Presenter’s Name: Presenter’s Title - Oracle · “The Blues are committed to developing long-term and thoughtful policy solutions to the challenges of ... Address Post-merger

Healthcare Payer SolutionsPresenter’s Name:Presenter’s Title:

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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


• Leadership in Healthcare

• Innovation in Industry Solutions

• Results Achieved by Oracle Customers

Agenda


Oracle in HealthcareDid You Know?

More than 350 leading healthcare providers run Oracle Applications

10 of the top 12 Fortune Global 500 healthcare organizations run Oracle Applications

More than 80 Healthcare Payers run Oracle Apps

20 of the top 20 US health insurers run Oracle Applications


The Challenges We’re Hearing

Grow Business Profitably:How do I respond rapidly to a dynamic market & improve profitability?“Companies that operate in many different markets need to accurately address the profitability of members and adjust rates accordingly.”

!

Enable Consumerism:How can I make healthcare information transparent through self-service channels so that customers are empowered to make the right health choices?“The Blues are committed to developing long-term and thoughtful policy solutions to the challenges of rising healthcare costs and the growing number of uninsured Americans.”

!

Address Post-merger Integration and Governance:How can my organization face industry consolidation and continue to meet increasing national and regional governance demands?“Our enterprise applications are strategic, allowing Wellpoint to quickly integrate acquisitions and still meet regulatory requirements.”

!


Analyst Quotes

“The list of enhancements, new features, and technology in the Oracle Siebel 8.0 CRM release are numerous and certainly reflect three years of development. In general, additions to the application follow the theme of reducing total cost of ownership for CRM and increasing the flexibility and approachability of the application.” February 2007

“Forrester evaluated leading enterprise CRM suites vendors across493 criteria and ranked Oracle's Siebel CRM as a Leader offeringbroad and deep functional capabilities, industry specialization, and the scalability to support global organizations.” February 2007

“Siebel Systems' production customers continue to demonstrate thehighest complexity and broadest functionality in the industry, which is enough to place it in the Leader's quadrant.” March 2006

“The Human Capital Management Applications Report, 2005-2010 report ranks Oracle as the market leader in the space by revenue, overtaking SAP.” August 2006





Agenda


Grow Business Profitably

Enable Consumerism

Address Post-Merger Integration and

Governance

Oracle Healthcare SolutionsIncrease Business Performance and Integrate Business Processes across the Healthcare Continuum



Requirement Oracle Capability The Oracle Difference

Most comprehensive distributor relationship management solution

Recruit, retain and increase market share with targeted distributors

Distribution Mgmt and Self-Service

Increase product innovation and speed-to-market Product Management

Best-in-class product master with integrated marketing / sales solution

Optimize provider networks Provider Relationship Management

Only insight-driven provider relationship management application within an SOA architecture

Enhance visibility into profitability drivers

Business Intelligence for Healthcare

Only enterprise business analytics solutions with pre-built healthcare profitability key performance indicators


Example: Distributor Relationship ManagementDrive Distribution Loyalty

RecruitRecruit

ServiceService

Retain

• Executeagentrecruitment programs

• Track and manage agent files

• Manage producer master

• Manage incentive compensationto accurately compensate agents and reward exceptional producers

• Gain insight into channel profitability through Partner Analytics Dashboards

• Enable channel with Partner Portal• Service Agent / Broker requests

utilizing call center capabilities

• Facilitate team selling: Distribute leads and collaborate on RFQ process

Drive distribution loyalty

Improve channel visibility

Streamline sales process across channels


SOLUTIONS• Automated agent/broker sales solution supporting

1,700 distributors with application capture via the Internet

CHALLENGES / OPPORTUNITIES• Reduce the cost of sales and enrollment • Reduce quote turnaround time

CUSTOMER PERSPECTIVE“eBlue is now being used by preferred agents. We have…accurate, clean, complete electronic applications. They were received in seconds with no stamps to buy and no envelopes to open….We have taken a huge step right here… .”Mike ReitzSenior Vice President and Chief Marketing Officer

RESULTS• Reduced enrollment time for new

members from 20 days to 6 days• Reduced sales and enrollment costs

by 50%

COMPANY OVERVIEW• Headquartered in Baton Rouge• District offices in Alexandria, Houma, Lafayette,

Lake Charles and Monroe. One out of every 4 Louisianans depends on Blue Cross for coverage

• State’s largest health insurer with more than one million members statewide

• US$1.6 billion in premium revenues• The company’s subsidiaries include HMO

Louisiana and Southern National Life Insurance Co.

