Healthcare insurance service provider DAK

DAK
Business Issue
Today, better informed consumer patients
are demanding a higher quality of care, and
insurers often have to consider providing
more complex and sophisticated medical
care processes. The traditional business
environment of health insurance funds is also
changing as doctors and hospitals become
more entrepreneurial.
These factors impact the funding of compulsory
health providers, eroding the ability of some
organizations to compete, and possibly in some
cases to survive.These challenges are only the
tip of the iceberg along with the influence of
government regulation.
Healthcare insurance service provider DAK optimizes its
business processes using software from Pegasystems - and
expands its expertise as an IT service provider for the public
insurance industry.
Pegasystems’ new software platform enhances “customer
experience” levels and optimizes cost savings for leading
German healthcare insurer…
As the once-nationalized German healthcare market opens up, it is
increasingly influenced by European trends, and the country’s compulsory
health insurers are challenged to expand their business practices.
Today, better informed consumer patients are demanding a higher quality
of care, and insurers often have to consider providing more complex and
sophisticated medical care processes. The traditional business environment
of health insurance funds is also changing as doctors and hospitals become
more entrepreneurial. These factors impact the funding of compulsory
health providers, eroding the ability of some organizations to compete, and
possibly in some cases to survive.
But these challenges are only the tip of the iceberg. Government regulation
has an increasing influence as well. The German government’s health
reform, planned for 2009, includes the creation of a health fund that
will penalize health insurance companies that have a “high number of
chronically ill members.” Even politicians who initially agreed on the fund
have begun to question its feasibility. Additionally, increasing prices for
pharmaceuticals and a generally unhealthier lifestyle among the German
population are leading to higher costs for medical healthcare services as
well.
Despite this challenging environment, DAK was profitable in 2007 and is
expected to break-even in 2008. This is in the face of DAK having to deal
with a 7% increase on pharmaceutical costs as well as one of the highest
rates of chronically ill members among German insurance
companies. DAK was able to achieve these results because
of its highly efficient and effective healthcare management
system. According to independent consumer organizations,
DAK is one of the most innovative and modern healthcare
providers and insurers in Germany.
� How do we qualify our employees for new service and
consulting tasks?
Providing customer-oriented health care
Similar to many other organizations, DAK has an organically
grown IT landscape. The core application, DAKIDIS,
consists of 5,000 program modules, which contain member
directory, tariffs and benefit management data. In addition
to DAKIDIS, employees had to leverage a variety of other
systems including the DAK-intranet, the phone system,
administrative tools, the Internet as well as other specific
applications containing internal work guidelines and public
insurance compliance information to process a single
customer request.
In 2005, DAK began an initiative called ProDAK, which was a
realignment of the entire organization to enable a stronger
focus on the member and the customer.
As a result, DAK’s health management system is now
tailored to the patient’s profile. Chronically ill patients
receive a customized holistic care program, while healthy
members benefit from the “DAKpro Balance” bonus
program. Through this program DAK rewards a healthy
lifestyle, regular preventive medical check-ups, and
achieving and maintaining healthy body indices and metrics.
As a modern healthcare service provider, DAK not only
helps keep its members fit, but the company itself, as
internal systems and processes are continuously checked
for efficiency. DAK’s IT department has an exceptional
reputation in the industry and offers its expertise and
IT-infrastructure as a service to other health insurance
companies in Germany.
However, the most important goal of the ProDAK
realignment is the optimization of customer service,
which has led to significant cost reductions, and increased
member and employee satisfaction.
In order to implement ProDAK and optimize the “customer
experience” via all interaction channels, DAK was required
to answer the following questions:
� What does the customer expect?
� How can we increase the quality of service for our
customers?
� How can we reduce performance costs and increase
customer satisfaction at the same time?
� How do we become quicker, more competent, flexible and
efficient?
� How can we showcase our excellent performance to
customers and prospects?
The role of IT during the realignment
Navigation between the different systems was very timeconsuming for DAK employees as they had to take notes to
remember data used in one system to work in a different
one. This was not only annoying to the staff, it had a negative
impact on customer service. DAK conducted an employee
survey and analysis of current service levels and found
that employees spent too much time dealing with the
complex application landscape and lacked essential time to
thoroughly consult with members and customers.
Consequently, the IT department was given the task of
implementing a modern and integrated consultant and
service desktop that would consolidate all necessary
applications for service staff. IBM was chosen as
implementation partner for the “DAKOR” project. From the
very start, employees were involved in the planning and
conceptual project design to cover all service requirements.
