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Oracle World Humana
- 2. Bruce Sterpka Vice President Corporate Information Management Humana Inc.
- 3. Business Intelligence at Humana A Bridge From the Past
- 8. EDW Data Subjects Claims Member Customer Health Mgt Corporate Provider Sales Medical Services Dental Rx Vision Pended Claims Rejected Claims Member Member History Member Coverage Member PCP Customer Customer Agent/ Rep Customer Coverage Customer Network Customer Plans Customer Cross Reference Customer Segment Auths Referrals PN Participation DM Participation Lab Results Rx Referrals Consol Market Division Legal Entity Market Region Market- State/Cnty State County Zip Provider Address Contract Facility Summary Group Provider Network Provider Enterprise Network Agent Broker Sales Channel Market Office
- 9. EDW Data Subjects Customer Service Finance - Underwtg Product Human Resources Marts Support Support IVR Log Web Log Secured Messages eMail Id Accounts Receivable Billed Premium Banking Customer Experience Member Experience Premium Rate Completion Factors Plan Benefits Sold Plan Humana Employee Humana Facility Humana Department Customer Enrollment & Claims Clinical Interventions Underwriting/ Actuarial Membership Counts Sales Activity Service Center Metrics Clinical Metrics Summary Diagnosis Disease Category Specialty Coddes Referral Types Cause Codes Customer xREF Member xRef Drug Class Admit Type Place of Treatment Coverage Type SIC Code Procedure Code Claim Type Code Claim Stat Code etc….
- 18. Meeting the Member Seizing “Moments of Motivation” EDW Use the Internet to notify that an alternative Rx of comparable quality is available which costs the consumer less Rx Pharmacy 1 Tier 2 Tier 3 Tier 4 Tier Rx claim information Rx filled “ Ask Your Doctor”
- 19. Focusing Care in the Right places High Utilizers Application Parameterized selection localizes data of interest Results sorted based on business process Drilldown to an individual level
- 20. Providing Guidance . . . Member Behaviors Pharmacy Claims Online Choices Medical Claims Member Contacts EDW Select Candidates Predictive Modeling Personal Nurse Contacts Identified Members
- 24. Fast Results…
- 29. A Q & Q U E S T I O N S A N S W E R S
Editor's Notes
- Independence to choose what they think is best Communication between plans and consumers Intelligent cost-sharing with financial protection Transparency to inform choices of providers & services Guidance for choosing and using health benefits wisely
- Eliminates over 30 market-specific databases used to support CSRs
- Eliminates over 30 market-specific databases used to support CSRs
- Eliminates over 30 market-specific databases used to support CSRs
- Our integrated approach includes a broad spectrum of programs and tools. At one end of the spectrum, we have traditional programs targeted at people who are high risk. These programs work and have been in place for a number of years. At the other end of the spectrum, we have tools for people who are healthy and/or able to manage their conditions independently and without much guidance. These have been developed and created by Humana and are the backbone of our e-health strategies. In between, we provide Personal Guidance, a bridge for people who are not high-risk or catastrophic, but whose emerging conditions or deteriorating health status serve as a signal of change. This program spans the gap of need for people who are not in need of a more traditional program, but also not capable of managing their condition completely independently.
- Eliminates over 30 market-specific databases used to support CSRs