Customer Relationship Management Health (CRM-H) Platform

Analysis Findings

for the Veterans Relationship Management PMO

Presented by Strategic Planning, Roadmap and Requirements Team (STARR)

Associated Veterans, LLC

July 1, 2015

Assessment Key Points •  Goal:

•  Propose a “single, modular, architected CRM-H(ealth) Platform” •  Comprised of common capabilities relevant to all VHA contact centers and

business lines

•  Approach:

•  Analysis Method: •  Refined extracted needs into a feature list •  Grouped features into capability groupings •  Crafted interpretation of Customer Journey •  Defined understanding of the VHA business (Zachman Framework) •  Developed a proposed CRM Capability Model agnostic of line of business

•  Results: •  Arrived at a proposed CRM-H Capability Business Architecture •  Accompanied by supporting models, flows, and other artifacts

Review VHA BRDs

Assess VBA Solutions

Engage Subject Matter

Experts

Extract Common Business

Needs

CRM-H Platform Capability Business Architecture

Customer Management Services •  Account Management •  Customer Information Management

•  Benefit Information (Health , Non Health) •  Demographic Information •  Military Service Information •  Medical Information

•  Medical Records •  Pharmacy and Medication •  Primary Care Providers •  Special Needs

•  Flashes and Alerts •  Profile Management

•  Preference Management •  Customer Data Information (CDI)

Access Management Services

•  Credentialing •  ID Management •  ID Proofing •  Role Based Access

Analytics and Reporting Services •  Case Management Performance •  Interaction Management Performance •  Customer Experience Performance

•  Call Resolution •  Customer Complaints

•  Performance Views: Business Unit, Team, Individual Performance

Benefit Management Services •  Benefit Marketing •  Claim Submission and Intake •  Eligibility and Entitlement

Determination •  Claim Processing and Management •  Benefit Delivery

•  Non Health •  Health Services

•  Appeals

Communications Management Services •  Outbound and Inbound Letters and

Correspondence •  Outreach •  Secure Messaging

Customer Relationship Management Services •  Customer Search •  Customer Identity •  Interaction and Contact Management

•  Interaction Channels •  Interaction History •  Interaction Notes •  Interaction Communications

•  Case Management •  Workflow •  Timeliness

Document Management Services •  Storage •  Search •  Retrieval •  Views

Partner Management Services •  On Boarding •  Access •  Partner Information

Program Monitoring, Control & QA Services •  Audits •  Customer Feedback •  Program Evaluation

Protocols and Procedure Services •  Knowledge Base •  Checklists

Relationship Management Services •  Relationship Info •  Relationship Search •  Relationship Administration

Request Management Services •  Intake •  Process •  Respond

System Administration Services •  Configuration Management •  User Management

Workforce Management and Planning Services •  Resource Management •  Resource Planning •  Resource Scheduling

Capability Structure Hierarchy: 1st Tier Capability (14 Total) •  2nd Tier Capability (47 Total)

•  3rd Tier Capability (16 Total)

Concentration of Capability Need by Line of Business

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Supporting Artifacts

1.  Tiered Structure View of CRM-H Platform 2.  Customer Journey Flows 3.  Core Business Diagram (Zachman) 4.  Platform Capabilities (Technical) 5.  Platform Integration Model (Technical) 6.  Platform Support for a VHA Virtual Customer

Service Model 7.  Zachman Framework Analysis

VHA Customer Service Tiered View

6

Veteran Customer Journey: VAMC

Veteran Customer Journey: Non-VA Medical Center

Beneficiaries Customer Journey: Non-VA Medical Centers

VHA Core Business Diagram (Zachman)

Tiered View of the CRM-H Platform

11

CRM-H Platform Integration Model

12

Proposed VHA Virtual Customer Service Model

13

Veteran

VHA H Platform

Beneficiary Care Giver Medical Service Provider

Insurance Provider

Issues and Questions Issues and

Questions Issues and Questions

Issues and Questions Issues and

Questions

1 800 999 8888 All Other

1 800 999 8888 Crisis

HRC

HEC

HAC VCL ???

CPAC

CPAC

Tier 1

Tier 2

Tier 3

CRM-H Platform = Game Changer for VA

•  Opportunity to transform the VHA business •  Proactively supports VA re-organization •  Provides business flexibility

Drives to goals of achieving: •  Standardization

•  Process •  User interface •  Customer Data Integration (CDI) •  Work Flow Management

•  Cost efficiencies •  Development •  Maintenance •  Workforce Management & Training

•  Customer Experience •  Veteran-centric approach to customer service

“The patient will see you now.”

Contents: •  R1C1 List of Key Data (What) •  R1C2 List of Key Processes (How) •  R1C3 List of Key Locations (Where) •  R1C4 List of Key Stakeholders (Who) •  R1C5 List of Key Events (When) •  R1C6 List of Key Goals (Why) •  R2C1 Conceptual Data Model •  R2C2 Business Process Model •  R2C3 Business Logistics Model •  R2C4 Use Case Diagram •  R3C2 Core Diagram

•  Account Information • Customer Information

•  Contact Information •  Military History •  Benefits Information •  Medical Information •  Facilities Information

• Rules and Regulations

•  Enroll Customers •  Schedule Appointments •  Authorize Non-VA Care •  Deliver Care (inpatient, outpatient) •  Provide Pharmacy Services •  Bill Customers •  Purchase Care •  Provide Customer Service

•  VAMC •  Non-VA Medical Facilities •  Corporate Offices •  Contact Centers •  Customer Premises

•  Veterans and Servicemembers •  Beneficiaries •  Caregivers •  Veteran Representatives •  Health Providers (VA and non-VA) •  VA Employees •  Insurance Companies •  Federal Agencies •  Congress •  White House

•  Legislation Enacted •  Outreach •  Customer Enrolled •  Appointment Scheduled •  Non-VA Care Authorized •  Care Provided •  Customer Hospitalized •  Prescription Filled •  Billing Addressed •  Service Issue Communicated •  Account Closed (e.g., FNOD)

•  Provide Outstanding Healthcare •  Expand Options for Accessing Care •  Improve Health Outcomes •  Improve Customer Service •  Reduce cost of Customer Support •  Single View of the Veteran

Pending

Pending