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Global Benefits Vision_Issue_2016_009 - Ph de-Dreuzy Predictive Analytics
1. global-benefits-vision.com June 2016
Knowledge & Wisdom for Global Employee Benefits Professionals
10 Worldliness
Natalie Richter
18 Generating valued outcomes from
your global well-being program
Andrew Sykes, Colin Bullen
30 Lockton Global Forum London 2016
Eric Müller-Borle
38 Predictive Analytics –
Knowledge is Power
Philippe de Dreuzy
The first step in building
a valuable legacy in global organizations
Natalie Richter
Page 10
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Profiles of Contributors
ErrorGobnon
Philippe de Dreuzy is President & CEO of MSH INTERNATIONAL overseeing the operations
for the Americas. MSH is a world leader in the design and management of international
healthcare insurance solutions for expatriates. Before MSH, Philippe spent some twenty
years in the United States. His last assignment was with Marsh McLennan Agency as Vice
President, managing international benefits plans as well as Property & Casualty programs.
Prior to Marsh, Philippe was part of the M&A team at British Telecom and was responsible
for the pursuit of business investments through acquisitions in Latin America. Among other
achievements, he had the opportunity to manage an $800 million dollar transaction in
Brazil with a multi-disciplinary team of experts in telecommunications. Before moving to
the United States, Philippe worked in Spain where he was managing the Sales & Marketing
department for CSK Software, a company focused in the design of financial trading tools for
the financial market.
Philippe de Dreuzy
philippe.dedreuzy@americas.msh-intl.com
MSH INTERNATIONAL
President & CEO
p
page 38 : Predictive Analytics – Knowledge is Power→
Since his arrival in Calgary in 2014, Philippe has launched
several major projects to help MSH INTERNATIONAL delivers
a better service to our clients, with more flexibility and
transparency. He has been instrumental in the launch of
Aviator, a unique dashboard tool providing on-line analytics
and predictive reporting.
Beside his position at MSH INTERNATIONAL, Philippe is a
member of the CCE (Conseiller du Commerce Extérieur) network, a
Trade Advisor group appointed by the French Foreign Ministry.
He holds an MBA from Georgetown University, Washington
DC in International Business and Strategic Planning. He is
fluent in English, French, Spanish and Brazilian Portuguese
and a dual French/U.S. citizen.
5. June 2016 - Global Benefits Vision 39
global-benefits-vision.com
Administering global healthcare benefits
has become a daunting task for multinational
employers. The ever-changing healthcare
environment requires us to be more vigilant
than ever. Local compliance and medical
cost containments have become our biggest
challenges, and insurance carriers, third party
administrators, consultants, and brokers
are busier than ever looking for relevant
information that will make the difference
in their value propositions. One of the major
elements of the cost containment equation,
however, continues to be overlooked.
For many insurance players, obtaining
valuable data to control medical premiums is
not a simple or straightforward task. In many
parts of the world, and especially in the United
States, the international insurance industry
remains opaque, frustrating employers of
all sizes and concentrations. Data is usually
presented at the macro level, and becomes
available only when medical policy is about to
be finalized. But when policy renewals are only
months away, it is too late for HR managers to
react, correct plan anomalies, or even study the
methods with which companies can mitigate
medical costs for the upcoming year.
Even for larger employers (usually above 100
expatriate employees), data is presented in static,
cumbersome, and confusing Excel reports that
people are understandably reluctant to read.
Claim information remains confined at the
country level, with disparate coding principles
resulting in essentially inaccessible standardized
reports. Brokers and consultants find themselves
consistently frustrated, as information remains
incomplete and even unreliable. Their value-
added becomes a commodity, where premium
pricing is the key factor in the decision-making
process for moving businesses elsewhere. Only
basic and generic demographics combined
with information on the general trends in
worldwide healthcare costs are available in
order to back up the usual increase in medical
expatriate premiums for which employers are
forced to compensate.
Thanks to innovations in database technology,
however, the confusing world of “Big Data”
can now be codified, analyzed, and visualized
in real time, and provide immediate insights
year-round. Simple-to-complex claim metrics
can detect crucial outliers that human beings
tend to otherwise miss. Remaining informed
presents an unforeseen competitive advantage
not only for the C suite, but also for myriad
healthcare industry players. Speed combined
with so-called “Big Data visualization” become
key assets for multinational organizations with
employees dispersed worldwide.
Indeed, the insurance industry is rapidly
evolving. Actors such as international
third-party administrators are now actively
developing new data visualization platforms,
transforming the integration of multiple data
sources into intuitive dashboard technologies
that perfectly embrace instantaneous data
Philippe de Dreuzy
6. 40 Global Benefits Vision - June 2016
Predictive Analytics – Knowledge is power
visualization. New metrics can be presented
immediately, allowing companies to identify
outliers that would otherwise go unnoticed. A
number of software players are entering the
fray with online and cloud-based dashboards
capable of operating on multiple browsers.
The average industry member can now view
information in an intuitive and graphical way.