Blue Cross Blue Shield of LouisianaReduces Cost of Sales and Enrollment



Enable Consumerism


Governance



Enable Consumerism


Understand provider quality metrics to support pay for performance

Healthcare Business Intelligence

Most complete set of capabilities to support pay-for-performance initiatives

Most advanced analytics to target member populationsfor medical outreach

Create effective medical management programs

Claims Service,Member Outreach, Claims Intelligence

Support collaboration amongst the plan, providers and members

Only next-generation, standards-based technology for meaningful healthcare information exchange

Healthcare Information Exchange (HIE)


Example: Enterprise Claims IntelligenceLeverage Claims Data to Drive Affordability and Satisfaction

Mine claims data to understand utilization trends

Improve customer service through embedded analytical insights

Ensure network mix and geographic distribution match membership needs

HEALTHCARECLAIMSDATA

HEALTHCARECLAIMSDATA

• Underwriting• Performance Reporting

• Claims inquiries• CDHP Support• Personal Health Record

• Wellness Programs• Disease Management• Case Management• Utilization Review

• Claims Inquiries• Contract Negotiations• Pay-for-performance

• Benefit Change Impact• Profitability

by LOB• Pricing

• Performance Assessment

• Network Adequacy Evaluation

AccountManagement

ProviderManagement

ProductManagement

MedicalManagement

MemberServices


SOLUTIONS• Oracle’s Siebel Analytics used by 2,000+ internal

employees across the enterprise• Integrated real-time and historical data from 15+

different database platforms• Live after 45 days

CHALLENGES / OPPORTUNITIES• Streamline the labor-intensive, costly and slow data

analysis process• Access and analyze data stored in a number of

legacy systems• Deliver reports in a timely manner; reduce

turnaround time

CUSTOMER PERSPECTIVE“Before we installed [Oracle] Siebel Analytics, … we had to hire consultants to do the job, at a cost of $1,000 per report…Now we’re generating the reports on our own and saving about $4 million a year –the turnaround time is down to approximately three days.”Lisa DavisManager of Enterprise Business Intelligence

RESULTS• Reduced costs of reporting/consultants

by $4 million in the first year• Reduced time for reporting and analysis

from 30-60 days to approximately three days or less

• Improved group medical loss ratio • Reduced time for complex security

parameter requirements for HIPAA compliance from 1,000 hours to 20 hours

COMPANY OVERVIEW• Leader in the state’s health industry serving more

than 8.3 million people and holding a 29% market share (more than double the nearest competitor)

• Consolidated total revenue of $6.97 billion and a profit margin of 4.9% statewide reported in 2005

• Provides employment for approximately 8,400 individuals in Jacksonville, Miami, Ft. Lauderdale, Orlando, Tampa and Pensacola

Blue Cross Blue Shield of Florida Reduces Time and Cost of Data Analysis



Enable Consumerism


Governance



Address Post-Merger Integration and Governance


Most complete and integrated human capital system which facilitates self-service for acquired employees

Facilitate on-boarding of acquired employees and reduce redundant HR systems

Human Capital Management

Guarantee financial reporting accuracy and real-time visibility into financial KPIs

Most scalable financial hub solution, which consolidates multiple ledgers to provide accurate financial reporting

Financials, Financial Hub, Treasury

Ensure compliance with extensive national, state and local regulations

Internal Controls Enforcer and Manager

Only compliance solution embedded seamlessly into back-office apps such as financials & human resources

Guarantee data privacy and security

Access, Security, Identity Management Best-in-class identity mgmt


Example: Human Capital Management & Self-ServiceReducing Costs and Providing Better Service

Management• Reduction in expense• Reduction in sick days• Productivity improvement

AutomationEfficiency

• Reduce headcount

• Increase employeeon-boarding velocity

• Decrease premiums

Self-Service Benefits KPIs• Turnover Ratio

BenefitConsultants

Open Enrollment

Web

IVR

Self Service Member

Reconciliation• Eligible

employees• COBRA• Opt Outs

Measure& Monitor

Increase Efficiency and Increase Employee Satisfaction

DevelopBenefits

Internal Focus Group

Gap Analysis

Redefined Benefits

Deploy toTest Group

Plan

Increase employee satisfactionLower transaction costIncrease retention

• Claims Expense Ratio• Benefits Administrator / Employee Ratio

Employee• Survey • Reduced Turnover


CHALLENGES / OPPORTUNITIES• Replace legacy HR system with more robust apps

platform to increase scalability and functionality • Quickly onboard new employees • Consolidate reporting • Lower the acquisition costs • Meet governance requirements

CUSTOMER PERSPECTIVE“Oracle’s PeopleSoft portal will help facilitate WellPoint’s aggressive business plan of expanding via mergers and acquisitions; specifically with the people, data and integration processes, as well as assisting with change management. Getting information to the right people—management, non-mgmt, union, nonunion, and so on—at the right time through the portal will make a significant difference.”Chuck Moore, Staff VP, HRIS & Administration

