Supercharging Business Intelligence with

MDM at Horizon BCBS of New Jersey

Presented by:
Balaji Krishnamoorthy

Biography

Balaji Krishnamoorthy
Director, Data Strategy & Management
Horizon Health Care Services, NJ
Information Management Strategy and
Architecture (Office of the CTO)

Balaji Krishnamoorthy- Bio

Balaji Krishnamoorthy has over 18 years of professional software experience in

leadership and strategic roles developing leading edge solutions for Fortune 100
clients. He possesses extensive experience working in the areas of MDM, Data
Integration, Data Warehousing / BI, Enterprise Architecture and Enterprise Data
Architecture.
As Director of Data Strategy and Management at Horizon Healthcare Services,
Balaji is a strategic change agent, focusing his business transformation experience
and leadership on developing a strong data and information architecture practice.
Previously, Balaji worked as a Senior Principal within the Health & Life Sciences
Practice within HP's Information Management Services; prior to that, as a Senior
Principal at Knightsbridge, a leading business intelligence consultancy that HP
acquired in late 2006.
Balaji earned an MS in Software Engineering from the University of Texas, and a
BS in Electrical and Electronics from Chennai, India.
He has spoken at the IM Blues Symposium and Data Governance and MDM
conferences. He is currently serving on Informaticas Product Advisory Council for
North America.

Data Strategy & Management

Structured
Data

Data
Data Architecture
Architecture

Unstructured
Data

Data
Data Governance
Governance
Information Technology Infrastructure

The Information Challenge We Face

Synthesize & govern data across silos & sources

Marketing

Sales

Incorrect
Incorrect
Contact
Contact Info
Info

Hospitals
Hospitals

Physicians
Physicians

Jbraverman@email.com
Jbraverman@email.com
Joseph
Joseph Braverman,
Braverman,
M.D.
M.D.

Portals

Provider Data
Management

Pended
Pended
Claims
Claims

Katlyn
Katlyn Smith
nd St
452
452 22nd
Newark,
NJ-07105
Newark, NJ-07105
PPO
PPO 20/150/40
20/150/40

No
No View
View of
of
Consumer
Consumer

Kate
Kate Smith
Smith
Medicare
Medicare B
B

PPO/HMO
PPO/HMO
Medicare
Medicare

Consumerism &
Health Exchanges

Customer
Service

Compliance

Medicaid
Medicaid

Data
Governance

Dental
Dental
Ancillaries
Ancillaries

Kate
Kate Smith
Smith
450
450 Second
Second Street
Street
HMO
HMO

Medical
Claims

Dr.
Dr. Joe
Joe Braverman
Braverman

Medicare
Advantage

Dental

Medicaid

Example: Provider Business Challenge 1

Support products for new network on public exchanges

Business Challenge

Illustrative Key Business Questions

Network must be established January

2013 and operational October 2013
Horizon must identify participation for
offering a new exchange product network
BCBSA may have new mandates for new
provider data quality index (PDQi)

How do we find and recruit par providers

for this network?
What is the distribution of specialties in
the region?
Which existing members are potential
targets and which ex-members are
prospects?
Who are our new leads and prospects?
What is the target profile of the
prospects?

The business wants to create and

analyze multiple scenarios quickly

Example: Provider Business Challenge 2

Support data quality measures like PDQI

Business Challenge

Illustrative Key Business Questions

Today, Provider Data File records for BCBSA

are a cumbersome and manual process
At least 70% of audited records must not
include critical errors
500 random records are checked by BCBSA
BCBSA keys in on:
Provider and Member Address errors
Phone Problem errors
Network Affiliation

Network
Can we track easily by Network and who
is in the network?
How many providers?
How many members?
Address
Can we establish greater confidence
sending the Golden Address to BCBSA?
Name
Can we have Names that are deduplicated across systems, ensuring the
Golden Record has the correct spelling?
Phone
Can we differentiate between the
different type of communication
methods?

But this has been hard up to now

MDM was designed to fix data issues and speed
business analysis and action
46% increase in
key populated
data fields
Name is deduplicated across
systems, ensuring
the Golden Record
has the correct
spelling
72% increase in
phone number
enhancements
through
standardization and
completeness
64% of existing addresses were enhanced
leading to better mapping. This includes
zip+4 which gives us better targeting,
communication and saves us delivery costs.
Address is now standardized and cleansed &
will be enriched in the future with Enclarity

70% increase in email enhancements

and fully centralized for consistent
sharing across Horizon

Example: Member and Provider

Business Challenge 3
Address Standardization Returned Mail Study

Business Challenge
10 to 20 % of all business correspondences
are returned (some contain addresses
within the Penn Plaza building)
Address Standardization and mapping of
City to Zip Code is obsolete
Source Systems store address in comment
fields that are difficult to decode and use
for correspondence
Majority of the addresses do not contain
the complete zip and zip4 making it harder
to deliver
Members cannot designate their preferred
method of correspondence

