UHCD Ideas

Request intake portal for the UnitedHealthcare Digital product team

Pre-Sale PCP Search for SAM v2 (SAM Cirrus)

Looking to define a pre-sales PCP search solution for SAM v2 (Sales Automation Management for Cirrus) as part of Cirrus/Polaris. SAM Cirrus will be the strategic  quoting, enrollment and renewal tool for UHC Oxford small business. Targeting to have SAM Cirrus up and running by 10/1/2018 with a business go live of targetef for after 1/1/2019.

 

The SAM Cirrus team is requesting the ability to stand up PCP search functionality into the SAM Cirrus tool by exploring & integrating current UHC provider search capabilities (could be through Rally or through ID API’s, etc).

 

The SAM Cirrus team requires engagement to build out the pre-sale PCP search strategy and define the approach from a UHC Digital perspective…there are a number of potential member enrollment interaction opportunities as well.

  • Guest
  • Aug 9 2017
Priority Important
Estimated Cost ($ Dollars)
Business Problem

need to enable pre-sales PCP search in SAM v2/Cirrus

Business Value

allow brokers/employers to review PCP availability & select PCPs as part of enrollment

Business Risk

negative broker experience in reviewing and selecting PCPs

Date Required By 2018-10-01
Who would be willing to pay for it? Polaris program
Regulatory No
Regulatory Date
Client Commitment Comments
  • Attach files
  • Admin
    Jonathan Rangoonwala commented
    August 9, 2017 21:48

    Assigned to E&I Segment Strategy for Craig Hankins and Chris Liesmaki to vet out

  • Craig Hankins commented
    August 14, 2017 16:46

    Questions for the submitting team (also sent via email):

    1. Is the intent to have SAM present provider search and have SAM capture the selected physician as the enrolling subscriber and/or dependent’s PCP? Or is the scope only to present providers with another method being used to capture the selected physician as the enrollee’s PCP?
    2. Have you reviewed the guest search? What of guest search works? What doesn’t? What are the gaps if SAM were to present it?
    3. What products and/or plans must this solution support?
  • Guest commented
    August 16, 2017 13:55

    Hi Craig – My responses are in bold as follows:

     

    1. Is the intent to have SAM present provider search and have SAM capture the selected physician as the enrolling subscriber and/or dependent’s PCP? Or is the scope only to present providers with another method being used to capture the selected physician as the enrollee’s PCP? My understanding is that we are not looking to move away from UHC’s existing PCP selection process; our focus remains entirely on enabling PCP search functionality. Our goal is to present information on PCP availability in available networks that are tied to plan selection options. Understanding if the PCP is in a network will assist the broker or group in plan selection. Members would need to follow the standard path for actually selecting the provider as a PCP outside of SAM.
    2. Have you reviewed the guest search? What of guest search works? What doesn’t? What are the gaps if SAM were to present it?         I am not familiar with guest search. Can you provide additional detail?
    3. What products and/or plans must this solution support? At this point, SAM v2 (SAM Cirrus) will be applicable only to Oxford small business products and/or plan offerings. Oxford is sold to CT, NY and NJ small groups, but membership could be located throughout the United States (example: CA satellite location for a NY group). At a future date, SAM will be expanded to cover additional product offerings outside the Oxford LOB, or small group business.
  • Guest commented
    August 31, 2017 21:19

    From: Russel, Andrew E Sent: Thursday, August 31, 2017 4:01 PM To: Hankins, Craig N Cc: Gillund, Adam B; Burritt, Christopher W Subject: RE: FW: Rally Connect - webservices contacts

     

    Hi Craig,

     

    I’m on the Choice side with Matt and we showed Adam/Rico (SAM v2) how Rally Choice is just leveraging and presenting data it’s getting via Rally Connect.  Based on that the recommendation was for SAM v2 to look at options to integrate directly with Connect in a similar fashion as Choice does.   They received some initial feedback that there aren’t any exposed Connect webservices presently but to submit a request Jonathan through the intake process.  Adam is reaching back out to Jonathan – assuming this is the same intake process and that they can just update with latest information?

