Maureen Lowe, Denise Matthews, Divyes Patel
BlueCross BlueShield of Tennessee

Maureen Lowe
Director, Client Reporting
BlueCross BlueShield of Tennessee
•
Responsible for providing information to drive benefit and clinical decision-making, analysis of medical cost drivers, existing service performance and clinical program outcomes as well as building collaborative relationships with customers and stakeholders
• Over 25 years of experience in the health insurance industry across technical, clinical and operational segments
•
Most recently held the role of Federal Government Systems Manager for the BlueCross BlueShield of
Tennessee Medicare Administrative Contractor implementation
•
Education
 Bachelor’s Degree Biology, University of Tennessee at Chattanooga
Phone: 423.535.4046
Email: Maureen_Lowe@bcbst.com

Denise Matthews
Program Manager, Medical Informatics
BlueCross BlueShield of Tennessee
• Responsible for planning, directing and ensuring the successful management, oversight and implementation of
Medical Informatics’ projects
• Over 17 years of healthcare experience in operations, government regulations, business development and project management
• Prior to joining the Medical Informatics Division in 2011, acted as a the Program Director for BCBST’s Medicare subsidiary.
•
Education
 Bachelor Degrees Sociology/Criminal Justice, University of Tennessee
Phone: 423.535.5602
Email: Denise_Matthews@bcbst.com

Divyes Patel
Manager, Rapid Application and Development
BlueCross BlueShield of Tennessee
• Responsible for building the Clinical DataMart and reporting & analytical reports and tools for the Medical
Informatics department
• Over 15 years of healthcare experience in reporting and informatics development
•
Prior to joining BCBST in 2011, worked for Ingenix Consulting leading a development team in building a Clinical
Value Measurement Infrastructure using SAS to automate clinical ROI savings calculations for OptumHealth clinical programs
•
Instrumental in building an industry leading clinical reporting package that tracked clinical activity to their financial outcomes for OptumHealth and was a lead developer to build a clinical reporting DataMart for reporting and adhoc uses
• Education
 Bachelor Degrees Chemistry and Economics, University of Tennessee
Phone: 423.535.6260
Email: Divyes_Patel@bcbst.com

• In 2011, BCBST Medical Informatics purchased Teradata to expand our strategic framework, data infrastructure, integrated clinical reporting and data mining environment
• Teradata provides an infrastructure that supports large volumes of claims data, eligibility, pharmacy, biometrics, HRAs, third party data
• In addition to expanding our infrastructure and reporting capabilities, BCBST wanted to leverage Teradata to support a mobile framework and strategy

• Once the need for mobile capabilities was recognized, Medical
Informatics began working with IS to identify potential vendors
• As a starting point, IS reviewed Gartner's top quartile for mobile BI
• In addition to reviewing new vendors, Medical Informatics assessed technology already in use by BCBST

• The typical procurement strategy at BCBST is to issue RFPs to potential vendors:
– Request a written response to a variety of questions/scenarios
– Onsite presentation for the finalists
• Due to the nature of mobile technology, we wanted to ensure the technology we selected would work in our environment:
– Was our data structure adequate?
– Do we have the right resources for mobile development/can our staff be trained?
– How long would it take us to deploy once we selected the vendor?
• Senior leadership made the decision to conduct Proof of Concepts
(POCs) with a multiple vendors rather than issue RFPs

• To determine the top two vendors for the POCs, we held brainstorming sessions with applicable vendors:
– Provided high level business requirements to the vendor prior to the brainstorming session
– Requested they present benefits of their platforms that were specific to our requirements
– Encouraged participation by multiple levels of MI management to ensure we captured all possible ideas/suggestions
• Based on the brainstorming sessions, MI selected two vendors to proceed to the POC round:
– BCBST developed a Statement of Work (SOW)
– Vendors were asked to price a 60 day on site work effort
– Output of the POC would belong to BCBST

• The Mobile BI Proof of Concept had five objectives:
– Create a prototype of an externally facing iPad application with write back capability
– Develop an internally facing provider dashboard
– Exhibit/showcase adhoc capabilities within the tool
– Ability to generate BCBST’s Financial and Clinical Insights Report (FCIR) using the tool
– Showcase the ease of use of the tool
• Other requirements of the Proof of Concept included:
– Vendor personnel had to work onsite at BCBST using a BCBST provided asset
– An executive status was required every two weeks
– Project status meetings with the team conducted three days per week

• The mobile application was derived using data from five large, selffunded accounts (de-identified)
• Key performance metrics from the BCBST Balanced Scorecard were used:
– Financial Trend
– Healthcare Utilization
– Population Risk
– Chronic Health Status
– Member Engagement
– Clinical Outcomes
Due to the 60-day limitation, vendors were asked to focus on two areas and provide two-three levels of drilldown within each component

• The provider dashboard was developed using a data set that included all Tennessee physicians (25,000+)
• We requested the vendors to develop the dashboard using the following domains:
–
–
Summary View
Demographic View
Due to the 60-day limitation,
– Performance View on three domains
– Direct Cost and Utilization View
– Risk Adjustment View
– Quality and Patient Experience View
– Indirect Cost and Steerage View

• The adhoc capability portion of the proof of concept was demonstrated/shown by using the data for the provider dashboard
• We requested the vendors to showcase the following capability:
– Ability to select report elements such as columns, measures, sort groups, filters and output formats that are customizable for each user
– Automatic condition drill-thru
– Ability to create any number of report combinations
– Ensure “single version of the truth”
• In addition to using the provider dashboard to demonstrate functionality, vendors were asked to hold a ½ day hands on session for our analysts

• The vendors demonstrated the ability to generate/automate reports by using BCBST’s Financial and Clinical Insights Report (FCIR)
• We requested the vendors to showcase the following capability:
– Ability to interact with the data in a secure, feature rich manner
– Ability to perform in-depth analytics and enhanced analytics such as charting
– Security, such as password protection
– Collaboration, including the ability to export and email
– Incorporation of MS office

• Vendors were evaluated using the following criteria and scoring:
Evaluation Factor
Total cost of ownership (incl. software, hardware, maintenance,
FTE)
Ease of use (end user navigation)
Vendor track record
Ease of use (administration and development)
Features and visualization
Security
Integration with Enterprise solution
Impact on organization
Scoring
Weight
2
1
1
2
2
3
3
3

• BCBST engaged Claraview (a subsidiary of Teradata) to help develop the BI roadmap for Medical Informatics
• Claraview assists in planning and deploying complicated BI projects using proven methodologies for solution delivery and BI program management
• Claraview was asked to assist in the following areas:
– BI platform selection/support
– BI platform TCO evaluation
– BI delivery and architecture roadmap

2-3 Year
Roadmap for
BI Delivery
Business
Needs
Matrixed with
Existing Data
BI Platform
Integration
BI Roles and
Responsibilities

• BCBST’s long range BI roadmap is being finalized.
• We expect to deliver the provider dashboard to internal users by
December 2012.
• We are working to have the mobile application to customers in the 1 st quarter of 2013.
• Key to BI success is having optimal data models!
• Questions?