Key process indicators based on data that is
collected around the world allows consultants
to rapidly act upon them. Combined with the
historical data available, insights on predictive
behaviors can save significant amounts of
money in administering healthcare plans; make
our decisions faster, more precise, and generally
superior than in the past; and enable employers
to fine-tune their benefits by properly analyzing
this new information. The key factor is data
visualization: see the outliers, analyze them,
and take concerted and deliberate action.
IDC estimates that Big Data analytics will be
a $187 billion market in 2019, up from $122
billion in 2015. A recent article in ZDNet notes
that utilities, resource industries, healthcare,
and banking will represent the majority of Big
Data and analytics revenue growth over the
next five years. Large enterprises will drive
$140 billion in revenue in 2019; even smaller
businesses (less than 500 employees) will
represent a quarter of Big Data revenue. The
United States will be the largest market for Big
Data and analytics tools—$98 billion by 2019—
followed by Western Europe, Asia-Pacific,
and Latin America.
1
Big data, analytics
expected to be $187
billion market in 2019
http://www.zdnet.
com/article/big-data-
analytics-expected-
to-be-187-billion-
market-in-2019/
Within the international healthcare industry,
examining raw data to uncover hidden patterns
is a necessary objective. If we start thinking
about the kind of healthcare information
HR managers would like to evaluate, the
list of key process indicators is lengthy and
unmanageable. The most significant challenge
is cross-referencing fields of data that can be
of the most use. Four categories of information
can be listed: customer usage metrics, claim
processing performance, medical network
access and utilization, and predictive analytics
based on historical data.
THE PARTICULAR CASE OF THE INTERNATIONAL HEALTHCARE INDUSTRY
7. June 2016 - Global Benefits Vision 41
global-benefits-vision.com
Information on demographics combined with
claims information offer many instructive views
of the data, highlighting various consumption
trends. HR managers can easily determine
which of the costly benefits offered through
Expat plans are actually used. A coherent
communication plan at the regional or country
level will later determine if the company's
overall wellness program is adequate or simply
a drain on its finances.
This data visualization displays four different
views of the data in just one widget. For those
who are not familiar with the terminology,
a web widget is a software application with
limited functionality that can be installed and
executed within a web page by an end-user.
Simply speaking a widget has the role of a
transient or auxiliary application, meaning
that it just occupies a portion of a webpage
and does something useful with information
fetched from other websites and displayed
in place. Using a software program becomes
more simple and intuitive for the user, where
they can zoom in with a click of a mouse and
focus on one region, a specific country, or even
to compare country medical consumption.
In our example, the first section shows the
entire population of the employee plan around
the world. Different shades of orange indicate
areas with differing population densities. The
second section shows the monetary volume of
claimants in a particular country, and allows
the user to overlay several countries at once.
The third shows the evolution of medical
consumption on a monthly basis. Finally, the
data can be published within a different time
period, allowing historical comparisons based
on budget constraints or other external factors.
HR managers can suddenly face an emergency
situation (epidemic outbreak, natural disaster,
terrorist attacks, etc.) where the latest information
can be extremely valuable. On the other hand,
this kind of information might prompt an HR
manager to break down benefits consumption
and discover the root causes of problems
in benefits program.
8. 42 Global Benefits Vision - June 2016
Predictive Analytics – Knowledge is power
Another widget showing the medical
network utilization in a specific country might
trigger the local HR manager to take action
and issue a note to all expats, explaining
the multiple advantages of accessing a
Preferred Provider Organization (PPO) network
instead of a different provider (care quality,
contractual pricing and procedures, direct billing,
etc.). Pushing expatriate employees to use a
specific medical network provides significant
cost savings that positively and immediately
impact bottom lines.
PPO
Preferred Provider
Organization
9. global-benefits-vision.com
Executives can look at claims in terms of
specific amount, age of employees, primarily
insured versus dependents, types of benefits,
classes of employees, or subsidiaries, making
the tool extremely useful for other event
correlations. The most important impact
stems from the fact that reports can be
altered online, immediately, and securely.
Big Data is nowadays secured within large
data warehouses scattered around the world
by hosting companies, offering scalability,
flexibility, and reliability through a secure and
cost-effective system with 24/7 data access.
June 2016 - Global Benefits Vision 43
10. 44 Global Benefits Vision - June 2016
Predictive Analytics – Knowledge is power
Authorized users with appropriate credentials
can find, access, upload, and consolidate data
onto any device thereby decreasing time-to-
resolution for high-impact analysis.
These requests can now be done in a fraction
of the time previously required to find, access,
load, and consolidate data from a variety of
siloed claim, billing, and customer systems.
11. June 2016 - Global Benefits Vision 45
global-benefits-vision.com
These new dashboard tools are useful for risk
managers and consultants monitoring benefit
plans, as well as healthcare administrators.
Key process indicators like the ones showing in
the category of claim processing performance
(average number of claims/lines validated, claim
turn-around-time, etc.) can boost productivity in
the back office of a Third Party Administrator
(TPA). Data can then be analyzed in several
dimensions at once, including claim data centers
concentrating on a specific claim adjudicator,
types of benefits, amount of claims processed,
and date of services.
