Establish a Data Governance Council for Better, Faster Decision-Making

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1 September 25 28, 2011 Dallas, TX Establish a Data Governance Council for Better, Faster Decision-Making Tina McCoppin, Ajilitee Balaji Krishnamoorthy, Horizon BCBS New Jersey Monday, September 26, 8:00 a.m. 1

2 Biographies Tina McCoppin Partner Ajilitee Agile information solutions Balaji Krishnamoorthy Director Data & Information Architecture Horizon BCBSNJ Information Management Strategy and Architecture (Office of the CTO) rizonblue.com 2

com Balaji Krishnamoorthy Director Data & Information Architecture Horizon

3 Our topic this morning A Data Governance Council is the key to transforming data governance into real business value Agenda 1. How a Data Governance Council fits into an overall IM strategy 2. How a Data Governance Council is created and operates 3. How to measure the impact of a Data Governance Council in terms of quantifiable business value 4. Tips for garnering internal support for an enterprise data governance program 3

How a Data Governance Council is created and operates 3.

4 Analogy time! Guess the right answer: Q: A DG Council and Program is to overall IM Strategy just like A: Bees, flies and ants are to a picnic B: Sin, cos and tan are to a triangle C: Betty, Barney and Wilma are to Fred D: Practitioners, Staff and Departments are to a Hospital 4

5 You are swif this morning! That s right! A DG Council and Program can be likened to the various departments that support a hospital which cannot improve health or save lives without its various components IM Strategy Components Master Data Mgt Metadata Mgt Data Quality Data Integration Data Security BI & Analytics Contact Mgt 3 rd Party Data Provider/Hospital Departments Accident and emergency Admissions Anaesthetics Breast screening Cardiology Hematology Intensive Care Maternity Neurology Radiology 5

lives without its various components IM Strategy Components Master Data Mgt Metadata Mgt Data Quality Data Integration Data

6 How Horizon established a DG Council from scratch 2010 Corporate goal of improved data integrity Sept-Oct 2010 Created a set of materials which described the current data issues, purpose of DG and the roles/responsibilities of a DG program Nov-Feb 2011 Met with LOB Directors and VPs 1:1 to socialize the deck. Identified level of interest Recommended the DG Council members and primary Business Sponsor to the CTO and CIO 2010 Kick-off of DG-Provider Pilot: interviewed LOBs re. provider demographic intake Created pain points from the interviews (350+!) and recommendations Created Enterprise DG Council Policy & Procedures Manual Mar-Present 2011 Monthly DG Council meetings (7 to-date) Early meetings were orientation and easy decision-making on policies Recent meeting have established enterprise-impacting policies 6

Identified level of interest Recommended the DG Council members and primary Business Sponsor to the CTO and CIO 2010 Kick-off of DG-Provider Pilot: interviewed LOBs re.

7 Current state problem summary Horizon s data integrity program cost big bucks! Tactical focus Data Governance in functional silos vs. across business processes No direct measurement of approach to integrated metrics and KPIs Limited Member & Provider experience and 360 views Approximately benefit coders (roughly $M/yr) $M/yr in estimated fraud losses $M/yr in returned mail due to incorrect address (for Subscriber and Provider) Tactical approach to IT projects No solid single sources of truth Resulted in overly complex and very expensive business processes & IT footprints 7

Approximately 125 250 benefit coders (roughly $M/yr) $M/yr in estimated fraud losses $M/yr in returned mail due to incorrect address (for Subscriber

8 Selling the concept Previous DQ effort vs. Data Governance Horizon s data integrity program was a necessary (but temporary) triage and intervention alleviating and preventing an impending Data Heart Attack 8

9 Selling the concept Previous DQ effort vs. Data Governance Data Governance is the maintenance regimen of beta blockers, diet, exercise, and monitoring that Horizon BCBS needs to proactively prevent the Data Heart Attack Data Governance 9

of beta blockers, diet, exercise, and monitoring that

10 Data Governance drivers and benefits Horizon Business Imperatives & Blue List Regulatory Compliance Key Performance Indicators (KPIs) Time to Market Benefits: Strategic Business Initiatives Core Business Products & Capabilities Member Touchpoint Measurement Cost Containment Customer Relationship Management Single Source of Truth (SSoT) Constraints Management Cost Avoidance Continuous data quality Rapid cross-business implementation of new applications Transparency, audit-ability and data lineage Increased capability to monitor project compliance with investment objectives 10

Relationship Management Single Source of Truth (SSoT) Constraints Management Cost Avoidance Continuous data quality Rapid cross-business

11 Why do we need Data Governance? Businesses have different ways of reporting data Multiple codes exist for the same thing Organization changes rapidly Prescribing Dispensing Semantic Disconnect Data is in different Formats Businesses use different IT systems IT systems change 11

for the same thing Organization changes rapidly Prescribing

12 Data Governance Council Composition Data Governance Council (Business, IT, and Administrative) Membership & Benefits Data Governor B.Krishnamoorthy Provider Claims IT Service Healthcare Management Product & Marketing Security Strategic Planning & Management Administration 12

