How data empowers member-centric transformation
Post on 04-Aug-2015
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ACO Strategy
A marketplace where provider and Payer can communicate through our secure hosting of provider records and payer claims –improving transparency for ACO adoption
Dell Private Exchange
Leveraging our learning's from the countries first exchange that is run by us at Massachusetts
Consumerism
Assess and spread your reach to consumers through digital experience and mobility. Use social media to reach individuals for both sales and improving a payer’s brand image.
Everest Group
Positioned as Leader and Star Performer in Payer ITO Service Provider Landscape (2013)
Strength and Focus
Dell and Health Plans
Working with Top Health Plan Organizations
Dell Health Plan Facts and Figures
More than 500technology partners
14,000+ healthcare associates
globally. 6,000+ healthcare payer
associates globally
Serving 100+ insurance
organizations, support for 65 million
policy holders
1.3M enrollments per annum, 98%of changes processed within 48hrs
11M+ calls handled annually, 310kitems audited approximately each year
96M+ claims processed annually,
99% of claims processed within SLA
• Kaiser Permanente
• WellPoint
• Aetna
• CIGNA
• Humana
• Harvard Pilgrim Healthcare
• Affinity Health Plan
• Emblem Health
• Blue Cross Blue Shield of RI
• United Health Group
• Massachusetts Connector
• CHPW
• Physicians Plus Insurance Corp
• WellCare
• CareSource
• NAMM California
• WEA Trust
• Delta Health
• Kern Health
• Blue Cross Blue Shield of MI
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Health plan members (& #7V hosts), Andy & Mandi
Andy Arends
Managing Principal, Health Plan Innovation & Consulting
@andy_arends
Andrew_Arends@dell.com
Mandi Bishop
Analytics Practice Lead, Health Plan Innovation & Consulting
@mandibpro
Mandi_Bishop@dell.com
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Member-Centric Maturity Model: B2B to C2B
Lorem ipsum
• Engage
• Collaborate
• Seek
• Interact
• Listen
• Inform
• Research• Improve
• Measure
• Impact• Influence
• Intervene
• Adv. Insights
• Analytics
• Integrate
• Crowd source
• Industry collaboration• Solutions at
intersection
• Basic insights
C2B
C2U
B2C
B2B
Laggard
• Automated intervention
• Business transformation
• Iterative innovation
Visionary
• Plan
Co
mp
etit
ive
Ad
van
tag
eA
do
pti
on
Mat
uri
ty
Plan Listen Engage Act
Claims, Sales & Marketing Data Big Data & Social Analytics Innovate
The differenceis in the data
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Anyone doubt we are headed to a consumer-oriented future?
Not too far away from now – in the next 6-7 years – 75 million Americans will be retail buyers of healthcare. And they’ll come to the marketplace with their own money and either a subsidy from their employer or a subsidy from their government. And it doesn’t much matter – they’ll be spending their money.”
~Mark Bertollini
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When I first started as a cardiac surgeon, 20 percent of the patients died. Success and quality were judged by whether the patient walked out or got carried out. Now, it’s quite different—nearly everyone survives. Now patients judge us in the same way they would judge a restaurant or a hotel: on the experience they have here. That experience has a physical, clinical, and emotional component. They’ll form their opinions and they will talk to people.
~Toby Cosgrove
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Technology enablers—what’s different now
Networks
• Near-ubiquitous connectivity at speeds that make data collection easy and video possible
• Near-field communication technologies (e.g., Bluetooth) that allow “spoke and hub” models among small smart devices and a hub that connects to the network
Hardware
• Inexpensive, powerful smartphones putting power in the hands of individual consumers
• Low-cost chipsets and battery technology allowing a new generation of small, smart devices and sensors
Software
• Cloud-based health plan applications and EMRs with open API models to receive data that can be monitored systemically
• Consumer-friendly apps that support easy data capture, connection to the care management applications, and provide simple feedback to the individual
Analytics
• More robust approaches to analytics, such as supporting care management and measuring provider performance and quality
• Purchasers of health care demand access to these tools (and creating their own), and are using them to align incentives for both consumers and providers
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Data in the old model
VelocitySlow, batch processes
Volume(Relatively) small volume
VariabilityMostly structured data
ValueSiloed within organization, low external value
Plan Systems
Lead MgmtMember /
Billing Platform
Network Mgmt
Care MgmtPlatform
Reporting Tools
Core Admin System
Sales & Enrollment BillingMedical
ManagementClaims
Claims data
Enrollment data
Sales & marketing
data
Billing data
Care management
data
HRA data
Do you need Dewey to derive insights?