Alerts on specific events also are easier to
detect. Fraud is of course the first vulnerability
that comes to mind, but often the mainframe
can handle fraud using specific algorithms. The
detection of a large claim coming through the
system, or the alert on the screening due to a
critical illness, is far more complex. It is now
possible to automatically construct a workflow
process following a particular chain of events.
The internals of such a system is similar to
using an event queue. Think of the event queue
as a pipeline—events asynchronously enter into
one end, and an event handler deals with events
appropriately as they arrive at the other end.
“Dealing with them appropriately” has a
variety of meanings in this context, and it
depends on the type of event.
For example, when an event representing a
customer signature on a new policy is picked off
the event queue, the event handler may trigger
a business process that “moves” the string of
events to the next phase. Perhaps it requires
to get a customer signed up for a new policy;
perhaps it notifies the billing department to
generate an invoice; perhaps the customer
has NOT signed their policy in an appropriate
amount of time, and the system recognizes that
this time has now expired; whenever a trigger
event occurs, the system generates a new event
TPA
Third Party
Administrator
Exhibit 1: High Claims Workflow
Source:MSHInternational
12. 46 Global Benefits Vision - June 2016
Predictive Analytics – Knowledge is power
into the pipe, and the event handler picks it up
and – for example - notifies the broker of the
need to call the customer.
Dealing with large medical claims (usually
over $50,000) coming through the direct
billing system for processing is not very
different; a series of events that can generate
significant savings in medical bills is similarly
engaged. The TPA medical department is
alerted automatically. The case management
team represented by medical doctors, pre-
certification administrators, and nurses is
then engaged and the patient or the hospital,
as well as any other providers involved in
the treatment of the insured, are contacted.
Since care has already started, it is essential
to do a constant follow-up as is appropriate
relative to the illness. The medical judgment
based on diagnosis and its consequence
between costs-versus-benefits is now being
carefully monitored.
In the above examples, events from a
particular business process were injected into
one end of the pipe. But those events can occur
spontaneously, and can be triggered by multiple
key process indicators designed within the
dashboard tool. Minor analytics can measure
the claims amount on a particular policy, or
the value of a country’s currency, etc. With
simple high- and low-water marks, events can
be thrown into the pipe based on a designated
“value-tripping,” essentially a water mark.
The analytics may be considerably more
complicated—perhaps even predictive. Events
can be triggered (injected into the event queue)
based on a very complicated set of algorithms
that use historical data to look for interesting
situations. The unique ability of these analytical
algorithms is that they can combine internal and
external data to create events that are difficult
for human beings to conceive. Furthermore,
external data sources are everywhere, including
the World Health Organization as well as
medical network data, direct billing providers,
medical evacuation companies, and many
more. Formatting data is becoming increasingly
streamlined and can be easily integrated
through Excel spreadsheets. All these data
13. June 2016 - Global Benefits Vision 47
global-benefits-vision.com
sources can either trigger events into the event
queue themselves, or be combined with internal
business data and associated analytics.
By combining historical claim data stored
in the cloud with actual data pulled during
the policy year, dashboard tools can help
managers better predict the overall financial
profitability of the medical plan. Predicted
“Net Loss Ratio” can be estimated with greater
accuracy. Underwriters familiar with the use
of terminology such as IBNR (Incurred But Not
Reported) can now automatically configure
such a data visualization platform and
obtain predictive analytics on a monthly
or quarterly basis. While historical data
cannot predict the future with absolute
certainty, it certainly can greatly help us
and allows us understand trends.
A few years back, such results
required hours of calculation through
Excel spreadsheets, or incompatible and
lengthy data files. Many assumptions were made
based on hypotheses and sketchy data coming
from different and incongruously formatted
sources of information.
The legacy of these systems that were
designed decades ago are a major challenge
for insurance carriers. Most of these concepts
are not new. today. This may explain why the
insurance market remains so opaque, unwilling,
or perhaps even incapable of providing more
in-depth analytics. Some may go further
by saying that they do not want to bear the
pressure at the time of renewal.
Meanwhile, new companies
like Google, Facebook, eBay, Uber,
and LinkedIn have developed huge
databases from scratch. With no traditional
IT infrastructures, these new players allowed
BigDatatostandalone,tobetheonlyfocusof
their analytics, and their only architecture.
SUPPORTING INTERNAL
BUSINESS DECISIONS
The primary purpose of data
analytics is to support the internal
business decisions of the C-Suite.
Often plan administrators
suspect something is not right,
but lack the evidence to influence
senior management so they can
make the right decisions. Other factors
influence the decision process; data on local
compliance, governance, medical network
access, and political and economic stability
remain difficult if not impossible to gather
in a concentrated environment. But there is
one conclusion we can make with certainty:
Big Data consolidation and visualization will
revolutionize the market. Indeed, certain
TPAs already are taking the initiative and will
undoubtedly be at a competitive advantage
soon. If there was ever a time to adapt to a new
way of doing things, the time is now. ∞
IBNR
Incurred But Not
Reported
14. 60 Global Benefits Vision - June 2016
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Index of Articles
