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Supercharging Business Intelligence with MDM at Horizon BCBS of New Jersey

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).

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Supercharging Business Intelligence with MDM at Horizon BCBS of New Jersey

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

  2. 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. 3

  4. Data Strategy & Management Master Data Management Data Quality Management Business Intelligence & Analytics Data Architecture Structured Data Unstructured Data Metadata Management Content Management Data Security Management Enterprise Data Integration 3rd Party Data Management Data Governance Information Technology Infrastructure

  5. The Information Challenge We Face Synthesize & govern data across silos & sources Consumerism & Health Exchanges Customer Service Marketing Compliance Sales Incorrect Contact Info No View of Consumer Hospitals ? Katlyn Smith 452 2nd St Newark, NJ-07105 PPO 20/150/40 Pended Claims Physicians Kate Smith Medicare B Data Governance PPO/HMO Jbraverman@email.com Medicaid Medicare Dental Ancillaries Joseph Braverman, M.D. Kate Smith 450 Second Street HMO Dr. Joe Braverman Portals Provider Data Management Medical Claims Dental Medicaid Medicare Advantage

  6. Example: Provider Business Challenge 1 Support products for new network on public exchanges Business Challenge Illustrative Key Business Questions • 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)

  7. The business wants to create andanalyze multiple scenarios quickly

  8. Example: Provider Business Challenge 2Support data quality measures like PDQI Business Challenge Illustrative Key Business Questions • 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? • 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

  9. But this has been hard up to now MDM was designed to fix data issues and speed business analysis and action 46% increase in key populated data fields • Name is de-duplicated across systems, ensuring the Golden Record has the correct spelling 72% increase in phone number enhancements through standardization and completeness • 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

  10. Example: Member and Provider Business Challenge 3 Address Standardization Returned Mail Study Business Challenge Illustrative Key Business Questions • 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 • 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

  13. Horizon Business Challenge – at a Glance 13

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

  15. MDM also addresses confidence of whether addresses are deliverable

  16. USPS Undeliverable as Addressed Mail in 2011- This is a universal problem – not just to Horizon ACME PRODUCTS 4759 WESTERN ST NEW YORK NY 10022-5279 498 CARL SHULER LAKE ST APT 3A CHICAGO IL 60614-1910 CARL SHULER 1414 LAKE ST APT CHICAGO IL 60614-1905 CARL SHULER PO BOX CHICAGO IL 60614-1910 CARL SHULER 1914 LAKE ST APT 3A CHICAGO IL 60614-1910 CARL SHULER 1414 LARK ST APT 3A CHICAGO IL 60614-1910 CARL BROWN 1414 LAKE ST APT CHICAGO IL 60614-1910 326 Millions of Pieces 234 156 147 148 Missing Apt or Suite Number Incorrect Number Incorrect Recipient Missing Number Missing RR or Box Number Incorrect Street Name

  17. Example: Member Business Challenge 4Support data quality that leads to improvements in our MTM and BEM scores 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 • EducationNavigation • 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

  18. 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?

  19. 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)

  20. MDM Data Quality Enhancements Benefits KPIs WIP Indicators and Cleansing Rule Examples SSN or TIN is standardized based on Federal Standards SSN or TIN Address Name Phone Email Date of Birth Gender Address is standardized based on USPS Standards WIP Name is standardized based on Data Governance Policies Phone is standardized based on Data Governance Policies • ACCURACY • Information should be highly accurate with regards to regulatory and operational standards 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 WIP

  21. MDM Implementation Data Statistics: Member and provider consolidated, standardized and cleansed across all lines of business and market segments, email addresses centralized

  22. MDM Provider Data Statistics: Identifying Par and Non-Par Provider across lines of business and market segments; Par and Non-Par Provider by networks

  23. 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

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

  25. Horizon Solution: Multi-Domain MDM Hub as a Solution Provider Customer Employee Member Product Disparate Data Reliably Resolved Consumerism & Health Exchanges Compliance Marketing Customer Service Sales  Enterprise Master Data Hub … Broker ICD-10 Data Governance Pri: Medicare B Sec: PPO 20/150/40 Kate Smith 452 Second Street, Newark, NJ-07105 Joseph Braverman, M.D. Jbraverman@email.com 3rd Party Organization Dental Medicare Advantage Portals Medicaid Provider Data Management Medical Claims

  26. Industry Benchmarks – Direct ROI for MDM Implementation

  27. Horizon is part of a leading trend in advanced information management Top Trends in the Global Information Management Space • 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 * Source - Gartner, MDM institute

  28. Enabling the Consumer 360° Using Multi Domain MDM Products & Benefits Member Information Integrating customer related data from internal and external sources is a key enabler with MDM Data Data Consumer 3600 View - Data Elements • Product • Benefit • Renewal • Ancillary Product • Wellness & Disease • HSA/FSA/HRA • Basic • Preferences • Extended • Prospect/Lead • Broker • Health Risk • PHR • Provider, PCP • Alternate Programs (e.g., ACO, etc.) • COB & other Ins. MDM 360° Interactions Transactions Interaction Data Interaction Data • Service Requests • Messages • Care Messages • Correspondence • Payment • Member Provider Interactions • Claims • Pre-Cert & Pre Authorizations • Care Management • Appeals & Grievances • Billing • Delegate Partner Data • EOB

  29. Questions and AnswersHow can you help?Thank you

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