Integrated service and consultant desktop components
With the DAKOR desktop now in place, DAK staff does not
need to switch between different applications to fulfill any
customer service request, as they are all integrated within
the system. Applications include VoIP telephony, document
management, DAKISIS, as well as a holistic view of the
customer including contact history and a step-by-step
process guidance for employees.
The state-of-the-art VoIP system enables employees
to use the phone within the DAKOR application. The
system redirects incoming calls automatically to the right
employee, company-wide. As soon as the caller is identified,
a holistic view of the customer opens up and the appropriate
employee is able to access the contact history including all
processes, documents and previous conversations. With
one click only, a member of staff can open all processes
and has access to all necessary information, which is
clearly presented on the desktop. The overview includes all
contract data, contact information, etc.
the customer, e.g. cases of hardship as well as sickness
benefits for children.
The DAKOR system consolidates DAK’s difficult to manage
and heterogeneous application landscape into one single
system that combines all of the functionality of the core
application, telephony, and other relevant applications. Now,
employees have centralized access to everything they need
to service a customer and do not need to switch between
systems, which has significantly simplified all processes.
Outlook
The Pegasystems-based DAKOR system is scalable and
extensible. Further applications can be easily integrated and
additional processes can be created and made available to
support necessary changes in DAK’s day-to-day business in
real-time. In the future, DAK plans to enable facsimiles and
emails to be automatically directed to the appropriate team
inboxes. A reminder function will also be added to help
employees better manage their workload.
The modern DAKOR desktop is based on the customer platform from
Pegasystems
For the first time ever, an integrated document
management system enables end-to-end paperless
processing. Within a centralized inbox all documents are
scanned and allocated to the respective teams according to
subject and addressor. The routing, i.e. the forwarding of the
digitized document to an employee’s desktop, is done via the
DAKOR system. If an employee clicks on the process, the
document, embedded within the editing screen of DAKOR,
automatically opens up and can be directly handled.
The DAKOR application offers easy navigation with a rolebased desktop that delivers only capabilities that are
relevant to an employee’s area of responsibility. And for
the first time ever, the employee is able to use “guided
processes” in which the application guides the user
through the required steps. This enables the employee
to fully concentrate on the interaction with the customer,
which is especially beneficial if the task is emotional for
DAK also plans to add a dedicated campaign management
system that will support a more targeted marketing
approach. This system will ensure that DAK contacts its
customers via their preferred communication channel and
all subsequent interactions will be individually tailored to
the needs of each customer.
This year, DAK will expand its holistic view of the customer
to provide employers and partner companies with a limited
role-based view of the customer. Additionally a holistic view
of the employer will be provided which supports the agent
in optimizing service to the employer. This view will help
reduce administrative costs by streamlining administrative
tasks and medical care processes. Reducing costs will
provide additional funds that can then be invested in
preventive medical measures and customer care.
DAK will continue to drive the expansion and development
of the DAKOR system with the active involvement of the
employees to continue to make the software even more
efficient. Also, the system will be further optimized
according to the results of a detailed customer satisfaction
analysis.
Is DAKOR becoming a bestseller?
Conclusion
DAKOR’s flexible consultant and service desktop concept
can also be used at other health insurance companies and
within different insurance industry sectors. With its sixth
generation service-oriented architecture, Pegasystems’
customer platform enables easy integration into other
insurers’ application environments.
DAK has started a strategic realignment with the help of its
IT department, which is doubly beneficial for customers as
the company is now able to provide better customer service,
and processes are more cost-efficient. This supports DAK’s
efforts to keep its membership fees stable.
In 2007, DAK established the wholly owned subsidiary
Esanio GmbH. The subsidiary incorporated DAK’s IT
department and now offers innovative IT services to
compulsory health insurance companies who can profit
from Esanio’s expertise and use its data processing
facilities. Esanio works as an IT service provider and
development partner for other public insurance companies,
enabling DAK to further develop and maintain solutions for
partner companies. Recently, DAK formed the IT alliance
BITMARCK with the national BKK and IKK insurance
groups.
DAKOR, based on Pegasystems, has put the customer at
the center of attention. Feedback from employees who use
DAKOR is positive and the implementation is within the set
timeframe.
“With the implementation of
the Pegasystems platform, DAK
has once more confirmed its
thought leadership status by
using innovative IT processes to
enhance the service provided by
public insurance companies.“
Andreas Strausfeld
CIO of DAK
For more information, please contact your Pegasystems representative, visit us on the Web at www.pega.com, or email us at
info@pega.com. © Copyright 2010 Pegasystems. All rights reserved.