Oracle Customer Success—Harvard Pilgrim Health Care

Harvard Pilgrim Health Care Speeds Transactions for Approximately 1 Million Claims Monthly—Improves Customer Satisfaction and Delivers Peace of Mind

Oracle Health Insurance Components running on Oracle Exadata enable us to keep health insurance as affordable as possible, reduce expenses, drive down operating costs, and process millions of transactions each year consistently and accurately—all while we continue to provide the best service possible to our members.

— Deborah Norton, CIO and Senior Vice President, IT and Operations

Harvard Pilgrim Health Care is a not-for-profit health plan serving more than 1.2 million members throughout New England, with its most recent expansion into Connecticut. Founded in 1969, the health plan has built its reputation on pragmatic innovation with goals of lowering costs, improving care, and enhancing the overall member experience. Harvard Pilgrim is known for its strong clinical programs, customer service, health improvement strategies, and innovative tools that offer consumers greater transparency and empower them to make better decisions about their health care.

Harvard Pilgrim has been consistently ranked among the nation’s highest-rated health plans.*

Business Challenge

Enable the rapidly growing health plan provider to efficiently and accurately process and manage millions of medical benefit claims annually
Continue to provide the outstanding customer service that distinguishes the company even in the midst of national healthcare reform and transformation

Improve ability to rapidly deliver innovative health insurance products to market
Automate manual processes and improve productivity to keep administrative costs low
Expand transparency and simplify explanations of benefits to improve customer satisfaction

Achieved a 360-degree view of member benefits and provider services and continued to strengthen the company’s reputation for providing outstanding service with Oracle Health Insurance Components, including Oracle Health Insurance Claims Adjudication
Ensured ability to rapidly and accurately process approximately 1 million claims transactions each month by running Oracle Health Insurance applications on Oracle Exadata Database Machine

Achieved an automated claims-processing rate of 90% to 92%—leading to greater accuracy and faster claims payments to members
Integrated the Oracle Health Insurance Components with Harvard Pilgrim’s Oracle E-Business Suite environment, enabling the insurer to standardize and accelerate payments to healthcare providers by automating a manual process
Improved competitive advantage by empowering lines of business to rapidly develop and support innovative health insurance products and services, thanks to a rules-based system that does not require time-consuming recoding when updating or introducing a new offering
Gained the ability to present financial messages and explanations of benefits in everyday English—boosting customer satisfaction and delivering peace of mind; reducing contact center inquiries; and giving customer-service representatives more time to focus on complex cases
Realized massively improved system performance with Orace Exadata Database Machine, in some cases increasing the speed of processing services and jobs as much as 90%, enabling Harvard Pilgrim to redeploy skilled technology professionals to focus on other strategic initiatives

The partnership with Oracle and, in particular, with Oracle Health Insurance has been nothing short of amazing. These are some of the finest technologists that I've ever worked with, and they are true professionals. When they tell you they're going to deliver something, they deliver it. It's usually ahead of schedule and usually has more in the bundle than we're expecting. Oracle Health Insurance Components and the Oracle team have really enabled us to achieve our mission and reach our business goals.

— Deborah Norton, CIO and Senior Vice President, IT and Operations

Execution

Harvard Pilgrim went live with the first phase of its Oracle Health Insurance application implementation in late 2011. Built on a service-oriented architecture, Oracle Health Insurance Components enable a phased implementation, allowing Harvard Pilgrim to avoid a big-bang system replacement and substantially reduce project risk. The company plans to roll out Oracle Health Insurance Claims Pricing and Oracle Health Insurance Product Definition in late 2014.

*NCQA’s Private Health Insurance Plan Rankings, 2011-15, HMO/POS/PPO. NCQA’s Health Insurance Plan Rankings 2010-11 – Private.
U.S.News/NCQA America’s Best Health Insurance Plans 2005-2009 (annual). America’s Best Health Insurance Plans is a trademark of U.S.News & World Report.
NCQA The State of Health Care Quality 2004.