#PegaHC

About UnitedHealth Group• Serving more than 85 million individuals worldwide with health benefits and services

• We serve individual consumer, employers, governments, commercial payers and intermediaries, physicians, hospitals, care professionals and pharmaceuticals and medical device manufacturers. Impact involves direct relationships with 6,100 hospital facilities and 855,000 physicians and caregivers.

• UnitedHealthcare and Optum serve members in all 50 states in the United States and more than 125 other countries.

• UHG 2014 revenues of $130.5 billion with 185,000 employees in 21 countries• 2014 Optum revenue $47 billion with 80,000+ employees

• Fortune 500 ranking: No. 14

• Named World’s Most Admired Company in the Insurance and Managed Care sector, 2011, 2012, 2013, and 2014, by Fortune. 

• Member, Dow Jones Industrial Average

3

#PegaHC

Better Together

4

Optum• Clinical education • Health care decision support• Lifestyle coaching• Behavior change value monetization• Pharmacy benefits and medication review

UnitedHealthcare• Plan, claims and benefits education• Issue resolution• Network and steerage• Provider relationships and shared savings

• Focused relationship with consumer that is preference- and needs-based• Intelligent segmentation and personalization• Issue resolution ownership and assurance• Alignment of management team and goals• Joint Affordability methodology and operational efficiencies

Better Consumer Experience. Better Health. Better Affordability. Better Together.

#PegaHC

Our Focus & Commitment

CREATING A BRANDED, ONE OPTUM EXPERIENCE

• Compassion• Empathy• Knowledgeable• Solution Oriented• Connected• Omni Channel• Highly Engaging• Ownership & Accountability

5

#PegaHC

3 Segments

11 Business Units

26+ Separate Operations

~95+ Unique Applications/Tools

~248+ Unique Call Types

~12,000+ Customer Facing FTEs

~22 Million+ Calls Handled Annually

Current Complexity• 150+ websites• Many IDs and passwords• Numerous transfers• Confusing terminology• Stating or requesting the same information

more than once.

Call to Action:The marketplace is demanding more integrated, highly accountable, consumer experience driven offerings.

The Current State Contains a Multitude of Complexity

6

#PegaHC

Apex Integrated Member Service Platform

7

VisionA solution that provides a

simplified, best-in-class agent desktop that

enables Admin Shared Service operating model

by reducing the complexity agents face in

handling and resolving administrative call types

from members, providers, and other constituents

Opportunity• Organize to better serve

clients based on client purchase behavior toward bundled solutions

• Interactions are customer-centric vs. product focused

• Quality, integration, and transparency to clients and internal support teams, operations, IT, and client engagement managers

Benefits & Outcomes

• Support the Administrative Shared Services Operating Model

• Enable the “one Optum” experience

• Improve operational efficiency and reduce complexity for our customers and employees

#PegaHC

Common Service Attributes1. Standard greeting and common authentication process2. Visibility to interactions from impacted workflows3. Provide workflows and scripting based on call intent for a

consistent user experience4. Presents information just-in-time, no more, no less5. Automatically populate member/account details based on IVR

data passed to agent desktop6. Automatically document interactions and cases during call flow

8

Customer Care 8,200 – 13,200 seats

#PegaHC

UHG PEGA Architecture

9

#PegaHC

Deployment

2013 2014 2015Jan Apr Jul Dec Jan Apr Jul Dec Jan Apr Jul Dec

Behavioral, Physical Health

& Financial Services R2, R3,

R3.2Behavioral Health &Financial Services

R1.0(Pilot)

OptumInsightProduct Support

R3.1Behavioral Health

R1.1

Behavioral HealthR1.2

10

#PegaHC

Platform Screenshots & Feedback

11

User Feedback Comprehensive and easy to use;

being able to document in one system

Makes the call error-proof because it is step by step on what needs to be done – anybody can catch on

We see members, as opposed to fractions of their coverage; we can see dependents too

An overall picture of the member’s coverage makes it easier to help them across aspects of their coverage; it will foster a sense of security and accountability

#PegaHC

Platform Screenshots & FeedbackUser Feedback Comprehensive and easy to use;

being able to document in one system

Makes the call error-proof because it is step by step on what needs to be done – anybody can catch on

We see members, as opposed to fractions of their coverage; we can see dependents too

An overall picture of the member’s coverage makes it easier to help them across aspects of their coverage; it will foster a sense of security and accountability

12

#PegaHC

Organizational Impact

13

#PegaHC

Implementation Strategy• Focus on member experience versus products or organizations• Develop future-state value streams and adhere to DCO• Build > Pilot > Collect Feedback > Incorporate• Business + end user involvement throughout process

14

#PegaHC

Lessons Learned• Train supervisors before front-line staff• Develop to-be process maps early• Tighter integration with impacted internal application teams• Reconcile methodologies• Involve UAT earlier• Execute pre and post-production pilots• More focus on UI guidelines

15

Q & A