How to put data and analytics to work in the era of healthcare reform

How to Put Data anD analytics to work in tHe era of HealtHcare reform anD analytics to work in tHe era of HealtHcare reform Demonstrated by Blue cross and Blue shield of north carolina

How to Put Data anD analytics to work in tHe era of HealtHcare reform taBle of contents With a teradata enterprise data warehouse (eDW) at its core, blue cross and blue Shield of North carolina (bcbSNc) has created a data and analytics-driven the role of Data and analytics at bcbSNc environment to improve the health of its members and provide a competitive edge in the era of healthcare reform. First, the company recognized the vital strate- companion Programs gic role of data and analytics by creating a center of excellence for Information and analytics Services and 8 an exciting Future moving the group under the chief Strategy and Inno-vation Officer, from the cIO. then bcbSNc initiated a Medical Quality Management assessment program that relied on the data and analytics environment to enable medical expense reductions of $95 million on a $5 million investment. the company also has begun expanding the way it uses its teradata eDW, extending it into areas that include strategic planning, network management, prod-uct design, as well as fraud prevention and remediation. this whitepaper details how bcbSNc leverages its teradata environment to achieve key strategic goals. as the leading health insurer in North carolina with more than $5 billion in annual revenue, blue cross and blue Shield of North carolina (bcbSNc) is a proven leader in North carolina's healthcare industry. Its success is built on its continual and innovative development of health-care products, services and information that help its members improve their health and well-being. "Our ceO has been a very motivated and visionary leader for helping improve the healthcare delivery system in North carolina," says Susan helm-Murtagh, vice-president of information management and analytic services at bcbSNc. In pursuing its goals, bcbSNc is particularly focused on the effective use of data and analytics. helm-Murtagh and her team have been at the forefront of this effort, having successfully made the case that data and analyt-ics are critical to continually improving medical care, marketing more effectively, operating more efficiently, and engaging individuals to better manage their own health and healthcare.

How to Put Data anD analytics to work in tHe era of HealtHcare reform tHe role of Data anD "What becomes more important is what you do with analytics at BcBsnc the data," he says. "how quickly you can get it, how you interpret it—these are the keys to who will do well in this environment…more and more, the job is to go through a 17-year veteran at bcbSNc, helm-Murtagh assumed the haystack and find the needle you didn't know was her current position in 2008 fully aware that one of her there to begin with." biggest challenges would be to successfully convert the massive amounts of data available to health plans and to find those needles—those game-changing insights— insurers—a volume that is going to grow significantly helm-Murtagh's group has focused on: 1) creating an over the next few years—into faster, more reliable, and organizational culture and structure that reflects the more actionable insights that align with the company's company's commitment to using data and analytics for strategic goals and vision. competitive advantage, and 2) developing a powerful, scalable technology environment.
the organizational change began with the creation of the center of excellence for Information and analyt-ics Services and its move to the strategy side of the house. "being under the chief Strategy Officer gives us a much better lens on how we need to position informa-tion and analytics to drive competitive advantage," says helm-Murtagh. the value she and her group have added is reflected in their growth. In 2008, there were a total of 70 staff members and contractors working for helm-Murtagh; now there are 270 full-time-equivalent staff members. culturally, says Norris, "the move focused us on the concept of insight IQ," which according to the corpo-rate executive board, "measures an employee's ability to find and analyze relevant information to make better decisions. the three elements of Insight IQ are informa- She also knew that the healthcare landscape was chang- tion attainability, information usefulness, and employee ing; recent events have only accelerated those changes. Payment reform, new product designs, the IcD-10 transi-tion, ehr implementations, new provider alignments and Subject matter experts throughout the organization newly eligible individuals without claim experience enter- must learn how to do rapid discovery on key business ing health insurance exchanges will require a new level of questions, something that if left solely in the hands of analytics capabilities. In addition, helm-Murtagh knows traditional data analysts would cause unacceptable that bcbSNc has to be ready to share and exchange bottlenecks. thus, data analysts needed to find a new data, often through health information exchanges. way to partner with business units that would facilitate widespread access to data and analytical tools while bcbSNc believes in this environment, "Data becomes minimizing associated risks.
the table stakes," says todd Norris, senior director of information management at bcbSNc. Norris cut his teeth "We realized this wasn't about how to train people on the in the retail industry, where the ability to gather and use tools, but how to think about data—we needed to legalize data for timely and relevant consumer engagement has the analytics," says Norris. to do that the team identi- evolved to a precise art form.
fied the key skills people needed to collect, analyze and How to Put Data anD analytics to work in tHe era of HealtHcare reform display information for decision making. they are now information, scored requests, understood the rationale implementing various training and help programs to dis- and then prioritized," says carleton. seminate best practices and have created a small set of user-friendly tools that the majority of people could use.
this led to the initial focus on medical quality manage-ment assessment (MQMa) in late 2009. rather than "We're making a fundamental shift toward empowering try to compete with other corporate projects, bcbSNc end users for more basic reporting, which elevates their focused on MQMa, because, says helm-Murtagh, "It has appetite and knowledge of information they're using— a direct line to medical loss ratio." and frees the staff to do more complicated analyses," says Marshall Davis-henaine, Director of enterprise In just 2.5 years, the MQMa initiative has enabled $95 analytics. through a combination of automation, out- million of medical cost saving initiatives on an origi- sourcing and business user self-service enablement, the nal investment of $5 million and helped the company company has already reduced by 55% the time required comfortably maintain a medical loss ratio within the by analysts to produce deliverables in three key areas— requirements outlined by the affordable care act (aca). membership reporting, group reporting, and the produc- that's the type of success upon which bcbSNc can con- tion of regular reports and extracts. tinually grow its data and analytics operation.