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Our data’s new normal
…and above all, Viscosity: how is data able to flow from source of origin to where it is needed most?
VelocityReal time / near real time
VariabilityMix of structured and unstructured
VolumeVery large data sets
VulnerabilityGreater need for security without impeding access
ValueUnlocked across the organization
VolunteeredProvided by members as well as by contracted entities
7Vs
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And did you know…Healthcare is a “social” service
it revolves around people, their lives and their communities
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84% Millennials
Buying decisions influenced by user-generated content1
40% healthcare consumers
Report social media
influences health
decisions2
40%chronic
condition sufferers
Use social media communities to cope3
41% physician selection
Choice affected by social media4
1 – DC Interactive Group2 - Media Bistro3 – Healthcare Finance News4 - Mashable
“Social” is essential
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Member-Centric Maturity: 7Vs from B2B to C2B
Lorem ipsum
• Engage
• Collaborate
• Seek
• Interact
• Listen
• Inform
• Research• Improve
• Measure
• Impact• Influence
• Intervene
• Adv. insights
• Analytics
• Integrate
• Crowd source
• Industry collaboration• Solutions at
intersection
• Basic insights
C2B
C2U
B2C
B2B
Laggard
• Automated intervention
• Business transformation
• Iterative innovation
Visionary
• Plan
Co
mp
etit
ive
Ad
van
tag
eA
do
pti
on
Mat
uri
ty
Plan Listen Engage Act
Claims, Sales & Marketing DataBig Data & Social
Analytics Innovate
Plan
• Population health strategy
Act
Engage
• Wellness incentive strategy
• Risk modeling• Data integration
strategy• SoMe strategy
• SoMe Data integration
• Clinical & claims data integration
• Advanced analytics & insights
• Intervention programs
• Social Intelligence Framework
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Meet John on B2B data
• Just turned 65
• Seeking MA coverage
• South FL resident
• Retiring state employee
• COULD be a 5-STAR member
Based on what you know, how would you court him?
And why would he care?
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Meet John on C2B data
• Avid cyclist
• Kayaks 300M+ annually
• Resting heart rate 60bpm
• Builds & races sports cars
• Road & Track columnist
• Weight stable 50 years
• Bluegrass musician
• Travel blogger
• Socially active IRL and online
• 13% Bodyfat
…would your marketing and care management approach change?
If you knew…
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Barriers to C2B viscous data nirvana
Latency:
data typically 24hr-60d
behind
Homogeny:
claims data is only 1 piece
of the picture
Unverified:
source data in flux, values
change, data lacks context
Not enough:
limited data sources
Non-participatory:
data taken, not given
Prohibitive security:
access limitations
can hamper advanced analytics
Blockage:
disparate data can’t freely
flow between systems
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Breaking through barriers
Speed:
Analyze data at rest and in
motion, in real-time
Diversity:
Source from clinical, claims, sales, marketing billing, lifestyle,
devices, wearables,
social
Validity:
Time/context-aware, linear
and non-linear
Unlimited:
Unprecedented storage,
automated data capture and integration,
federated query processing
Freely given:
Consumers provide data to
support analytics initiatives
Appropriately available:
Obfuscation, advanced de-identification
supports insights AND
privacy
Seamless:
Interoperable, integrated, everywhere
25 by meaningfully engaging with individuals
Achieve C2B with viscous data,provide accountable care for populations
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Three Questions
• What do you know about your members?
• What could you know about your members?
• What are you going to do with it?
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