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Supercharging Business Intelligence withMDM at Horizon BCBS of New Jersey
Presented by:
Balaji Krishnamoorthy
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Biography
Balaji Krishnamoorthy
Director, Data Strategy & Management
Horizon Health Care Services, NJ
Information Management Strategy andArchitecture (Office of the CTO)
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Balaji Krishnamoorthy- Bio
Balaji Krishnamoorthy has over 18 years of professional software experience inleadership and strategic roles developing leading edge solutions for Fortune 100clients. He possesses extensive experience working in the areas of MDM, DataIntegration, Data Warehousing / BI, Enterprise Architecture and Enterprise DataArchitecture.
As Director of Data Strategy and Management at Horizon Healthcare Services,Balaji is a strategic change agent, focusing his business transformation experience
and leadership on developing a strong data and information architecture practice.Previously, Balaji worked as a Senior Principal within the Health & Life SciencesPractice within HP's Information Management Services; prior to that, as a SeniorPrincipal at Knightsbridge, a leading business intelligence consultancy that HPacquired in late 2006.
Balaji earned an MS in Software Engineering from the University of Texas, and aBS in Electrical and Electronics from Chennai, India.
He has spoken at the IM Blues Symposium and Data Governance and MDMconferences. He is currently serving on Informaticas Product Advisory Council forNorth America.
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Information Technology Infrastructure
Data ArchitectureStructured
DataUnstructured
Data
Data Governance
Master DataManagement
EnterpriseData
Integration
BusinessIntelligence &
Analytics
DataSecurity
Management
3rdParty DataManagement
Data QualityManagement
MetadataManagement
ContentManagement
Data Strategy & Management
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The Information Challenge We Face
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DataGovernance
CustomerService
Consumerism &Health Exchanges
ComplianceSales Marketing
MedicareAdvantage
MedicalClaims
Provider DataManagement
Dental Medicaid
Medicare
PPO/HMO Medicaid
Dental
Physicians
Ancillaries
Hospitals
Pended
Claims
Incorrect
Contact InfoNo View of
Consumer
JosephBraverman, M.D. Dr. Joe Braverman
Kate Smith
450 Second Street
HMO
Katlyn Smith
452 2ndSt
Newark, NJ-07105PPO 20/150/40 Kate Smith
Medicare B
Portals
Synthesize & govern data across silos & sources
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Example: Provider Business Challenge 1Support products for new network on public exchanges
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How do we find and recruit parproviders for this network?
What is the distribution of specialties inthe region?
Which existing members are potentialtargets and which ex-members areprospects?
Who are our new leads and prospects?
What is the target profile of theprospects?
Network must be established January2013 and operational October 2013
Horizon must identify participation foroffering a new exchange product
network
BCBSA may have new mandates for newprovider data quality index (PDQi)
Business Challenge Illustrative Key Business Questions
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The business wants to create andanalyze multiple scenarios quickly
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Example: Provider Business Challenge 2Support data quality measures like PDQI
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Network
Can we track easily by Network and whois in the network?
How many providers?
How many members?
Address Can we establish greater confidence
sending the Golden Address to BCBSA?
Name
Can we have Names that are de-duplicated across systems, ensuring theGolden Record has the correct spelling?
Phone
Can we differentiate between thedifferent type of communicationmethods?
Business Challenge Illustrative Key Business Questions
Today, Provider Data File records for BCBSAare a cumbersome and manual process
At least 70% of audited records must notinclude critical errors
500 random records are checked by BCBSA
BCBSA keys in on: Provider and Member Address errors
Phone Problem errors
Network Affiliation
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But this has been hard up to nowMDM was designed to fix data issues and speed
business analysis and action
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46% increase inkey populateddata fields
64% of existing addresses were enhancedleading to better mapping. This includeszip+4 which gives us better targeting,communication and saves us delivery costs.Address is now standardized and cleansed &will be enriched in the future with Enclarity
70% increase in email enhancementsand fully centralized for consistentsharing across Horizon
72% increase inphone numberenhancementsthroughstandardization andcompleteness
Name is de-duplicated acrosssystems, ensuringthe Golden Recordhas the correctspelling
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Example: Member and ProviderBusiness Challenge 3
Address Standardization Returned Mail Study
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10 to 20 % of all business correspondencesare returned (some contain addresseswithin the Penn Plaza building)
Address Standardization and mapping ofCity to Zip Code is obsolete
Source Systems store address in commentfields that are difficult to decode and usefor correspondence
Majority of the addresses do not containthe complete zip and zip4 making it harderto deliver
Members cannot designate their preferredmethod of correspondence
Business Challenge Illustrative Key Business Questions
What is a Quality Standard?