Of course talented people and a strategic organizational It also positions the company for further success amidst structure must be paired with technology that can do the the disruptive changes on the horizon in the healthcare job. this is where teradata enters the picture, because industry. In fact, partly due to its teradata eDW and the it is the backbone of an analytics environment unparal- success of the MQMa, bcbSNc is confidently embarking leled in its ability to deliver timely and reliable business on its next set of strategic initiatives including a leader- insights across a business. "With teradata partnering in ship role in the North carolina hIe, an accountable care the analytics space, they're simplifying how this work organization (acO), bundled payment experiments and gets done," says Norris. patient-centered medical homes.
bcbSNc is using a teradata enterprise data ware- though there is still progress to be made—there always house to collect, integrate and organize a wide range is—bcbSNc has gone a long way toward achieving its of data that is continually expanding. core data today initial goals and is already a rich and powerful example includes information about providers, members, member for how to put data and analytics to work in the health- contracts, fee schedules and seven years of claims infor- mation. adjudicated claims are loaded daily. In addition, for a variety of initiatives bcbSNc turns to best-of-breed analytics such as SaS and the Optu- as the company's first and largest data-driven initiative mInsight Symmetry episode treatment Group (etG) with their new eDW, MQMa is the biggest consumer of software, which interact smoothly with the teradata teradata eDW processing and an enormous success to eDW. bcbSNc is also looking at migrating external date. Its potential for reducing medical expenses and the processing for point-in-time and geospatial metrics support it lends to initiatives such as provider quality, to leverage the relatively new in-database features of sales and marketing and actuarial give further evidence teradata. Finally, bcbSNc sees a nice convergence in of why it was an ideal starting point. the SaS in-database analytics that will boost perfor-mance and eliminate unnecessary data movement and "MQMa was an effort to build out the teradata eDW and analytics in a more customer-centric way," says Darryl Wansink, Director of healthcare and research evaluation. as the organizational structure and technology environ- by beginning with high volume requests such as disease ment fell into place, tom carleton, now the company's registries, enrollment in disease- management programs, director of strategic development, worked to create a and changes in benefit design, the company believed it roadmap for the transition to using the teradata eDW. would be able to address the bulk of spending that was "With business owners throughout the company, we ripe for reductions without compromising care quality— put together a methodology and framework, gathered and in some cases even improving it. How to Put Data anD analytics to work in tHe era of HealtHcare reform Supports over $95mm in cost reduction initiatives meDical exPense initiative INcreaSe aDhereNce OF hePatItIS c DruGS INcreaSe aDhereNce OF PlavIx tIereD NetWOrk creatION IDeNtIFy buSINeSS areaS rOle buSINeSS re-eNGINeerING OPPOrtuNItIeS DOMeStIc MeDIcal tOurISM blue QualIty PhySIcIaN PrOGraM (PrIMary care) blue QualIty PhySIcIaN PrOGraM (carDIOlOGy) blue QualIty PhySIcIaN PrOGraM (Other) tarGeteD PrOvIDer NeGOtIatIONS 360 MeMber, PrOvIDer aND eMPlOyer vIeW veNDOr OPtIMIzatION reDuce er utIlIzatION – PhaSe 1 reFINe PPa lISt MeDIcal PrOceDure-baSeD GrOuPer FOcuS revIeW INItIatIveS – MultIPle PhaSeS cOSt aND QualIty traNSPareNcy – DIM buNDle PayMeNt MODel SPINe PPa PrOGraM Davis-henaine points to one initiative the company were pretty dramatically associated with a handful of undertook to reduce unnecessary procedures. "by virtue procedures—lumbar spinal fusion surgery was one— of looking at data in a holistic manner and benchmarking but not seeing a real difference in terms of our out- it against regional and national trends, we determined comes," he says. that we were seeing medical expense increases that

How to Put Data anD analytics to work in tHe era of HealtHcare reform after a communication effort with the provider com- that insight has helped bcbSNc explore ways to sup- munity, the company instituted a prior authorization port the health of the entire family when an individual is program that asks providers to stop and consider diagnosed with a serious condition, like cancer, or when before automatically recommending spinal fusions. "Our someone already in a disease management program is approach wasn't to try to deny all such procedures, but diagnosed with a co-morbid condition. to make sure the decisions were thoughtful and rational, so from payer's perspective, we're not incurring costs the MQMa team also analyzes how benefit design affects for procedures that don't show greater efficacy, and how members consume healthcare. In one case, the from the member's perspective they get help making company waived or lowered co-pays on select generics educated and informed decisions." this one effort alone, and found this had a big positive impact on therapeutic says Davis-henaine, contributed to $15 million in savings adherence, improving the health of its members. calculated from a change in trend. "We looked at this over time, rather than just one year, and used fact tables to do propensity score matching— to measure the correlation between lower out-of-pocket expenses of the patient and improved health outcomes and/or lower costs," says Wansink. "In this case, even if we lost a little profit, we were willing to pay to improve quality." comPanion Programs While not technically under the purview of MQMa, other initiatives leverage MQMa data and the teradata eDW to create a more efficient and clinically effective bcbSNc.
