Analytics: An Enabler to Health Plan Transformation

Transcription

1 Analytics: An Enabler to Health Plan Transformation The Business Intelligence & Analytics for Healthcare Conference & Exhibition July 11, :15 am Presented by: Darren Taylor Vice President, Enterprise Analytics and Data Management Blue Cross and Blue Shield of Kansas City

2 Agenda The Importance of Analytics Blue KC Focus Over Time Analytic Maturity June 2010 Data Organization Analytic Solutions Focus on Analytics July 2011 Organization Platform Result Conclusion Guiding Principles

3 The Importance of Analytics Health plans are faced with complex business and regulatory opportunities that require effective use of analytics Improve health outcomes and reduce cost to customers Proactive management of medical loss ratios and risk adjustors Identification of risk without traditional underwriting processes Patient centered medical homes and accountable care organizations Prove return on investment for health and wellness solutions Consumer segmentation and direct marketing (B2C movement) Exploration and execution of diversification strategies

4 Blue KC - Focus Over Time Blue KC Mission: To use our role as the area s leading health insurer to provide affordable access to healthcare and to improve the health of our members (est. 1997) OLTP and Privacy Y2K HIPAA Data Management Data Warehouse Packaged Analytics Analytic Maturity Proactive/Predictive Data Mining

5 Analytics Maturity Model June 2010 Business Enablement Stage 1 Operation Stage 2 Improvement Stage 3 Alignment Stage 4 Empowerment Stage 5 Transformation Organization & Strategy Creating strategic agility and differentiation Foresight Service Mgmt. Fostering business innovation and people productivity Knowledge Portfolio Mgmt. Integrating performance management and intelligence Insight Program Mgmt. and Governance Measuring and monitoring the business Information Running the business Facts and data Project Activity Project Mgmt. June 2010 Ad Hoc Solutions Localized Solutions Shared Resources Enterprise Standards Enterprise Services Enabling Technology

6 Data is an Asset June 2010 Recognized as an industry leader for Enterprise Data Warehouse 2010 TDWI Best Practice Winner EDW Category 2010 Computerworld Best Practice Winner for Running the Business on BI 2011 Computerworld Laureate Winner Successful with data and BI, but dependent on several external vendors for analytic solutions 6

7 Multiple Versions of Analytic Truth June 2010 Conflicting methods HEDIS Duplicate functionality Fraud and Abuse Cost and Use EDW Single View of Data Award- Winning Predictive Risk Group Reporting DM ROI Multiple user interfaces Poor performance Low user adoption High cost approach Proprietary data sent everywhere (even to competitor subsidiaries)

8 Organization June 2010 Dedicated data management team in place and operating for six years great Decentralized BI tech team not good Business accountable for own analytics good, but not effective If everybody s accountable, nobody s accountable

9 Analytics Maturity Model Business Enablement Stage 1 Operation Stage 2 Improvement Stage 3 Alignment Stage 4 Empowerment Stage 5 Transformation Organization & Strategy Creating strategic agility and differentiation Foresight Service Mgmt. Jan 2012 Fostering business innovation and people productivity Knowledge Integrating performance management and intelligence Insight Measuring and monitoring the business Information Running the business Facts and data Project Activity Project Mgmt. Program Mgmt. and Governance June 2010 Portfolio Mgmt. Jan 2011 July 2011 Ad Hoc Solutions Localized Solutions Shared Resources Enterprise Standards Enterprise Services Enabling Technology

10 Blue KC - Focus on Analytics Q Accountability Re-Organization Mission Guiding Principles Q Business Plan Objectives Strategies Approvals Q1-Q Delivery People Platform Results Enterprise Analytics and Data Management Mission: To deliver and enable credible, actionable analytic solutions by integrating talented people, world-class data, and superior technologies (est. 2010)

11 Organization July 2011 Data Management Analytic Solutions Enterprise Analytics Data Integration Development of Analytic Solutions Enterprise Financial, Clinical and Operational Analysis Enterprise Data Warehouse Analytic Vendor Management Actuarial Science Enterprise Data Governance Analytic Solutions Architecture Analytics Governance

12 Opportunity New Platform In late 2010, Blue KC took control of our analytic future and developed an analytics solution strategy to reduce dependency on packaged solutions lower total cost of ownership for analytics create an advanced, comprehensive solution and as a result, enable Blue KC and it s subsidiary companies with capabilities that creates a strategic advantage. 12

13 Action Platform Ingredients This new approach entailed building a comprehensive, integrated analytic solution from the ground up The Ingredients: Internal department dedicated to analytic solutions External expertise in designing analytic solutions and retail analytics Internal and external data from EDW and consumer sources Best-in-class DW appliance for scalability and performance Best-in-class BI application for reporting, visualization, dash boarding, OLAP, advanced data mining Several industry-best analytic methods (e.g., predictive risk scores, benchmarks, consumer data, etc.) Several proprietary analytic methods (e.g., propensity to buy, readmission propensity, back surgery propensity, etc.) 13

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15 Result - Platform Though new total cost of ownership was justified on administrative savings alone, the real win is that the new platform enables Blue KC to be proactive in advanced analytics, creating new business value Cost-of-care Savings: identification of trends and tend drivers Profit Generation: target marketing for health and ancillary Program Validation: program effectiveness evaluation Intelligence in Healthcare Reform Era: predict consumer behavior Know Customers or No Customers 15

16 Conclusion - Guiding Principles People - Who we are Positive Accountable Qualified Products - What we do Accurate Actionable Fast Process - How we do it Enabling Efficient Understood