Compunnel Business Intelligence, Master Data Management & Compliance (Healthcare) Largest Health Insurance Company in New Jersey
Business Intelligence, Master Data Management & Compliance (Healthcare) Improving Commercial Operations: Efficiency, Timeliness & Accuracy of Member & Provider Information The largest health insurance company in New Jersey needed to improve operational efficiency, timeliness and accuracy of data to enable the state's largest health insurer to become more agile and more equipped to respond to changing market demands in an evolving health insurance market. CompunneI is a leading provider of business technology services with nearly 20 years of experience. One of its areas of specialty is information management and business intelligence services for healthcare sales and marketing operations. Compunnel was selected to help the health insurance company achieve its business intelligence requirements for commercial operations. Compunnel helped the organization integrate multiple data sources to enhance business performance and, create a more complete and accurate database of the state s medical providers and institutions. Compunnel successfully provided the right business intelligence solution and an expert IT staffing team to achieve the health insurance company s business objectives. The health insurance company achieved a successful outcome with the integration of multiple data sources to enhance business performance and a more complete and accurate database of the state s medical providers and institutions Data accuracy was increased The company gained the ability to generate required business intelligence reports Member and provider satisfaction was improved About the Health Insurance Company The New Jersey-based health insurance company provides health insurance products and services to more than 3.6 million members. It is a not-for-profit, tax-paying health insurer that is part of a larger network and has more than 5,000 employees and revenue of $8.8 billion in 2011. The company s mission is to make healthcare work by improving the healthcare experience for its members and the communities it serves. 2
Challenges Faced Health Insurance Company s Commercial Operations Challenge The health insurance company found that inaccurate, untimely and isolated data in out-of-date legacy systems was limiting operational performance and impacting customer satisfaction. In addition, there was no easy or effective way to analyze the data. The sales and marketing operations needed an integrated data solution to be able to quickly respond to market challenges and accurately target potential customers. Compunnel was engaged to implement a business intelligence solution and provide a flexible team of expert IT resources to enhance business operations and improve the member and provider experience. Inaccurate, untimely and isolated data in out-of-date legacy systems was limiting operational performance and impacting customer satisfaction. The IT landscape at the health insurance company consisted of 10 systems that author and store some or most of the member and provider data, including claims systems that store additional attributes of members and providers needed to process a medical claim. When a member or provider requested a change to personal information in one of these systems, the other systems did not always get updated at the same time. Some of these legacy systems have been online for more than 10 years and historically, the data was not always entered in a consistent manner. As a result, each month 10,000 to 15,000 letters were getting returned back to the company because of incorrect addresses. For members, this was causing issues, because: For providers, this was causing issues, because: - Benefit and claim summary information may not reach members because of an error in address. - A member may have to call multiple times to get information updated in multiple systems. - New patients cannot search and find them. - A provider may not get paid on a timely basis, because mail and correspondence does not reach the provider. In addition, because data was spread out in multiple systems, the health insurance company had no way of measuring current data quality and changes in data quality over time as provider or member information is added or updated. 3
Requirements & Compunnel s Customized Services The Business Intelligence Project Requirement With new health-care laws going into effect and health exchanges being set up, the health insurance company wanted to prepare the company to be ready to provide health insurance to individuals in an open market. Overall, the company wanted to improve operational efficiency, timeliness and accuracy of information. Specifically, the company wanted: Compunnel implemented a Master Data Management solution for the health insurance company to create a unified and accurate 360 0 view of provider and member records. Accurate information on all members and their dependents that are currently covered by each of their insurance plans. Easy access to information on new customers that the company can target. The most complete and accurate database of the state s medical providers and institutions, which would benefit members when they want to look up a provider or a facility on the company portal. Accurate provider information would also improve operational efficiencies, such as claims processing. Business Intelligence reports on data anomalies and issues that currently exist with the various systems which are used to maintain the member and provider data. The Compunnel Information Management & Business Intelligence Solution Compunnel implemented a Master Data Management solution for the health insurance company to create a unified and accurate 360 0 view of provider and member records. Master Data Management (MDM) creates a framework that defines the structure and content of data within the provider and member domains as it is to be used across the enterprise. This framework defines who providers and members are, what services providers are qualified to provide and members have coverage for, where the services are provided, the relationship of the provider to institutions and the participating status of the provider with regard to the various businesses that make up the health insurance company. The multi-domain MDM hub solution consolidates and stores all the provider and member data in a single repository. This is the first multi-domain MDM approach in the insurance industry, especially using the tool that was selected the Informatica MDM tool. The first phase of implementation involved consolidating provider and member data from 10 internal systems and two third-party vendors into a single entity. The data can be further identified by roles such as provider, member or institution. Of the 1.5 million provider records and 20 million member records coming from internal systems, 8 million unique parties were identified. 4