When All necessary elements are completeand correct
Primary Address Number, Pre-directional, Street Name, Street Suffix,
Post-Directional Secondary Identifier,Secondary Number, City, State, ZIP +4 Code
Fully spell out or abbreviate words usingUSPS standard abbreviations
Address Standardization across Brokers, Groups, Members, Consumers,
Providers, and Employees Uniform Contact Types
Primary Method for Contact /Correspondence
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We have Address Challenges at Horizon..but certainly not like this!!!
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Without knowing, these seem to look okaybut they were not forwarded to their
destination!!
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Horizon Business Challengeat a Glance
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Return Mail Study
Total PiecesSubscriber
UndeliverableProvider
Undeliverable
Subscriberwith Horizon
Address
Provider withHorizonAddress
Subscriberwith
CorrectedAddress
Providerwith
CorrectedAddress Checks
Letterforms/Other ID Cards
4848 3859 396 171 72 257 33 12 48 0
79.60% 8.17% 3.53% 1.49% 5.30% 0.68% 0.25% 0.99% 0%
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The data to answer address challenges neededdata in a consistent, accurate and timely fashion
that did not exist. MDM addresses this.
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Address Cleansing increasedby approximately 70%Includes mapping of city tozip
Consolidated EmailAddresses for members
50% enhancement of zip
codes including zip+4correctly populated
New data like Geocoding map Medicare members totheir nearest careManagement facility andmode of transportation
Address is standardized and cleansedas per USPS Postal Standards
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MDM also addresses confidenceof whether addresses are deliverable
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Missing Apt orSuite Number
IncorrectNumber
IncorrectRecipient
MissingNumber
Missing RR orBox Number
IncorrectStreet Name
ACME PRODUCTS
4759 WESTERN ST
NEW YORK NY 10022-5279
CARL SHULER
1414 LAKE ST APT
CHICAGO IL 60614-1905
CARL SHULER
1914 LAKE ST APT 3A
CHICAGO IL 60614-1910
CARL BROWN
1414 LAKE ST APT
CHICAGO IL 60614-1910
CARL SHULER
LAKE ST APT 3A
CHICAGO IL 60614-1910
CARL SHULER
PO BOX
CHICAGO IL 60614-1910
CARL SHULER
1414 LARK ST APT 3A
CHICAGO IL 60614-1910
498
326
234
156 148 147
MillionsofPieces
USPS Undeliverable as AddressedMail in 2011- This is a universalproblem not just to Horizon
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Example: Member Business Challenge 4Support data quality that leads to improvements
in our MTM and BEM scores
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Business Challenge Illustrative Key Business Questions Maintain Member Touchpoint
Management (MTM) scores foroperational and service program for allbranded, core health businesses:
Enrollment
Claims Inquiries Plan Accessibility
NEW! Support improving new BlueExperience Metric (BEM) scores
Member experience and engagement
Network access
EducationNavigation
Customer Service
Claim Payment
What baseline addresses should be usedfor Enrollment Member Accuracymeasurements?
How are the scores across cohortsconsistent across time?
How do I achieve enrollment timelinesswhich includes ID card management?
FDP and LDP (First, Last DayProcessing metrics are affected by USmail contacts e.g. Benefit Booklets. Howdo I ensure my communications are
getting through in a timely way? How can I validate and manage some of
the MTM audited fields
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Example Business Challenge:How do you enable Member Touch point Measures (MTM)
and Blue Experience Measures (BEM) for Member?
Where is Horizons 360oview?
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The MDM Value Proposition
Data Fragmentation
Problem: Master data is fragmented across multiple systems vertically & horizontally
MDM: Bring together data from multiple systems and build whole records and data sets using match &merge
Data Duplication
Problem: Same Master data attributes exist in multiple systems, leading to data divergence (DOB: System A= 6/1/80, System B = 1/6/80)
MDM: Pick best value, based on trust scores
Data Quality
Problem: As with all data, Master data quality deteriorates over time
MDM: Pre-cleanse and standardize data (e.g. gender )
Single Source of Truth
Problem: Multiple systems have slices of truth with inconsistent data quality and standardization
MDM: Bring together and present single source of truth for consumption by users and systems
Bridging the Gap Problem: Vertical systems dont bridge well across Members, Providers, Products, Customers, Employees
etc.