RESULTS• Eliminated data redundancies and

improved reporting accuracy • Streamlined personnel updates and

allowed users to configure benefits • Gained visibility into critical business

info and improved operational efficiency

COMPANY OVERVIEW• Leading US health plan with 34M members - covers

1 in 9 Americans; 2005 revenue $45B• Blue Cross or Blue Cross Blue Shield licensee in

14 states• Offers broad range of medical & specialty products• Fortune magazine ranked Wellpoint as #1 in list of

“America’s Most Admired Companies”

Wellpoint Improves Employee Satisfaction and Reduces HR Costs

• Portal

SOLUTIONSPeopleSoft Enterprise • Human Capital Management • Financial Management


• Human Capital Management

• Financials, Financial Hub, and Treasury

• Internal Controls Enforcer and Manager, HCM

• Identity Management and Database Data Vault

Address PostAddress Post--Merger Merger Integration and Integration and

GovernanceGovernance

• Claims Service, Member Outreach, Claims Intelligence

• Provider Relationship Management

• Healthcare Information Exchange

• Healthcare Business Intelligence and Provider Billing

Enable ConsumerismEnable Consumerism

• Distribution Management and Partner Portal • Universal Product Master, Marketing Automation,

Healthcare Sales Solution• ERP, Database and Middleware• Business Intelligence for Healthcare

Grow Business Grow Business ProfitablyProfitably

Oracle Healthcare Payer Solutions Summary

OracleOracle

ISV Partners

ClaimsClaims Adjudication

Fraud & Abuse

Claims Service

Self-Service

Channel Mgmt

Channel Sales

Decision SupportDecision Support

Corporate AdministrationCorporate Administration

InfrastructureInfrastructureMaster Data Management

Integration Framework

Content Management

Middleware & Database

Payer Core OperationsPayer Core OperationsSales &

UnderwritingProduct Dev &

Marketing

Product Design

Pricing

Consumer & Channel Mktg

Events

Corporate Marketing

Sales Planning

Direct Sales

Compensation MgmtRating & Underwriting

Membership & Benefits

Appeal & Grievance Mgmt

Application Processing

Policy Issuance

Member Enrollment

Reinsurance

Benefits Administration

Application Processing

ServicePremium Billing

Member Services

Provider Services

Self-Service

Networks

Network Development

Contract Management

Performance Assessment

Medical Management

Referrals &Authorizations

CareManagement

Exec AnalyticsChannel Insight Operational Insight Profitability HR AnalyticsCustomer Insight

Quality Assurance Finance & Treasury

Planning & Forecasting Regulatory Compliance

Human Resources

Risk Management

Healthcare Payer Solution Footprint



The Only Complete Healthcare Payer Solution

PartnersPartners PeoplePeoplePeople

PlatformPlatform

ProcessProcess

ResultsResults

Oracle Uniquely Delivers a Competitive Advantage by Leveraging People, Partners, Process, and Platform


People: Oracle’s Ecosystem Creates Advantage

950 customers participating in Customer Advisory Boards

500 Industry & Product strategy council members

35 Fusion strategycouncil members

1,300 participants in early customer adoption programs

425 user groups

30,000 applications customers

220,000 database customers

5,000 middleware ISVs

1,700 application ISVs

9,000 database ISVs

30,000 middleware customers

29,000 developers, support engineers

and consultants275,000 275,000

Customers Customers Benefiting Benefiting

from Shared from Shared InnovationInnovation


#1 Enterprise Software Vendor• ERP, CRM, SCM and more• Most scalable, reliable, secure infrastructure• Most complete range of on-demand and on-premise

deployment options

Built-In Healthcare Payer Capabilities• Healthcare business analytics including profitability KPIs• Standards-based Healthcare Information Exchange• Best-in-class data privacy and security controls• Embedded compliance solution for financials and HR for

addressing national, state, and local regulations

Largest Software Support Team• 21,000+ development and support engineers • 145+ countriesDatabaseDatabase