Compunnel s Customized Services Other Systems Business Intelligence & Information Management Compunnel provided experienced, quality IT staff with a deep understanding of health care insurance for a Business Intelligence team. Business Intelligence & Information Management Solution Overview The solution also involved building reports using a business Intelligence tool to identify data integration, data anomalies and data issues at various points as the data reaches the MDM for final consolidation. The plan is to build a repository to store the data enrichment characteristics over time and generate trend reports, helping the health insurance company gauge changes in data quality. Technology solutions implemented included Informatica MDM 9.1, Informatica Power Center 9.1, Address Doctor 5, Oracle EE 11.2.0.2 Data Repository, IBM Websphere 7 Application Server and IBM s Cognos BI Tool. To achieve the health insurance company s goals, Compunnel provided experienced, quality IT staff with a deep understanding of health care insurance for a Business Intelligence team. The team could be quickly ramped up as needed. Up to 50 highly qualified resources were staffed for the company, enabling the company to achieve its time-to-market goals. 5
Benefits & Outcomes The Business Results of BI As a result of the Business Intelligence/MDM solution that Compunnel implemented, the health insurance company achieved its mission and these results: Golden copy: A master golden copy was now in place identifying all unique providers and members that are in one or more of the health insurance company s systems. The most recent and accurate information of a party was now being captured in one repository that all downstream applications can consume. Updates to any one system can be fed to all other systems on a daily basis. Operational efficiency: Improving operational processes now enabled the organization to increase customer satisfaction. Project staffing An on-site Business Intelligence/Data Warehouse team staffed through Compunnel is engaged to see how the data quality is changing with time. The team expands and contracts as needed. The team includes data architects, DBAs, MDM architects, ETL developers, QA, project managers, business analysts and BSAs. Effective targeting: Identifying potential customers from a sales force system and third-party data providers was now more feasible and accurate to more effectively target these prospective customers. Consolidation of data: Getting accurate specialty, network and location information on a provider was now possible, as well as identifying if a provider is an in-network or out-of-network provider. Compliance Staying in compliance with current state and federal laws is critical. Periodic reports, that need to be sent to federal and state agencies, can now be generated from the MDM system. Compunnel enabled the health insurance company to improve operational efficiency, timeliness, accuracy of data, and readiness to respond to the changing market demands. For the next phase of the company s business intelligence plans, the company is planning an implementation with a high performance Data Warehouse tool, such as Teradata, through which all claims transactional data can be integrated with the master data. The health insurance company s team will then be able to perform real-time analysis and identify meaningful insights on overall consumer demographics, their medical needs and the best way to service them. 6
Compunnel The Right Choice The Compunnel Difference Compunnel has been providing successful customer outcomes to healthcare organizations for more than 10 years. Backed by deep domain expertise in the healthcare industry, we offer specialized IT resources with commercial operations and technical expertise. We provide exceptional project management based on processes perfected over nearly 20 years. Compunnel provides roadmap assessments and consultative guidance, discovery, design, building, deployment and operational support. Compunnel provides consultative advice on the most effective approaches and ways to save on costs. We explain how we will ensure that each project is primed for success. We provide roadmap assessments and consultative guidance, discovery, design, building, deployment and operational support. Compunnel works from a foundation focused on data governance and architecture. Compunnel reduces time to market by implementing a set of BI Framework Solution Accelerators and its Operations Discovery Guidebook to capture the right information and reduce potential implementation gaps. We provide highly specialized and cost-effective teams drawing from our expert IT resources of 1,000+ worldwide. We help organizations significantly reduce costs, typically up to 40% less, with our flexible onsite and offshore model. For more information about Compunnel's Information Management & Business Solutions for Pharma Sales & Marketing Operations, visit: www.compunnel.com, call (800) 696-8128 or email us at contact@compunnel.com. Compunnel Software Group is a leading global business technology services company. Recognized for our comprehensive portfolio of technology services and outsourcing solutions, we combine extensive industry knowledge with highly tailored application development and information management services. APPLICATION DEVELOPMENT 0DOWNTIME CLOUD SOLUTIONS BUSINESS INTELLIGENCE LEARNING SOLUTIONS IT STAFFING 7