Interface User Interface Ancillary Ancillary Database Database Database Ancillary Ancillary Core Legacy #3 Core Legacy #2 Core Legacy #1 Enrollment Billing A/R Capitation Claims Authorizations Referrals Enrollment Billing A/R Claims Authorizations Referrals Enrollment Billing Capitation Claims Authorizations Referrals DATA WAREHOUSE DATA WAREHOUSE ENTERPRISE WIDE SHARED IT RESOURCES Technologies Applications Regulatory Reporting Regulatory Reporting .…a health and consumer services company making people’s lives better But our historical perspective made it hard to deliver... • Multiple systems • Duplicative support and investment requirements • Limit business process transformation opportunities • Old “2nd tier” technology limits: • E-business transformation opportunities • Ability to rapidly deploy new products • Deployment of vendor-supported applications • Consumes scarce IT resources on activities that do little to advance business strategies

  5. .…a health and consumer services company making people’s lives better So we created some rules for change... • Information management and use • Mission-critical • Corporate asset • Access strategy driven by business • Efficient solutions to meet customer demands (e.g., Internet, telephone, EDI, IVR) • Consistency will prevail over variation • Process • Systems • Commercially available software • No desire to be bleeding edge • Core business - proven technologies and stable vendors • Non-core business - lower cost and acceptable levels of performance

  6. The Future State is a set of business and IT transformation projects that will: Consolidate - eliminate the deployment of redundant applications and technologies Rationalize - migrate to common applications supported by standardized business processes Innovate – identify and deploy applications and technologies that promote business transformation Organize – provide a framework for future business and IT investments Business Logic/Functions Access to PHS ENTERPRISE INFORMATION MANAGEMENT ENTERPRISE ACCESS Data Mart Internet Intranet Enterprise Information Repository Business Logic/Functions VRU EDI Customers ENTERPRISE ACCESS Paper/EDE PBHI RxSol PDV Partner Connectivity Data Mart Data Warehouse Rx Connect Health Plan TBD Data Warehouse ENTERPRISE APPLICATION INTEGRATION Consumers Brokers Employers Members Providers Employees TECHNOLOGY INFRASTRUCTURE .…a health and consumer services company making people’s lives better And we set a direction towards the Future State…

  7. Key Business Driver Future State Milestones .…a health and consumer services company making people’s lives better We established a plan of attack…... System Selection Core Legacy Migrations

  8. .…a health and consumer services company making people’s lives better And we have made good progress thus far... • Outsourcing contract finalized and transition is well underway • Currently implementing several Future State projects • Final decision on Core Systems and Financial Systems to be made in near term

  9. .…a health and consumer services company making people’s lives better Outsourcing will bring benefits to the business… • Facilitate the delivery of Future State • Reduce/control operating expenses • Improved performance and speed of delivery • Access to “world class” capabilities • Increased funding through efficiency improvement

  10. .…a health and consumer services company making people’s lives better And independent experts concur... Software Engineering Institute - Capability Maturity Model (SEI-CMM) Low Typical PacifiCare (Pre-Outsourcing) 1.8 Medium WithOutsourcing (After 12 months) 3.0 High Exceptional

  11. .…a health and consumer services company making people’s lives better We maintain control, but have developed strategic partnerships… • CGE&Y - Future State Strategic Planning • Keane, Inc - Application Maintenance and Enhancements • IBM - IT Infrastructure

  12. .…a health and consumer services company making people’s lives better And we have aligned our structure to support Future State • Future State • Combined business and IT organization • Retained resources and control of strategy, architecture and investment decisions • Ongoing IT Operations • Outsourcing supplier management • Systems oversight

  13. Questions & Comments