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transcript
Analytics: An Enabler to Health Plan Transformation
The Business Intelligence & Analytics for Healthcare
Conference & Exhibition
July 11, 2011 – 11:15 am
Presented by: Darren Taylor
Vice President, Enterprise Analytics and Data
Management
Blue Cross and Blue Shield of Kansas City
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
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
Blue KC - Focus Over Time
1997-2003
• OLTP and Privacy
• Y2K
• HIPAA
2004-2010
• Data Management
• Data Warehouse
• Packaged Analytics
2011-2018
• Analytic Maturity
• Proactive/Predictive
• Data Mining
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)
Analytics Maturity Model – June 2010
Project
Activity
Project
Mgmt.
Portfolio
Mgmt.
Service
Mgmt.
Localized
SolutionsEnterpriseStandards
Enterprise
Services
Running the business
Facts and data
Measuring and monitoring the
business
Information
Integrating performance
management and intelligence
Insight
Fostering business innovation and
people productivity
Knowledge
Creating strategic agility and
differentiation
Foresight
Ad Hoc
Solutions
Business
Enablement Stage 1
Operation
Stage 2
Improvement
Stage 3
Alignment
Stage 4
Empowerment
Stage 5
Transformation
Shared
Resources
Enabling
Technology
Organization
& Strategy
Program
Mgmt. and
Governance
June
2010
Data is an Asset – June 2010
6
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
Multiple Versions of Analytic Truth – June 2010
EDW
Single View of Data
“Award-Winning”
HEDIS
Group
Reporting
DM ROI
Predictive Risk
Cost and Use
Fraud and
Abuse
• Conflicting methods
• Duplicate functionality
• Multiple user interfaces
• Poor performance
• Low user adoption
• High cost approach
• Proprietary data sent
everywhere (even to
competitor subsidiaries)
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”
Analytics Maturity Model
Project
Activity
Project
Mgmt.
Portfolio
Mgmt.
Service
Mgmt.
Localized
SolutionsEnterpriseStandards
Enterprise
Services
Running the business
Facts and data
Measuring and monitoring the
business
Information
Integrating performance
management and intelligence
Insight
Fostering business innovation and
people productivity
Knowledge
Creating strategic agility and
differentiation
Foresight
Ad Hoc
Solutions
Business
Enablement Stage 1
Operation
Stage 2
Improvement
Stage 3
Alignment
Stage 4
Empowerment
Stage 5
Transformation
Shared
Resources
Enabling
Technology
Organization
& Strategy
Program
Mgmt. and
Governance
June
2010
Jan
2011
July
2011
Jan
2012
Blue KC - Focus on Analytics
Q3 2010
• Accountability
• Re-Organization
• Mission
• Guiding Principles
Q4 2010
• Business Plan
• Objectives
• Strategies
• Approvals
Q1-Q3 2011
• 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)
Organization – July 2011
Data Management
Data Integration
Enterprise Data Warehouse
Enterprise Data Governance
Analytic Solutions
Development of Analytic Solutions
Analytic Vendor Management
Analytic Solutions Architecture
Enterprise Analytics
Enterprise Financial, Clinical and
Operational Analysis
Actuarial Science
Analytics Governance
Opportunity – New Platform
12
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.
Action – Platform Ingredients
13
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, re-
admission propensity, back surgery propensity, etc.)
Result - Platform
15
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”
Conclusion - Guiding Principles
People - Who we are
• Positive
• Accountable
• Qualified
Process - How we do it
• Enabling
• Efficient
• Understood
Products - What we do
• Accurate
• Actionable
• Fast