Data Governance Council Coverage Healthcare Management Product & Marketing Provider Service Membership & Benefits Medical Policy Utilization Management Complex Case Management Chronic Care Management

13 Data Governance Council Coverage Healthcare Management Product & Marketing Provider Service Membership & Benefits Medical Policy Utilization Management Complex Case Management Chronic Care Management Health Program Management Portfolio Mgt Product Development Product Instantiation Product Selection Brand Marketing Marketing Campaign Campaign Mgt Sakes Network Management Relationship Management Provider Profiling Provider Contracting Inquiry Mgt Manage Service Protocols Contact Center Call Center Mgt Provider HCM Claim Product Explanation Marketing Producer Account Set-up & Maintenance Group Enrollment Verify Member Manage Membership Underwriting Account Impl. Claims Information Technology Planning Audit Security Claim Acquisition Claim Adjudication Claim Pricing Advise Claim Outcome IT Strategy Application Development Product Support Infrastructure System Strategy Blue List Healthcare Act Human Resources & Finance Mandates epmo Process Management Actuarial Legal Auditing Compliance Regulatory Risk Management Security PHI PI ISO/IEC NCPDP HITECH HIPAA * Includes Market Segments (FEP, Public, Medicare, Medicaid, Commercial) * Includes Product Line of Business(Medical, Dental, Vision, Pharmacy, etc. )*Includes Product Line ( HMO, PPO, POS, etc.) 13

Provider Profiling Provider Contracting Inquiry Mgt Manage Service Protocols Contact Center Call Center Mgt Provider HCM Claim Product Explanation Marketing Producer Account Set-up & Maintenance

14 DG Council 2011 metrics Council Member DSMs Quotes Attendance Delegates Intakes Claims (2012) Services (2012) Planning NA Provider Security NA Governor NA IT NA Product & Mktg (2012) Membership & Ben 1* Auditing NA Healthcare Mgt NA 1 2* 0 0 * Mission Critical Approved Identifying Candidates 14

Governor NA 10 6 0 2 IT NA 1 6 0 0 Product & Mktg (2012) 0 5 1 1 Membership & Ben 1* 3 6 0 2

15 Voting and policies established by Horizon s DG Council since March 2011 Voted on What constitutes a Quorum and how decisions are reached DG Council performance goal metrics (pledging advocacy, attendance, intakes, 5-year maturity model) Governed data elements (any group who needed a change had to validate with the Data Steward) Unique Provider (Individual) data elements needed (e.g., TIN, NPI) Unique Institution (both Group and Institution) TIN, EIN Unique Member Name, Address, DOB, SSN Subscriber / Member Identifiers USPS Address Standardization (use Address Doctor and MDM for matching) Address Type Standardization conform to HL7 Provider Specialty Taxonomy -- conform to CMS labels (NUCC) 15

16 Focus on Business Function-speak not Data speak Where Transactions pull together the different types of data: Master Control/Reference Transactional (values) CONTROL / REFERENCE DATA Generally controlled through Approved Lists of Values (LOVs) Patient name, address, phone Relationship Insured name, State address, phone Birthdate Gender DX TRANSACTIONAL DATA (How many, how fast, how much) MASTER DATA (Who, what, where) CPT Charges Units INFERRED through the Master Data Provider Type Provider Specialty TIN 16 Billing provider 16

Patient name, address, phone Relationship Insured name, State address, phone Birthdate Gender DX TRANSACTIONAL DATA (How many, how

17 Governance Rule of Thumb The people doing the work know more about their jobs than any manager ever will Good governance helps them do their jobs, it doesn t get in their way 17 10/ 4/2

Lack of tools to support transparency and visibility for Data Stewards Inappropriate: DG

18 Why Data Governance fails Horizon s DG Council is addressing these hurdles: Decision-making has traditionally been made for business expediency over best practices Lack of tools to support transparency and visibility for Data Stewards Inappropriate: DG Council size lack of engagement representation empowerment Lack of chessboard thinking TOO BIG too small 18

19 What s happening in the field? Show of hands: How many of you have a DG Council? How many of you meet monthly? How many of you have a scorecard for your DG Council? How many of you have Enterprise-changing policies coming out regularly? (e.g., change to process, change to DQ, etc.) 19

20 Key takeaways Data Governance programs tend to fall short of expectations because they wind up as tactical data quality initiatives A DG Council takes a holistic approach Priorities and standards Tools and technologies Clearly defined executive, steward and stakeholder roles and responsibilities 20

takes a holistic approach Priorities and standards Tools and technologies

21 Thank you and good luck! Any questions? May the Force of a Data Governance Council be with you. 21

Driving Immediate Value from a Phased MDM Program

September 25 28, 2011 Dallas, TX Driving Immediate Value from a Phased MDM Program Balaji Krishnamoorthy, Horizon BCBS NJ John Bair, Ajilitee Tuesday, September 27 10:45-11:30 am 1 Biographies Balaji Krishnamoorthy