Digitalization as a Journey · Preferences 360 Profile Omni-Channel Interaction Insights 60M+...
Transcript of Digitalization as a Journey · Preferences 360 Profile Omni-Channel Interaction Insights 60M+...
Digitalization as a Journey
® You don’t join us – We join you !
February 2019
Claus T. Jensen, CTO
2Proprietary©2018
Our Promise: “We Join You” – Connected HealthPeople need help obtaining better, more proactive, personalized care. By combining analytics and human touch we will create a new approach to health care.
• Synthesizes everything we know
about you
• Understands your goals and
preferences
• Provides you with actionable
insight
INSIGHT TO HELP YOU ACHIEVE YOUR GOALS
• Curates and coordinates all
messages we send you
• Remembers and learns from all
interactions you have with us
• Predicts and engages through
Next Best Action
A COORDINATED EXPERIENCE THAT WOWS YOU
• Identifies you across time, space
and products
• Never forces you to register more
than once
• Reconciles and conforms data
from many sources
INTEGRATION THAT GIVES YOU ACCESS TO EVERYTHING
EXPERIENCE FOUNDATIONAL
Security and Stability
3Proprietary©2018
Fun Facts - Aetna Size and Complexity
Aetna is a diversified health company with a broad range of products and services
Benefit Admin Model Service Model Care Model
Actionable InsightsReporting & Business Performance
Engagement
Transactional
~38.8M Members
Ecosystem PlatformAccount for Life Global IDNext Gen
AuthenticationPreferences 360 Profile
Omni-Channel
Interaction
Insights
60M+ Annual
Member Logins
1B+ Printed Pages
~1.2M Healthcare
Professionals~5,700 Hospitals ~150K Brokers
20+ Product Lines, 8.7K Networks
80% Auto-Adjudication Rate
390M+ Medical Claims per year
120M+ Calls per year
25K Customer Service Reps
8,000+ Nurses
80+ Clinical Programs
18M+ Member Care Plans
20K+ HIPAA Reports 275 Local Markets2.3M Members Identified for various
Clinical Programs
4Proprietary©2018
The Parameters for Growth are Multiplying
IT Scale and Growth is no longer tied to Membership alone
• As we transform our
engagement model and
increase the omni-
channel touchpoints for
the health consumer,
the scale and
complexity of IT
operations increase
significantly
• New capabilities such
as Next Best Action,
Voice interactions and
Intelligent processes
add to the upwards
pressure
New Parameters for Growth+50%
Increase in digital
interactions
2xAdded product
complexity
21pbNew analytical
data
0%Increase in
infrastructure cost
0%Increase in
operational
incidents
5Proprietary©2018
Integrated Platform Ecosystem Enables InnovationCustomer obsession means accelerated innovation for the entire population and enhanced ability to focus on true consumer needs
An Integrated Business Platform with great technology ecosystem processes enable us to incubate ideas quickly,
evaluate and drive to production for all 38m+ members
Historical Innovation Innovation In the FutureDisparate business platforms leading to sluggish, segmented
member impact
MEDICARE
MEMBER
INNOVATION
MEDICAID
COMMERCIAL
6Proprietary©2018©2018
Business Platform Strategy – Strategic ProgramsStrategic, simultaneous investments are transforming the Business Operating Platforms
Sales & Marketing Platform
(Member Messaging &
Non-Member Constituents)
Service Platform Clinical & Logistics Platform
United Data Fabric
(Non Real-Time Data, Hybrid)
Benefit Admin Model Service Model Care Model
Actionable InsightsReporting & Business Performance
Provider
&
Network
Platform
ACAS (Commercial)
QNXT (Medicaid)
NextGen (Medicare)
Digital Consumer Experience
(Authenticated Member Experiences)
Engagement
Transactional
Specialty
Other
(Plan Sponsor, Broker, Rx, Funds)
Ecosystem PlatformAccount for Life Global IDNext Gen
AuthenticationPreferences 360 Profile
Omni-Channel
Interaction
Insights
• Aetna Health
• Apple Partnership
• Provider Data Innovation
• Medicare NextGen
• Aetna One Advocate
• Guided Personal Service
• Community Care
• Financial Data Repository
Major Ongoing Programs
1
2
3
4
5
6
7
88
4
3
75 6
1 2
# = Not yet fully integrated with strategic platforms
7Proprietary©2018
Deliver
connected
health by
integrating
the
consumer
journey
across the
delivery
spectrum
What does an Ecosystem Platform look like?Ecosystem enablers for providing a Connected Health journey
Multiple identities
“We always know you”
Discon-nected
data sources
Unified Data Fabric
Multiple preferen-
ces
We remember what you
told us
Individualization
Global Identity Integrated InsightsPreferences and Permissions
Proprietary
Identity key mapping
Single authenticated ID
Preferences
Permissions
Integrated via Global ID
Data catalog
Consistent semantics
Integrated via Global ID
and Permissions
Integration technologies and practices must work together across the board
8Proprietary©2018©2018
Unique
Capability
Data
Provider(s)
DP GW - DC
Hybrid Cloud API Management PlatformA single API management platform that simplifies creation, management and consumption of APIs, keeps API development costs low and security high
Highlights
API consumers can access any