     

    Thanks on feedback Craig. Andrew

     

     

    From: Hankins, Craig N Sent: Thursday, August 31, 2017 4:48 PM To: Russel, Andrew E Cc: Gillund, Adam B Subject: RE: FW: Rally Connect - webservices contacts

     

    Ok so you met with the Choice team which is the path we identified prior with Jeff Liggett. So from the email string here there’s an impact that Choice would have to get a different data set or some sort of enhancement to get the right network data needed for the SAM PCP selection? Am I getting that right? How did Choice look overall, is it a likely good fit vs. Connect alone to get the more comprehensive set of requirements you had?

     

    From: Russel, Andrew E Sent: Thursday, August 31, 2017 3:24 PM To: Hankins, Craig N Cc: Gillund, Adam B Subject: FW: FW: Rally Connect - webservices contacts

     

    Hi Craig –

     

    Hope you are doing well.    I was meeting with the Adam and some folks from the SAM v2 effort to explain how Digital Onboarding’s (Rally Choice) provide/PCP search functionality is enabled. This is stemming from an intake ticket they put through your groups process (details attached).  Key next step recommendation coming out of the call was to have the SAM v2 team contact the Rally Connect team directly as they are really the source for what Choice presents.   Trying to steer Adam and team in the right direction here so should they work with Jonathan to update their original intake request with these findings so that solutioning discussions can continue by engaging the Connect team?

     

    Thanks for any input.

    Andrew

     

     

     

    From: Gillund, Adam B Sent: Thursday, August 31, 2017 4:01 PM To: Russel, Andrew E; Schlatter, Matthew Subject: RE: FW: Rally Connect - webservices contacts

     

    Craig Hankins and Chris Liesmaki

     

    Adam Gillund | Director, Product| UnitedHealthcare,  Employer & Individual

    (office) 507.275.4444 | (cell) 507.531.7327 | (email) adam_b_gillund@uhc.com 

     

    Our United Culture. The way forward.

    ■ Integrity ■ Compassion ■ Relationships ■ Innovation ■ Performance

     

    From: Russel, Andrew E Sent: Thursday, August 31, 2017 2:54 PM To: Gillund, Adam B; Schlatter, Matthew Subject: RE: FW: Rally Connect - webservices contacts

     

    Who was involved with the IDEA?  They might not have realized that we’re really leveraging Connect in our solutioning so just pointed our way.

     

    From: Gillund, Adam B Sent: Thursday, August 31, 2017 3:53 PM To: Russel, Andrew E; Schlatter, Matthew Subject: RE: FW: Rally Connect - webservices contacts

     

    I am just a bit confused because that is how we really got to you in the first place. WE submitted an Idea per Jonathan’s request, so I feel like we have come full circle.

     

    Adam Gillund | Director, Product| UnitedHealthcare,  Employer & Individual

    (office) 507.275.4444 | (cell) 507.531.7327 | (email) adam_b_gillund@uhc.com 

     

    Our United Culture. The way forward.

    ■ Integrity ■ Compassion ■ Relationships ■ Innovation ■ Performance

     

    From: Russel, Andrew E Sent: Thursday, August 31, 2017 2:51 PM To: Gillund, Adam B; Schlatter, Matthew Subject: RE: FW: Rally Connect - webservices contacts

     

    Hi Adam – I would definitely recommend getting in to their intake process as that’s going to likely be required either way.   I’m checking on who is the business owner over Connect now just to see where they can provide input/assistance.

    Andrew

     

    From: Gillund, Adam B Sent: Thursday, August 31, 2017 3:35 PM To: Russel, Andrew E; Schlatter, Matthew Subject: FW: FW: Rally Connect - webservices contacts

     

    A bit of a dead end already.

     

    Adam Gillund | Director, Product| UnitedHealthcare,  Employer & Individual

    (office) 507.275.4444 | (cell) 507.531.7327 | (email) adam_b_gillund@uhc.com 

     

    Our United Culture. The way forward.

    ■ Integrity ■ Compassion ■ Relationships ■ Innovation ■ Performance

     

    From: Christopher Carey [mailto:christopher.carey@rallyhealth.com] Sent: Thursday, August 31, 2017 2:28 PM To: Gillund, Adam B; Rangoonwala, Jonathan S Subject: Re: FW: Rally Connect - webservices contacts

     

    Adam,

     

    Rally Connect currently doesn't support external calls to our API currently. In terms of roadmap, I have CC'd Jonathan who helps manage intake coming from UHC. He can work with you with to outline the need and then get it through the intake process.

