Presentation at AHIP OpsTech and Consumer Forum, focusing on the 7Vs of data driving the member-centric health plan enterprise: velocity, volume, variability, vulnerability, veracity, volunteered, and viscosity.
2. 2
ACO Strategy
A marketplace where
provider and Payer can
communicate through our
secure hosting of provider
records and payer claims –
improving transparency for
ACO adoption
Dell Private Exchange
Leveraging our learning's
from the countries first
exchange that is run by us at
Massachusetts
Consumerism
Assess and spread your reach
to consumers through digital
experience and mobility. Use
social media to reach
individuals for both sales and
improving a payer’s brand
image.
Everest Group
Positioned as Leader and Star
Performer in Payer ITO
Service Provider Landscape
(2013)
Strength and Focus
Dell and Health Plans
Working with Top Health Plan Organizations
Dell Health Plan Facts and Figures
More than 500
technology partners
14,000+ healthcare associates
globally. 6,000+ healthcare payer
associates globally
Serving 100+ insurance
organizations, support for 65 million
policy holders
1.3M enrollments per annum, 98%
of changes processed within 48hrs
11M+ calls handled annually, 310k
items audited approximately each
year
96M+ claims processed annually,
99% of claims processed within SLA
• Kaiser Permanente
• WellPoint
• Aetna
• CIGNA
• Humana
• Harvard Pilgrim Healthcare
• Affinity Health Plan
• Emblem Health
• Blue Cross Blue Shield of RI
• United Health Group
• Massachusetts Connector
• CHPW
• Physicians Plus Insurance Corp
• WellCare
• CareSource
• NAMM California
• WEA Trust
• Delta Health
• Kern Health
• Blue Cross Blue Shield of MI
3. 3
Health plan members (& #7V hosts), Andy & Mandi
Andy Arends
Managing Principal, Health Plan Innovation
& Consulting
@andy_arends
Andrew_Arends@dell.com
Mandi Bishop
Analytics Practice Lead, Health Plan
Innovation & Consulting
@mandibpro
Mandi_Bishop@dell.com
4. 4
Member-Centric Maturity Model: B2B to C2B
Lorem ipsum
• Engage
• Collaborate
• Seek
• Interact
• Listen
• Inform
• Research
• Improve
• Measure
• Impact
• Influence
• Intervene
• Adv. Insights
• Analytics
• Integrate
• Crowd source
• Industry collaboration
• Solutions at
intersection
• Basic insights
C2B
C2U
B2C
B2B
Laggard
• Automated
intervention
• Business
transformation
• Iterative
innovation
Visionary
• Plan
CompetitiveAdvantage
AdoptionMaturity
Plan Listen Engage Act
Claims, Sales & Marketing Data
Big Data & Social
Analytics
Innovate
The
difference
is in the
data
7. 7
Anyone doubt we are headed to a consumer-oriented
future?Not too far away from now – in the next 6-
7 years – 75 million Americans will be retail
buyers of healthcare. And they’ll come to
the marketplace with their own money and
either a subsidy from their employer or a
subsidy from their government. And it
doesn’t much matter – they’ll be spending
their money.”
~Mark Bertollini
8. 8
When I first started as a cardiac surgeon, 20
percent of the patients died. Success and
quality were judged by whether the patient
walked out or got carried out. Now, it’s quite
different—nearly everyone survives. Now
patients judge us in the same way they
would judge a restaurant or a hotel: on the
experience they have here. That experience
has a physical, clinical, and emotional
component. They’ll form their opinions and
they will talk to people.
~Toby Cosgrove
9. 9
Technology enablers—what’s different now
Networks
• Near-ubiquitous
connectivity at speeds
that make data
collection easy and
video possible
• Near-field
communication
technologies (e.g.,
Bluetooth) that allow
“spoke and hub” models
among small smart
devices and a hub that
connects to
the network
Hardware
• Inexpensive, powerful
smartphones putting
power in the hands of
individual consumers
• Low-cost chipsets and
battery technology
allowing a new
generation of small,
smart devices
and sensors
Software
• Cloud-based health plan
applications and EMRs
with open API models to
receive data that can be
monitored systemically
• Consumer-friendly apps
that support easy data
capture, connection to
the care management
applications, and provide
simple feedback to
the individual
Analytics
• More robust approaches
to analytics, such as
supporting care
management and
measuring provider
performance and quality
• Purchasers of health care
demand access to these
tools (and creating their
own), and are using
them to align incentives
for both consumers
and providers
10. Do you have data you need to engage…
…is it instantly actionable?
11. 11
Data in the old model
Velocity
Slow, batch
processes
Volume
(Relatively)
small volume
Variability
Mostly
structured data
Value
Siloed within
organization,
low external
value
Plan Systems
Lead Mgmt
Member /
Billing
Platform
Network
Mgmt
Care Mgmt
Platform
Reporting
Tools
Core Admin
System
Sales & Enrollment Billing
Medical
Management
Claims
13. 13
Our data’s new normal
…and above all, Viscosity: how is data able to flow
from source of origin to where it is needed most?