MiddlewareMiddleware

ApplicationsApplications

ConsultingConsulting

TrainingTraining

SupportSupport

Process: Top to Bottom Support for Healthcare Payers


Platform: Oracle Fusion Middleware Leads the MarketBestBest--SellingSelling

• 32,000+ Customers Deployed • 70% of World’s 50 Largest Firms• $1B+ Business

Oracle 55%

Oracle 55%

Others 45%

Others 45%

Source: Gartner’s Market Share Application Integration & Architecture

Source: Gartner’s Market Share Application Integration & Architecture

40%

30%

20%

10%

0%

39.6%

6.7% 7.1%

Oracle IBM Total Mkt

Growth Rates

#1 Middleware By Share

Fastest Growing Middleware

Highest RatedHighest RatedOnly Vendor in Gartner and

Forrester Leader Quadrants for All Middleware Components

Source: Forrester Research Ranking of Application Platform Servers

Oracle

IBMSAP

Microsoft

0% 5% 10% 15% 20% 25% 30%

SOA Vendor of Choice

Oracle Leads the Pack

IBMSAP

SUN Microsystems

Microsoft

Novell

LeadersStrongPerformersContenders

Strong

StrongWeakWeak

Strategy

Market Presence

CurrentOffering

Oracle

Most ComprehensiveMost ComprehensiveIndustry's Most Comprehensive

Platform for Developing, Deploying& Integrating Enterprise Apps

Rich Functionality

ORCLORCL IBMIBM SAPSAPJ2EE Server & Dev ToolsEnterpriseService BusPortal, Collab,Content MgmtBPEL Process ManagementActivity MonitoringBusiness Rules EngineSOA ManagementBusiness IntelligenceIntegrity Management





Agenda


What Customers are Achieving…

increased enrollment by 200% with on-line quoting

added 200,000 new members while reducing both call durationand wait times by 20% utilizing Oracle Siebel Contact Center

reduced sales and enrollment costs by 50% through Oracle Siebel Healthcare Sales

achieved an additional $9 million of interest earned in trust funds during first seven months utilizing Oracle Financials General Ledger

reduced costs of reporting / consultants by $4 million in first year of Oracle Siebel implementation


Best-in-class product master with integrated sales through enrollment automation

Most complete set of capabilities to implement pay-for-performance

Only compliance solution embedded seamlessly into back-office applications such as Financials and Human Resources

Only Oracle…

The Oracle Difference

Appendix

Additional Slides


With the Recent Acquisitions Oracle Becomes Stronger in Healthcare Payer

• 80+ payer customers, touching over 200M members• Infrastructure for Medicare / Medicaid • Widest range of technology & deployment options• World-class, award-winning technical support• Completely committed to customer success

10 of the Top 10US Health Payersrun Oracle Apps

• Marketing leading CRM

• Strong industry expertise

• Leading provider of business intelligence applications

• Market leading Human Capital Management

• Leading providerof financial andEPM applicationsto payers

• Leading provider of ERP applications

• Largest technology vendor to Payer industry


Oracle Applications Strategy

• Leadership Today: Protect & Grow Our Application Install Base

– Greatly expanded base– Thousands of customers across almost

every industry

• Broaden Our Solution Footprint– Greatly expanded apps portfolio— we’re

now a more important partner for our customers

– Core industry solutions– Complete apps / middleware / database

footprint drives standardization

• Bring Innovation to Our Customers– We are delivering next-generation

capabilities first

• Applications Unlimited– Continued value for customers in existing

product lines– Dedicated development teams and

roadmaps

• Convergence and Integration– Adoption of next generation technologies &

Fusion Middleware in existing applications – Application Integration Platform delivering

industry processes

• Next Generation of Solutions– Fusion– Best of the product lines, superior

ownership initiative, usability, adaptability

STRATEGY EXECUTION


Applications UnlimitedFive Product Releases … Innovation Continues!

JD Edwards EnterpriseOne 8.12• 5 New Products• 291 Enhancements

Siebel 8.0• 10 New Products• 366 Enhancements

JD Edwards World A9.1• 4 New Products• 1297 Enhancements

PeopleSoft 9.0• 2 New Products• 1478 Enhancements

Oracle E-Business Suite 12• 18 New Products• 2443 Enhancements


Oracle Application Integration ArchitectureAIA Process to Drive Footprint Integration

AIA Architecture BenefitsIndustry best practice processes Sustainable integration connects current applications Pre-built SOA provides a framework for continuous innovation

KEY DELIVERABLES• Industry Reference Models

– Protect investments by integrating existing applications using documented industry best practices• Process Integration Packs (PIPs)

– Quickly integrate Oracle Applications and eliminate risk through pre-built, sustainable integrations• Business Process Analysis Suite

– Accelerate time to value by leveraging pre-built, open, standards-based architecture


Ownership Experience

• Faster to deploy• Easier to manage• Less risky

Partner Experience

• Easier to integrate• Easier to extend• Easier to support

User Experience

• More useful• Easier to use• Works the way

users work

Oracle Fusion Applications: New Functionality + Better Ways of Doing Things

Oracle Fusion Middleware

Oracle Fusion Applications

Documents

Presenter’s Name: Presenter’s Title - Oracle · “The Blues are committed to developing long-term and thoughtful policy solutions to the challenges of ... Address Post-merger