API on any gateway with the
same security token; single set of
policies and crypto materials
DataPower gateways in multiple
datacenters
Cross Domain traffic uses
managed APIs for access (even
inside a datacenter)
Integration as a specialized
discipline
Dual disintermediation via
(payload mapping) APIs on top of
Services; different lifecycles
Opportunistic APIs are not
reusable, each API consumer gets
their own custom API
Domain based teams and
ownership for APIs and services
1
2
3
4
5
6
7
Data
Provider(s)
DP GW - AWS
API Consumers
Management
Console
Developer Portal
Analytics
1
2
Data
Provider(s)
DP GW - Azure
Ultra low cost, nimble speed
API E2E: ~$5K (industry leading)
New APIs in days to weeks
API changes in hours to days
9Proprietary©2018
Putting it All Together – A Real Example Avoidable Readmissions
#1 Collecting individualized data by using global ID to correlate data sources, data catalog to
bring the data together and the consistent semantics to understand what was collected
#2 Apply analytics to identify at risk patients recently at the ER or hospitalized by using
permissions to determine compliance rules for cross-leveraging data
#3 Engage the patient by using preferences to determine the best channel of contact, knowing
that her desires are respected because of global ID and consolidated preferences
#4 Coordinate care and service by using the global ID and the API platform to expose consistent
information to clinicians, CSR’s and Minute Clinic personnel
#5 Continue the dialog via digital tools by using global ID, global account and the API platform to
make sure the patient has unified access to everything we offer
How Integration Enabling Technology Helps
10Proprietary©2018
Spotlight: Single Pane of GlassThe ecosystem platform enables a single pane of glass approach
ConsumersOmni-channel
Engagement
Platform
Service
Clinicians
CSRs
Supply Chain
Constituents
Local Groups
Business
Information Model
11Proprietary©2018
Operational Data Availability~70% of all operational data is accessible via our world class hybrid cloud API management and integration platform, moving rapidly towards 100%
Support Data J
45%
Core Data B
100%
Support Data G
70%
Support Data L
40%
Ancillary Data P
0%
Ancillary Data O
20%
Ancillary Data N
25%
Core Data D
95%
Core Data F
75%
Support Data H
65%
Ancillary Data M
35%
Core Data E
75%
Support Data K
45%
Core Data C
100%
Core Data A
100%
Support Data I
60%
❖ Active Program/Activities
12Proprietary©2018©2018
Spotlight: Next Best ActionTo deliver a differentiated member experience, Next Best Action (NBA) capabilities must be in-flight integrated across channels and signal sources
Business Operating PlatformNext Best Action Analytics
Fully Mature Next Best Action Platform
Situational Decision Process (Real-Time)
Co
gn
itiv
e F
ee
db
ac
k L
oo
p
(Re
al-
Tim
e)
Suggested Action,
Time and Channel
Communication Manager(Choke & Control Messages)
Interaction Tracker(Record Interactions in Real-Time)
Service, Clinical
and Compliance
items
Predictive Analytics
(Predicting Impact)
• Available now – Global
preferences and ability to run
opportunistic campaigns
• In progress – Individual,
predictive, analytical signals
that are globally consistent
• Future – Global tracking of
all interactions and in flight,
real time, prioritization of
actions in the context of
personal goals and priorities
Example: An in flight pre-
authorization is probably more
important to a member than a
new flu shot campaign
NBA Journey
DATA LAKE
Benefit Administration
Clinical & Logistics
Brokering of Priorities / Omni-channel Orchestration
Systems of Engagement
Digital Apps
CSRClinician
PrintMarketing
Local
13Proprietary©2018
Analytical Data Availability
The Unified Data Fabric for Systems of Insight is well established – and used (a lot)
All but one All but oneNearly
complete
Majority and
growing
Limited but
growing
Primarily via
EDW
Claims
Member/Membership
Customer
Policy/Benefits
Organization
Provider
Revenue
Reference
Clinical Management
Sales & Commission
Da
ta S
ub
jec
t A
rea
s
Curated Data Enriched Data
Analytically
Conformed(globally consistent)
Conformed(uniform subject)
Viewable(source specific)
Raw Ingest(source specific)
Integrated(business centric)
Analytically
Enriched(usage specific)
14Proprietary©2018
Select Portfolio Principles – Key Takeaways
Success requires strong leadership, perseverance and thoughtful platform integration
#1Avoid discontinuity for the health consumer by ensuring coordination between different
organizations
#2Always use the right “source of truth” for data and insight, do not make copies of data where
it can be avoided
#3Consolidate platforms within each “capability category”, eliminate functionality sprawl yet
allow each category to evolve independently
#4 Use our world-class integration platform to create a customer obsessed experience
#5None of this will work without the ecosystem platform capabilities (i.e., we would not have
the freedom to evolve while integrating what the consumer sees/experiences)
Portfolio Principles