MDM: Provide visibility across multiple data domains (e.g. providers that are also members)
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MDM Data QualityEnhancements Benefits
SSN or TIN
Address
Name
Phone
Date of Birth
Gender
SSN or TIN is standardized based on FederalStandards
Address is standardized based on USPSStandards
Name is standardized based on Data
Governance Policies
Phone is standardized based on DataGovernance Policies
Email is standardized based on DataGovernance Policies
Date of Birth is standardized based on Data
Governance Policies
Gender is standardized based on DataGovernance Policies
Indicators and Cleansing Rule ExamplesACCOUNTABILITYWhen any of the guiding principles is violated, the error should beidentified, attended to and resolved in a prompt manner by amonitored process with an auditable record of changes
CONSISTENCY
Information should be consistent wherever it is viewed throughoutthe enterprise. In addition, each Provider, contract, customer,Member , product, etc. should be uniquely identified
FLEXIBILITYThe data, metadata, policies and procedures for data qualityshould be continuously refreshed to remain consistent with thechanging needs of the business
STANDARDSThe standards for the definition, usage, consistency and accuracyof data for each organization (Provider, Member, Claims,Marketing) that handles enterprise (master) or departmental datashould be consistent with one another
TIMELY Information should be accessible in the most timely manner inorder to make timely decisions
KPIs
WIP
WIP
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ACCURACY Information should be highly accurate with regards to regulatoryand operational standards WIP
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MDM Implementation Data Statistics:Member and provider consolidated, standardized and
cleansed across all lines of business and market segments,email addresses centralized
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MDM Provider Data Statistics:Identifying Par and Non-Par Provider across lines of businessand market segments; Par and Non-Par Provider by networks
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MDM Member Data Statistics:Identifying Members across multiple line of business will enable
us to track them across products and market segments whenMDM includes Group and Plan data in Phase 2 a key
requirement of Health Care Reform and Exchanges
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MDM Provider - Exclusion Statistics:Provider /Practitioners Omitted from MDMBased on Exclusion Rules by Source System
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Horizon Solution:Multi-Domain MDM Hub as a Solution
Disparate Data Reliably Resolved
DataGovernance
CustomerService
Consumerism &Health Exchanges
ComplianceSales Marketing
MedicareAdvantage
MedicalClaims
Provider DataManagement
DentalMedicaid
Joseph Braverman, [email protected]
Portals
Provider Customer Employee Member Product
Enterprise Master Data Hub
Broker
ICD-10
Kate Smith452 Second Street,Newark, NJ-07105
Pri: Medicare BSec: PPO 20/150/40
3rdParty
Organization
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Industry Benchmarks Direct ROI for MDM Implementation
ROI Impact Item P&L Impact Industry Benchmark Improvement
Reduced Data Management Costs IT Costs (Opex) 10%
Reduced Costs of Reporting through Automation GeneralAdministration Costs
15%
Reduced costs in Managing Data Completeness IT Costs (Opex) 10%
Reduced costs of Regulatory Non-Compliance Opex 5%
Reduced Marketing Reach Costs Sales & Marketing
Costs
12%
Reduced Costs through enhanced efficiency inmanagement of Business Processes like ClaimsAdjudication, Member Eligibility, ContractsManagement, Provider Management, NetworkManagement etc.
Cost of Revenue 5-10% for various BusinessProcesses
Increased Cross Sell/Up Sell Revenue 5%
Increased New Member Enrollment Revenue 5%Increase in Amount of Insurance PremiumCollected
Revenue 2%
Increase in Share of Wallet and Margins Profit 5%
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Horizon is part of a leading trend inadvanced information management
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Top Master Data management Trends & Challenges that haveemerged over the last 2 years* are:
By 2013, 30% of the total companies implementing MDMprograms may run into challenges due to insufficient MDMStrategy
By 2014, 66 percent of Fortune 1000 organizations will
have deployed two or more MDM solutions to supporttheir enterprise MDM strategies
Top Trends in the Global Information Management Space
* Source - Gartner, MDM institute
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TransactionsInteractions
Member Information Products & Benefits
Basic
Preferences
Extended
Prospect/Lead
Broker
Health Risk
PHR
Provider, PCP
Alternate Programs (e.g., ACO, etc.)
COB & other Ins.
Data
Service Requests
Messages Care Messages
Correspondence
Payment
Member Provider Interactions
Interaction Data
Product
Benefit
Renewal
Ancillary Product
Wellness & Disease
HSA/FSA/HRA
Data
Claims
Pre-Cert & Pre Authorizations Care Management
Appeals & Grievances
Billing
Delegate Partner Data
EOB
Interaction Data
Enabling the Consumer 360Using Multi Domain MDM
Consumer 3600
View - Data Elements
Integrating customer related data from internal and external sources is a key enabler with MDM
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Questions and Answers
How can you help?
Thank you
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