Velocity
Real time / near real
time
Variability
Mix of structured and
unstructured
Volume
Very large data sets
Vulnerability
Greater need for
security without
impeding access
Value
Unlocked across
the organization
Volunteered
Provided by members
as well as by
contracted entities
7Vs
19. 19
Member-Centric Maturity: 7Vs from B2B to C2B
Lorem ipsum
• Engage
• Collaborate
• Seek
• Interact
• Listen
• Inform
• Research
• Improve
• Measure
• Impact
• Influence
• Intervene
• Adv. insights
• Analytics
• Integrate
• Crowd source
• Industry collaboration
• Solutions at
intersection
• Basic insights
C2B
C2U
B2C
B2B
Laggard
• Automated
intervention
• Business
transformation
• Iterative
innovation
Visionary
• Plan
CompetitiveAdvantage
AdoptionMaturity
Plan Listen Engage Act
Claims, Sales & Marketing Data
Big Data & Social
Analytics
Innovate
Plan
• Population
health strategy
Act
Engage
• Wellness
incentive
strategy
• Risk modeling
• Data integration
strategy
• SoMe strategy
• SoMe Data
integration
• Clinical & claims
data integration
• Advanced
analytics &
insights
• Intervention
programs
• Social
Intelligence
Framework
20. 20
Meet John on B2B data
• Just turned 65
• Seeking MA coverage
• South FL resident
• Retiring state employee
• COULD be a 5-STAR member
Based on what you know,
how would you court him?
And why would he care?
21. 21
Meet John on C2B data
• Avid cyclist
• Kayaks 300M+ annually
• Resting heart rate 60bpm
• Builds & races sports cars
• Road & Track columnist
• Weight stable 50 years
• Bluegrass musician
• Travel blogger
• Socially active IRL and online
• 13% Bodyfat
…would your marketing and care
management approach change?
If you knew…
22. 22
Barriers to C2B viscous data nirvana
Latency:
data typically
24hr-60d
behind
Homogeny:
claims data is
only 1 piece
of the picture
Unverified:
source data in
flux, values
change, data
lacks context
Not enough:
limited data
sources
Non-
participatory:
data taken,
not given
Prohibitive
security:
access
limitations
can hamper
advanced
analytics
Blockage:
disparate data
can’t freely
flow between
systems
23. 23
Breaking through barriers
Speed:
Analyze data at
rest and in
motion, in real-
time
Diversity:
Source from
clinical, claims,
sales, marketing
billing, lifestyle,
devices,
wearables,
social
Validity:
Time/context-
aware, linear
and non-linear
Unlimited:
Unprecedented
storage,
automated data
capture and
integration,
federated query
processing
Freely given:
Consumers
provide data to
support
analytics
initiatives
Appropriately
available:
Obfuscation,
advanced de-
identification
supports
insights AND
privacy
Seamless:
Interoperable,
integrated,
everywhere
Pause to ask the audience – what DATA do they have about US, right now, at this moment? That we work for Dell, our approximate age ranges, that we are employed (and hopefully have an associated paycheck), that we are likely to be covered by a large group employer insurance plan. But what ELSE do they know?
(They should be able to tell that we’re social-media savvy, since I’m including our Twitter handles. And, if THEY are socially savvy, they can immediately look us up to determine our influence level, and find out all kinds of OTHER things about us – or me, at least.)
And how could they find out?
How member-centric are YOU? (let the audience choose what level of maturity they have)
B2B – limited consumer choice, limited consumer engagement
B2C – business “pushes” info to consumers in effort to attract/retain healthy, financially-stable members
C2U – consumers engage with health plan to improve care and services, on their own behalf
C2B – consumers influence business buying and health plan benefits, form OWN “B”s (affinity plans, small non-employee groups)
Andy’s slide
Andy’s slide.
UPS has adapted insanely well.
When your member calls the 800# on their card, can the person answering that call find out why their claim was denied, what a particular diagnosis code means, which targeted member interventions or disease management programs that member belongs to and what the next steps are, which wellness programs or perks might be available in the member area, etc.? Can you, as an organization, pivot your member care management plan based on population health analytics that might show insight into new, effective treatment plans and lifestyle factors that would improve outcomes?
Let’s assess the mess – data supporting the member journey in the old model, siloed, intractable
Self-explanatory. Data without viscosity – integrated and interoperable – is still just another data silo.
Volatility
Verifability
Vitality
Andy discusses this slide – Mandi picks up once Andy introduces “Viscosity”. Viscosity’s the nirvana of the C2B enterprise!
With 7Vs and viscous data, we *can have* a meaningful 360-degree view of the member. Claims experience. Billing experience. Medication adherence. Lifestyle indicators. Clinical informatics. Member engagement with plan. Member engagement with community. Actionable intelligence, delivered to your desktop. Notice the emphasis on social, with engagement/influence/reach scoring….
…and did you know, social is NOT OPTIONAL?
Social media engagement is essential. As healthcare continues to become more consumer-centric, it will be critical for organizations to harness the power of social in order to grow and thrive.
Andy slide - How Dell technology enables meaningful member engagements through viscous data
When a member calls, what if you were able to see that they’d missed their first 2 payments in 5 years, that they were visiting a counselor, and that they had not filled their Zoloft prescription in over 30 days? What if you could identify a concern before it became one?
This is my dad, John. His birthday is this month, and he clearly takes turning 65 seriously. He’ll be shopping for Medicare Advantage. And he’s got plenty of choices. How would YOU get and retain his business?
What would traditional data sources tell you?
Rx history – Lipitor, Lasix, Efudex, Imitrex (so you know he’s got high cholesterol, may be hypertensive, has had skin cancer/pre-cancerous treatment, and)
Claims history – squamous cell removal X2, 10-day ICU/5-day inpatient stay 20 years ago after car accident
Pretty vanilla info. So what COULD you know that would differentiate your offering/pursuit from the other plans?
John has a wide circle of friends and sphere of influence, and he keeps company with exactly the kind of Medicare Advantage population YOU WANT to attract and retain. Not only is he physically active, but he’s an outspoken community leader and is an evangelist for products and services he appreciates. Meaningfully engaging with him gives you access to thousands of similarly health-minded individuals. And he knows it. He’s looking for coverage and incentives that speak to his fitness lifestyle and diverse interests – and it’s a big market out there.
Want to visualize these barriers somehow – this should be dialogue b/w Mandi/Andy, not bullets