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)
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.
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Data Strategy & Management
Structured
Data
Metadata
Management
Data Quality
Management
Data Architecture
Enterprise
Data
Integration
Master Data
Management
Data
Security
Management
Unstructured
Data
Business
Intelligence &
Analytics
Content
Management
3rd Party Data
Management
Data Governance
Information Technology Infrastructure
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The Information Challenge We Face
Synthesize & govern data across silos & sources
Marketing
Sales
Incorrect
Contact Info
Hospitals
Physicians
Jbraverman@email.com
Joseph
Braverman, M.D.
Portals
Provider Data
Management
Pended
Claims
Katlyn Smith
452 2nd St
Newark, NJ-07105
PPO 20/150/40
No View of
Consumer
Kate Smith
Medicare B
PPO/HMO
Medicare
Consumerism &
Health Exchanges
Customer
Service
Compliance
Medicaid
?
Data
Governance
Dental
Ancillaries
Kate Smith
450 Second Street
HMO
Medical
Claims
Dr. Joe Braverman
Medicare
Advantage
Dental
Medicaid
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Example: Provider Business Challenge 1
Support products for new network on public exchanges
Business Challenge
Illustrative Key Business Questions
 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)
 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?
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The business wants to create and
analyze multiple scenarios quickly
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Example: Provider Business Challenge 2
Support data quality measures like PDQI
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
 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 deduplicated across systems, ensuring the
Golden Record has the correct spelling?
 Phone
— Can we differentiate between the
different type of communication
methods?
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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 deduplicated 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
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Example: Member and Provider
Business Challenge 3
Address Standardization Returned Mail Study
Business Challenge
 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
Illustrative Key Business Questions
 What is a Quality Standard?
— When All necessary elements are complete
and correct
 Primary Address Number, Predirectional, 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
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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 okay…
but they were not forwarded to their
destination!!
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Horizon Business Challenge
– at a Glance
Return Mail Study
Subscriber Provider with
with Horizon
Horizon
Address
Address
Subscriber
with
Corrected
Address
Provider
with
Corrected
Address
Checks
Letter
forms/Other
ID Cards
Total Pieces
Subscriber
Undeliverable
Provider
Undeliverable
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 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
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MDM also addresses confidence
of whether addresses are deliverable
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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
Millions of Pieces
CARL
CARL
CARL SHULER
SHULER
SHULER
BROWN
1414
PO
1914
BOX
LAKE
LARKST
STAPT
APT
APT3A
3A
1414
LAKE
ST
CHICAGO
CHICAGO
CHICAGO IL
IL
IL 60614-1905
60614-1910
60614-1910
326
234
156
Missing Apt or
Suite Number
Incorrect
Number
Incorrect
Recipient
Missing
Number
148
Missing RR or
Box Number
147
Incorrect
Street Name
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Example: Member Business Challenge 4
Support data quality that leads to improvements
in our MTM and BEM scores
Business Challenge
 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
Illustrative Key Business Questions
 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
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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 Horizon’s 360o view?
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The MDM Value Proposition
•
Data Fragmentation
–
–
•
Data Duplication
–
–
•
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: 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: 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
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)
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MDM Data Quality
Enhancements Benefits
KPIs
Indicators and Cleansing Rule Examples
ACCOUNTABILITY
• When any of the guiding principles is violated, the error should be
identified, attended to and resolved in a prompt manner by a
WIP
monitored process with an auditable record of changes
ACCURACY
• Information should be highly accurate with regards to regulatory
and operational standards
SSN or TIN
Address
WIP
CONSISTENCY
• Information should be consistent wherever it is viewed throughout
the enterprise. In addition, each Provider, contract, customer,
Member , product, etc. should be uniquely identified
FLEXIBILITY
• The data, metadata, policies and procedures for data quality
should be continuously refreshed to remain consistent with the
changing needs of the business
Address is standardized based on USPS
Standards
Name
Name is standardized based on Data
Governance Policies
Phone
Phone is standardized based on Data
Governance Policies
Email
Email is standardized based on Data
Governance Policies
STANDARDS
• The standards for the definition, usage, consistency and accuracy
of data for each organization (Provider, Member, Claims,
Marketing) that handles enterprise (master) or departmental data
should be consistent with one another
Date of Birth
TIMELY
Gender
• Information should be accessible in the most timely manner in
order to make timely decisions
SSN or TIN is standardized based on Federal
Standards
Date of Birth is standardized based on Data
Governance Policies
Gender is standardized based on Data
Governance Policies
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 business
and 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 when
MDM 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 MDM
Based on Exclusion Rules by Source System
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Horizon Solution:
Multi-Domain MDM Hub as a Solution
Disparate Data Reliably Resolved
Compliance
Marketing
Sales
Consumerism &
Health Exchanges
Customer
Service
Enterprise Master Data Hub
Provider
3rd Party
Organization
Customer
Employee
Provider Data
Management
Broke
r
Product
Kate Smith
452 Second Street,
Newark, NJ-07105
Joseph Braverman, M.D.
Jbraverman@email.com
Portals
Member
Medical
Claims
Medicare
Advantage

…
ICD-10
Pri: Medicare B
Sec: PPO 20/150/40
Dental
Data
Governance
Medicaid
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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
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%
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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
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Enabling the Consumer 360°
Using Multi Domain MDM
Integrating customer related data from internal and external sources is a key enabler with MDM
Consumer 3600 View - Data Elements
Member Information
Products & Benefits
Data
Data
–
–
–
–
–
–
–
–
–
–
Basic
Preferences
Extended
Prospect/Lead
Broker
Health Risk
PHR
Provider, PCP
Alternate Programs (e.g., ACO, etc.)
COB & other Ins.
–
–
–
–
–
–
Product
Benefit
Renewal
Ancillary Product
Wellness & Disease
HSA/FSA/HRA
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
Questions and Answers
How can you help?
Thank you
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