Supercharging Business Intelligence with MDM at Horizon BCBS of New Jersey Presented by: Balaji Krishnamoorthy.

Supercharging Business Intelligence with MDM at Horizon BCBS of New

Jersey

Presented by: Balaji Krishnamoorthy

Biography

Balaji Krishnamoorthy

• Director, Data Strategy & Management• Horizon Health Care Services, NJ• Information Management Strategy and

Architecture (Office of the CTO)

3

Balaji Krishnamoorthy- Bio

Balaji Krishnamoorthy has over 18 years of professional software experience in leadership and strategic roles developing leading edge solutions for Fortune 100 clients. He possesses extensive experience working in the areas of MDM, Data Integration, Data Warehousing / BI, Enterprise Architecture and Enterprise Data Architecture.

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 Sciences Practice within HP's Information Management Services; prior to that, as a Senior Principal at Knightsbridge, a leading business intelligence consultancy that HP acquired in late 2006.

Balaji earned an MS in Software Engineering from the University of Texas, and a BS in Electrical and Electronics from Chennai, India.

He has spoken at the IM Blues Symposium and Data Governance and MDM conferences. He is currently serving on Informatica’s Product Advisory Council for North America.

4

Information Technology Infrastructure

Data ArchitectureData ArchitectureStructured

DataUnstructur

ed Data

Data GovernanceData Governance

Data Strategy & Management

The Information Challenge We Face

5

DataGovernance

?

Customer Customer ServiceService

Consumerism &Consumerism &Health ExchangesHealth ExchangesComplianceComplianceSalesSales MarketingMarketing

MedicareAdvantage

MedicalClaims

Provider DataManagement

Dental Medicaid

MedicareMedicarePPO/HMOPPO/HMO MedicaidMedicaid

DentalDental

PhysiciansPhysicians

AncillariesAncillaries

HospitalsHospitals

PendedClaims

PendedClaims

IncorrectContact Info

IncorrectContact Info No View of

ConsumerNo View of Consumer

Joseph Braverman, M.D.

Joseph Braverman, M.D. Dr. Joe BravermanDr. Joe BravermanKate Smith

450 Second StreetHMO

Kate Smith450 Second Street

HMO

Katlyn Smith452 2nd St

Newark, NJ-07105PPO 20/150/40

Katlyn Smith452 2nd St

Newark, NJ-07105PPO 20/150/40 Kate Smith

Medicare BKate SmithMedicare B

Portals

[email protected]@email.com

Synthesize & govern data across silos & sources

Example: Provider Business Challenge 1 Support products for new network on public exchanges

6

How do we find and recruit par providers for this network?

What is the distribution of specialties in the region?

Which existing members are potential targets and which ex-members are prospects?

Who are our new leads and prospects?

What is the target profile of the prospects?

Network must be established January 2013 and operational October 2013

Horizon must identify participation for offering a new exchange product network

BCBSA may have new mandates for new provider data quality index (PDQi)

Business ChallengeIllustrative Key Business

Questions

The business wants to create andanalyze multiple scenarios quickly

7

Example: Provider Business Challenge 2Support data quality measures like PDQI

8

Network— Can we track easily by Network

and who is 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 the Golden Record has the correct spelling?

Phone— Can we differentiate between the

different type of communication methods?

Business Challenge Illustrative Key Business Questions Today, Provider Data File records for

BCBSA are a cumbersome and manual process

At least 70% of audited records must not include critical errors

500 random records are checked by BCBSA

BCBSA keys in on: — Provider and Member Address

errors— Phone Problem errors— Network Affiliation

But this has been hard up to now MDM was designed to fix data issues and speed

business analysis and action

9

46% increase in key populated data fields

64% of existing addresses were enhanced leading to better mapping. This includes zip+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 enhancements and fully centralized for consistent sharing across Horizon

72% increase in phone number enhancements through standardization and completeness

Name is de-duplicated across systems, ensuring the Golden Record has the correct spelling

Example: Member and Provider Business Challenge 3

Address Standardization Returned Mail Study

10

10 to 20 % of all business correspondences are returned (some contain addresses within the Penn Plaza building)

Address Standardization and mapping of City to Zip Code is obsolete

Source Systems store address in comment fields that are difficult to decode and use for correspondence

Majority of the addresses do not contain the complete zip and zip4 making it harder to deliver

Members cannot designate their preferred method of correspondence

Business Challenge Illustrative Key Business Questions What is a Quality Standard?

— When All necessary elements are complete and 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 using USPS® standard abbreviations

Address Standardization across— Brokers, Groups, Members,

Consumers, Providers, and Employees

— Uniform Contact Types— Primary Method for Contact /

Correspondence

11

We have Address Challenges at Horizon…

..but certainly not like this!!!

11

12

Without knowing, these seem to look okay…

but they were not forwarded to their destination!!

12

Horizon Business Challenge – at a Glance

13

Return Mail Study

Total PiecesSubscriber

UndeliverableProvider

Undeliverable

Subscriber with Horizon

Address

Provider with Horizon

Address

Subscriber with

Corrected Address

Provider with

Corrected Address Checks

Letter forms/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%

The data to answer address challenges needed data in a consistent, accurate and timely fashion that did not exist. MDM

addresses this.

