mdm business benefits-final2

8/11/2019 MDM Business Benefits-final2

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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

[email protected]

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?


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


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


CARL BROWN

1414 LAKE ST APT


CARL SHULER

LAKE ST APT 3A


CARL SHULER

PO BOX


CARL SHULER

1414 LARK ST APT 3A


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

Email

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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