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COLLABORATIVE HEALTHCARE

SUMMIT 2012

Transforming Healthcare –

The Future is Now!

Wednesday | October 24, 2012 | Boston, MA

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COLLABORATIVE HEALTHCARE

SUMMIT 2012

How Leading Organizations

Optimize the Customer Experience

and Automate Operations

Alan Trefler

CEO and Founder

October 24, 2012

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Unsustainable

Cost Increases

Benefit - Shifting

Models

Government

Regulations

Consumers

More Educated

Customers More

Demanding

Healthcare

Reform

Aging Population

New Payment

Models

New Delivery

Models

Social Media

Legacy System

Limitations

Tough Economy

Tsunami of Changes in Healthcare

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RAISED CUSTOMER SATISFACTION 40%

SAVED $25M & IMPROVED CUSTOMER SATISFACTION

RETAINED ADDITIONAL 4% OF MOST VALUABLE CUSTOMERS

IMPROVED SERVICE LEVELS TO INCREASE CUSTOMER LOYALTY

Optimize Customer Experience

Automate Operations

DRAMATICALLY IMPROVED SUPPLY CHAIN EFFICIENCY

CONSOLIDATED FIVE CALL CENTERS INTO ONE

CREATED ONE CLAIMS PROCESS AROUND THE GLOBE

ENABLED AGILE ENTERPRISE ORDER ORCHESTRATION

STREAMLINED ACCOUNT OPENING AND ON-BOARDING

DOUBLED MARKET SHARE IN ONE YEAR

ENABLED MULTI-CHANNEL CROSS-SELL, UP-SELL

ENROLLED 1 MILLION CITIZENS IN 6 MONTHS

DRIVE REVENUE

30% REVENUE GROWTH

ENHANCE EFFICIENCY

40% PRODUCTIVITY GAIN

ENGAGE CUSTOMERS

5 POINT RETENTION

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360°

Who Why/What When/Where/How

Intent Data Process + +

360° 360°

Automate Operations

Optimize Customer Experience

1080° 720° High Definition

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SERVICE ORIENTED ARCHITECTURE (SOA) LEGACY

APPLICATIONS Infrastructure (App Server, Database, etc.)

Execution Gaps

“Make it easy!” “Meet my needs” “Understand me”

Oriented ArchitectureTM (COA)

EFFICIENCY

CROSS-SILO

CROSS-CHANNEL

Customer

Archaic

Development

Chaotic

Processes

Ineffective

Systems

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Directly Capture Objectives Empower Change & Collaboration

Familiar business metaphors accessed through a web browser

Easy forms guide & protect users

Working models replace paper specs & requirements

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SERVICE ORIENTED ARCHITECTURE (SOA) Infrastructure (App Server, Database, etc.)

Execution Gaps

Archaic

Development

Chaotic

Processes

Ineffective

Systems

Customer Oriented ArchitectureTM (COA)

DIRECTLY CAPTURE

OBJECTIVES

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CROSS-SILO

CROSS-CHANNEL

EFFICIENCY

LEGACY

APPLICATIONS

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Request Modify care programs to cover more visits

in New York for Commercial Members Modify care programs to cover more visits

in New York

for Commercial Members

Situational Layer Cake Align Customer and Business Intent

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SERVICE ORIENTED ARCHITECTURE (SOA) Infrastructure (App Server, Database, etc.)

Execution Gaps

Archaic

Development

Chaotic

Processes

Ineffective

Systems

Customer Oriented

DIRECTLY CAPTURE

OBJECTIVES

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LEGACY

APPLICATIONS

SITUATIONAL

LAYER CAKE

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Architecture (COA)

CROSS-SILO

CROSS-CHANNEL

EFFICIENCY

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6R Case Automation Drive Work to Done

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Anticipatory Retrieval

Adaptive Analytics Open Database

Productivity & Quality Alerts

Model & Simulate

Priority

Cases & Folders

Skill Based Routing Tailored

Interactions

Next Best Action

Multi-Channel

Imaging

Web Services

Telephony System-Driven

Processing

Guided Processing

Automated Transactions

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SERVICE ORIENTED ARCHITECTURE (SOA) Infrastructure (App Server, Database, etc.)

Execution Gaps

Archaic

Development

Chaotic

Processes

Ineffective

Systems

Customer Oriented Architecture (COA)

6R CASE

AUTOMATION

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Anticipatory Retrieval

Adaptive Analytics Open Database

Productivity & Quality Alerts

Model & Simulate

Priority

Cases & Folders

Skill Based Routing

Tailored Interactions

Next Best Action

Multi-Channel

Imaging

W eb Services

Telephony

System-Driven Processing

Guided Processing

Automated Transactions

DIRECTLY CAPTURE

OBJECTIVES

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SITUATIONAL

LAYER CAKE

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HEALTHCARE PROCESSES

CROSS-SILO

CROSS-CHANNEL

EFFICIENCY

LEGACY

APPLICATIONS

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1080°

Who Why/What When/Where/How

Intent Data Process + +

Automate Operations

Optimize Customer Experience

High Definition

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Optimize Customer Experience

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$100 MILLION IN SAVINGS AND 20 POINTS AHEAD OF INDUSTRY IN CUSTOMER SERVICE

“CHATS represents a major step forward…to boost

customer and member satisfaction and raise the service,

quality, affordability and work environment of Kaiser’s

contact centers.”

BUSINESS GOALS

FIRST CALL resolution rate

Improve operational efficiency to

enhance customer satisfaction and

reduce costs

Streamline workflow and provide user

guidance

Support real-time personalized

healthcare

Integrate and deliver critical

information to improve member

interaction

RESULTS

Trenita R. Ward

VP California Member Service, Call Centers

FOR HEALTHCARE CUSTOMER SERVICE

by J.D. Power and Forrester Research

90% 20% IMPROVEMENT in Call Handling Time

20% REDUCTION in training time $100M SAVINGS

#1

over 10 years

16 16 © 2012 Pegasystems Inc. COLLABORATIVE HEALTHCARE SUMMIT 2012

Leadership Through Client Success

Revenue in $M

Multiple patents and awards for software innovation

Growing global alliance partners network

Over 2,000 staff worldwide

$100 $126

$162

$212

$264

$337

$416

2005 2006 2007 2008 2009 2010 2011

6 YEARS OF

REVENUE GROWTH >25%

PEGA

PEGA

#1 IN BPM BY GARTNER AND FORRESTER

IN CASE MANAGEMENT

PEGA

#1 BY FORRESTER

PEGA PEGA

LEADER IN CRM BY GARTNER AND FORRESTER

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Execution Gaps

CASE MANAGEMENT

AUTOMATION

Real Business Value in 90 Days Enablement & Partners Drive Fast Results

SERVICE ORIENTED ARCHITECTURE LEGACY

APPLICATIONS Infrastructure (App Server, Database, etc.)

EFFICIENCY

CROSS-SILO

CROSS-CHANNEL

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Build for Change®

Pega software revolutionizes

how leading organizations

optimize the customer experience &

automate operations