14

Address Cleansing increased by approximately 70% Includes mapping of city to zip

Consolidated Email Addresses for members

50% enhancement of zip codes including zip+4 correctly populated

New data like Geocoding – map Medicare members to their nearest care Management facility and mode of transportation

Address is standardized and cleansed as per USPS Postal Standards

MDM also addresses confidence of whether addresses are deliverable

15

Missing Apt or Suite Number

Incorrect Number

Incorrect Recipient

Missing Number

Missing RR or Box Number

Incorrect Street Name

ACME PRODUCTS4759 WESTERN STNEW YORK NY 10022-5279

CARL SHULER1414 LAKE ST APT CHICAGO IL 60614-1905

CARL SHULER1914 LAKE ST APT 3ACHICAGO IL 60614-1910

CARL BROWN1414 LAKE ST APTCHICAGO IL 60614-1910

CARL SHULER LAKE ST APT 3ACHICAGO IL 60614-1910

CARL SHULERPO BOX CHICAGO IL 60614-1910

CARL SHULER1414 LARK ST APT 3ACHICAGO IL 60614-1910

498

326

234

156 148 147

Mil

lio

ns

of

Pie

ce

s

USPS Undeliverable as Addressed Mail in 2011- This is a

universal problem – not just to Horizon

16

Example: Member Business Challenge 4Support data quality that leads to improvements

in our MTM and BEM scores

17

Business Challenge Illustrative Key Business Questions Maintain Member Touchpoint

Management (MTM) scores for operational and service program for all branded, core health businesses:

• Enrollment• Claims• Inquiries• Plan Accessibility

NEW! Support improving new Blue Experience Metric (BEM) scores

• Member experience and engagement• Network access• Education

Navigation• Customer Service• Claim Payment

What baseline addresses should be used for Enrollment Member Accuracy measurements?

How are the scores across cohorts consistent across time?

How do I achieve enrollment timeliness which includes ID card management?

FDP and LDP (First, Last – Day Processing metrics are affected by US mail contacts e.g. Benefit Booklets. How do I ensure my communications are getting through in a timely way?

How can I validate and manage some of the MTM “audited” fields

Example Business Challenge: How do you enable Member Touch point Measures (MTM) and Blue Experience Measures (BEM) for

Member?Where is Horizon’s 360o view?

18

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 don’t bridge well across Members, Providers, Products,

Customers, Employees etc.– MDM: Provide visibility across multiple data domains (e.g. providers that are also members)

19

MDM Data Quality Enhancements Benefits

SSN or TIN

Address

Name

Phone

Email

Date of Birth

Gender

SSN or TIN is standardized based on Federal Standards

Address is standardized based on USPS Standards

Name is standardized based on Data Governance Policies

Phone is standardized based on Data Governance Policies

Email is standardized based on Data Governance Policies

Date of Birth is standardized based on Data Governance Policies

Gender is standardized based on Data Governance Policies

Indicators and Cleansing Rule ExamplesKPIs

WIP

WIP

20

ACCURACY• Information should be highly accurate with regards to regulatory and operational standards WIP

MDM Implementation Data Statistics: Member and provider consolidated, standardized and

cleansed across all lines of business and market segments, email addresses centralized

21

MDM Provider Data Statistics: Identifying Par and Non-Par Provider across lines of

business and market segments; Par and Non-Par Provider by networks

22

MDM Member Data Statistics: Identifying Members across multiple line of business will

enable us to track them across products and market segments when MDM includes Group and Plan data in

Phase 2 – a key requirement of Health Care Reform and Exchanges

23

MDM Provider - Exclusion Statistics: Provider /Practitioners Omitted from MDM Based on Exclusion Rules by Source System

24

25

Horizon Solution: Multi-Domain MDM Hub as a Solution

Disparate Data Reliably Resolved

DataGovernance

Customer Customer ServiceService

Consumerism &Consumerism &Health ExchangesHealth Exchanges

ComplianceComplianceSalesSales MarketingMarketing

Medicare AdvantageMedical

ClaimsProvider Data Management

DentalMedicaid

Joseph Braverman, M.D.

[email protected]

Joseph Braverman, M.D.

[email protected]

Portals

ProviderProvider CustomerCustomer EmployeeEmployee MemberMember ProductProduct

Enterprise Master Data Hub

Broker

Broker …… ICD-10ICD-10

Kate Smith452 Second

Street,Newark, NJ-

07105

Kate Smith452 Second

Street,Newark, NJ-

07105

Pri: Medicare BSec: PPO 20/150/40

Pri: Medicare BSec: PPO 20/150/40

3rd Party Organization

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

General Administration 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 in management of Business Processes like Claims Adjudication, Member Eligibility, Contracts Management, Provider Management, Network Management etc.

Cost of Revenue 5-10% for various Business Processes

Increased Cross Sell/Up Sell Revenue 5%

Increased New Member Enrollment Revenue 5%

Increase in Amount of Insurance Premium Collected

Revenue 2%

Increase in Share of Wallet and Margins Profit 5%

26

Horizon is part of a leading trend in advanced information management

27

Top Master Data management Trends & Challenges that have emerged over the last 2 years* are:

By 2013, 30% of the total companies implementing MDM programs may run into challenges due to insufficient MDM Strategy

By 2014, 66 percent of Fortune 1000 organizations will have deployed two or more MDM solutions to support their enterprise MDM strategies

Top Trends in the Global Information Management Space

* Source - Gartner, MDM institute

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 360°Using Multi Domain MDM

Consumer 3600 View - Data ElementsIntegrating customer related data from internal and external sources is a key enabler with MDM

Questions and AnswersHow can you help?

Thank you

29