     

    Thanks for reaching out.

     

    Cheers,

     

    Chris

     

    On Thu, Aug 31, 2017 at 10:43 AM, Gillund, Adam B <adam_b_gillund@uhc.com> wrote:

    Hi Chris – See below. Do you have a document that describe the inputs/outputs for the Connect APIs

     

    Adam Gillund | Director, Product| UnitedHealthcare,  Employer & Individual

    (office) 507.275.4444 | (cell) 507.531.7327 | (email) adam_b_gillund@uhc.com 

     

    Our United Culture. The way forward.

    ■ Integrity ■ Compassion ■ Relationships ■ Innovation ■ Performance

     

    From: Larry Rubin [mailto:larry.rubin@rallyhealth.com] Sent: Thursday, August 31, 2017 12:39 PM To: Schlatter, Matthew Cc: Russel, Andrew E; Burritt, Christopher W; Gillund, Adam B Subject: Re: Rally Connect - webservices contacts

     

    I would get that from Chris.  We use a unique version of the Connect API.  I would connect with Chris and let him figure out what you need.

     

    Larry Rubin

    VP Product

    M: 630-885-7946

    larry.rubin@rallyhealth.com

    Rally by Rally Health, Inc.

     

    On Thu, Aug 31, 2017 at 12:34 PM, Schlatter, Matthew <matthew_schlatter@uhc.com> wrote:

    In the meantime, do you have any docs that describe the inputs/outputs for the Connect APIs you call? 

     

    Thanks.

     

    From: Larry Rubin [mailto:larry.rubin@rallyhealth.com] Sent: Thursday, August 31, 2017 12:33 PM To: Russel, Andrew E Cc: Burritt, Christopher W; Gillund, Adam B; Schlatter, Matthew Subject: Re: Rally Connect - webservices contacts

     

    I would start with Chris Carey (christopher.carey@rallyhealth.com).  He runs Product for Connect.

     

    Larry Rubin

    VP Product

    M: 630-885-7946

    larry.rubin@rallyhealth.com

    Rally by Rally Health, Inc.

     

    On Thu, Aug 31, 2017 at 12:28 PM, Russel, Andrew E <andrew_e_russel@uhc.com> wrote:

    Hi Larry,

     

    Quick question for you.  Per our earlier email traffic I provided an overview to our SAM/Polaris team for how we (Choice) presently integrates with Connect to obtain provider/PCP data for our experience.   They are looking to for similar capabilities as what we have been able to put in place so our thinking is that we should have them talking directly with the Rally Connect team to learn more specifics about available web-services.   Would you know appropriate contacts we could point them to so they can begin feasibility discussions?

    Thanks. Andrew

     

     

    Hi Adam/Rico,

     

    Here are the key points from this morning’s discussion:

     

    1. Required Configuration - Rally Choice Admin:

    o    Each Employer/Customer medical plan gets manually configured by the IMO team with a Network Name (Dropdown of ~20 valid values presently – see below)

    o    Each network name is mapped on a Rally Choice crosswalk table to a delsys id value

     

     

    1. Rally Choice - Member Enrollment Experience:

    o    When the Employee is in Choice and goes in to the Provider/PCP search – Choice is sending these delsys id values (associated to the plans the Employees’ Employer is offering) over to the Rally Connect side to engage the webservices

     

    o    Rally Connect is providing Choice back with the provider directory data associated with the delsys ids provided

    • Rally Choice uses data to build UI experience – provider listing, validation of in/out of network, etc

     

    o    When the user selects a PCP, Choice send the unique provider id value in the 834 file to UHC (loads via EEMS to CDB)

    o   Presently in place for the subscriber.  Dependent PCP selection to be deployed in Q3

     

    Look-up  Table in Rally Choice Admin:

  • Admin
    Jonathan Rangoonwala commented
    September 26, 2017 15:28

    Currently Rally does not have any plans to build API’s to be used externally to their applications – it’s not a hard no but like everything we prioritize our work based on the value we are looking to create/drive. Also there may be other ways to meet your goals/use cases but to do that we need to define what we want to accomplish at a high level. Once we get this “one pager” pulled together we’ll be able to more adequately review and prioritize this work.

     

    Chris Liesmaki will take point on helping you all pull together the “one pager” when he’s back in the office (starts 10/2).