For example, the company analyzes provider perfor-mance with the help of OptumInsight Symmetry etG software. "We use the output of claim grouper logic to do risk-adjusted tiering on five specialties: cardiology, obstetrics, orthopedics, gastroenterology, and general surgery," says Wansink. Norris provides another classic example: high-cost imag-ing. "We did a long analysis and found we could get a using SaS, the team calculates provider scores and 34% lift by having physicians pre-approve high-cost integrates them in the data warehouse for the network imaging for certain conditions," says Norris. "We proba- management team to use. the methodology and scores bly have 20 ideas like that. but if it takes 12 months to do also are fully visible to providers to engender trust and the analysis, it's not worth it. by doing this sort of analy- the company communicates with providers in a variety sis in a disease registry in teradata we can complete of ways to encourage higher quality, more efficient care. the analysis in two days and then the whole dynamic bcbSNc also incentivizes its members to use the provid- changes. It's an example of how we can now analyze ers with the best scores.
medical trends that can be offset with some change. before it was just a hunch. Now we can do the analysis the actuarial side of the house is another important user very quickly to figure out if the hunch will pay off." of the teradata eDW. "We're responsible for pricing and managing $5 billion of revenue every year and the way as for the needles they didn't even know they were look- we do that is accurate projection of expenses," says chief ing for, Norris tells of an analysis that revealed that even actuary Patrick Getzen. "We need our data warehouse when patients respond well to self-management for one to get us the right data—clean and detailed—so we can condition, they often lose focus if they get another illness project accurately, 18-24 months out." or someone else in their family contracts a serious illness. How to Put Data anD analytics to work in tHe era of HealtHcare reform Getzen notes that one of the things they're looking at now is new provider reimbursement arrangements—setting up an acO, for example—for which they need trustworthy data and robust modeling to understand a Medical Quality Management assessment how to attribute payments. initiative that relies on data and analytics played a central role in a $95 million reduction Similarly, the coming health Information exchange (hIe) in medical expenses on a $5 million investment will pose new data challenges. "I am licking my chops and dreading the day," says Wansink. "It'll be like drink- consolidation of information management and ing from a fire hose—an unstructured fire hose—but the a portion of enterprise analytics into a single timing, collaboration, types and quality of data offer function and moving it to the strategy side of tremendous potential." the house, combined with dramatic increases in demand for information and analytics, caused he believes the hIe will enable bcbSNc to gain more the center's staff to grow from 70 in 2008 to insight into many areas that impact people's health and the cost of care, including the conditions a person is being the creation and fostering of a data-driven treated for, psychosocial factors, prescription drug data, environment—along with staff training in how and health behaviors. "If we can successfully integrate the to make the most of that environment—led data, we'll be getting a much better picture of the patient to as much as a 55% reduction in the amount and quality of the providers' care," says Wansink.
of time full-time analysts spend on work that is now automated, outsourced and enabled another aspect of the hIe affects bcbSNc's bottom line. by business user self-service. Identification today, the company has a large stake in North carolina's of an area where procedures were being individual market and anticipates significant churn once done unnecessarily and putting patients at North carolina establishes its exchange in 2014 and over unnecessary risk led to a prior authorization a million individuals turn to it to shop for their coverage. program that garnered $15 million in savings.
"Since many of these people will be new members for us, we won't know a lot about them. We'll have to quickly gain insights about them so we can better warehouse," says carleton. For example, the company is understand how to best attract and engage them," says looking into the effect of new patient monitoring tech- nologies and telemedicine as exciting prospective areas. "We will not be able to bring disruptions to the market, an exciting future unless we can get the right information quickly." Finally, carleton notes bcbSNc is constantly on the for more information lookout for disruptive initiatives that may not even be on the radar screen today—and believes the teradata eDW to find out more contact your local teradata representa- plays a critical role in that regard. "everything we do, we are leveraging the information we have sitting in that 10000 Innovation Drive Dayton, Oh 45342 the best Decision Possible is a trademark, and teradata and the teradata logo are registered trademarks of teradata corporation and/or its affiliates in the u.S. and worldwide. teradata continually improves products as new technologies and components become available. teradata, therefore, reserves the right to change specifications without prior notice. all features, functions, and operations described herein may not be marketed in all parts of the world. consult your teradata representative or for more information.
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