Illustrative Key Business Questions

What is a Quality Standard?
When All necessary elements are complete
and correct
Primary Address Number, Predirectional, Street Name, Street Suffix,
Post-Directional Secondary Identifier,
Secondary Number, City, State, ZIP +
4 Code

Fully spell out or abbreviate words

using USPS standard abbreviations
Address Standardization across
Brokers, Groups, Members, Consumers,
Providers, and Employees
Uniform Contact Types
Primary Method for Contact /
Correspondence

10

We have Address Challenges at Horizon

..but certainly not like this!!!

11

Without knowing, these seem to look okay

but they were not forwarded to their
destination!!

12

Horizon Business Challenge

at a Glance
Return Mail Study
Subscriber Provider with
with Horizon
Horizon
Address
Address

Subscriber
with
Corrected
Address

Provider
with
Corrected
Address

Checks

Letter
forms/Other

ID Cards

Total Pieces

Subscriber
Undeliverable

Provider
Undeliverable

4848

3859

396

171

72

257

33

12

48

79.60%

8.17%

3.53%

1.49%

5.30%

0.68%

0.25%

0.99%

0%

13

The data to answer address challenges needed

data in a consistent, accurate and timely fashion
that did not exist. MDM addresses this.
Address Cleansing increased
by approximately 70%
Includes mapping of city to
zip
Consolidated Email
Addresses for members
50% enhancement of zip
codes including zip+4
correctly populated
New data like Geocoding
map Medicare members to
their nearest care
Management facility and
mode of transportation

Address is standardized and cleansed

as per USPS Postal Standards

14

MDM also addresses confidence

of whether addresses are deliverable

15

USPS Undeliverable as Addressed

Mail in 2011- This is a universal
problem not just to Horizon
ACME PRODUCTS
4759 WESTERN ST
NEW YORK NY 10022-5279

498
Millions of Pieces

CARL
CARL
CARLSHULER
SHULER
SHULER
BROWN
LAKE
ST
1414
PO
1914
BOX
LAKE
LARKST
STAPT
APT
APT3A
3A
1414
CHICAGO
CHICAGO IL
IL
IL 60614-1905
60614-1910
60614-1910
CHICAGO

326

234
156
Missing Apt or
Suite Number

Incorrect
Number

Incorrect
Recipient

Missing
Number

148
Missing RR or
Box Number

147
Incorrect
Street Name

16

Example: Member Business Challenge 4

Support data quality that leads to improvements
in our MTM and BEM scores

Business Challenge
Maintain Member Touchpoint
Management (MTM) scores for
operational and service program for all
branded, core health businesses:

Enrollment
Claims
Inquiries
Plan Accessibility

NEW! Support improving new Blue

Experience Metric (BEM) scores

Member experience and engagement

Network access
Education
Navigation
Customer Service
Claim Payment

Illustrative Key Business Questions

What baseline addresses should be used
for Enrollment Member Accuracy
measurements?
How are the scores across cohorts
consistent across time?
How do I achieve enrollment timeliness
which includes ID card management?
FDP and LDP (First, Last Day
Processing metrics are affected by US mail
contacts e.g. Benefit Booklets. How do I
ensure my communications are getting
through in a timely way?
How can I validate and manage some of
the MTM audited fields

17

Example Business Challenge:

How do you enable Member Touch point Measures (MTM)
and Blue Experience Measures (BEM) for Member?

Where is Horizons 360o view?

18

The MDM Value Proposition

Data Fragmentation

Data Duplication

Problem: As with all data, Master data quality deteriorates over time
MDM: Pre-cleanse and standardize data (e.g. gender )

Single Source of Truth

Problem: Same Master data attributes exist in multiple systems, leading to data divergence (DOB: System A
= 6/1/80, System B = 1/6/80)
MDM: Pick best value, based on trust scores

Data Quality

Problem: Master data is fragmented across multiple systems vertically & horizontally
MDM: Bring together data from multiple systems and build whole records and data sets using match &
merge

Problem: Multiple systems have slices of truth with inconsistent data quality and standardization
MDM: Bring together and present single source of truth for consumption by users and systems

Bridging the Gap

Problem: Vertical systems dont bridge well across Members, Providers, Products, Customers, Employees
etc.
MDM: Provide visibility across multiple data domains (e.g. providers that are also members)

19

MDM Data Quality

Enhancements Benefits
KPIs

Indicators and Cleansing Rule Examples

WIP

ACCURACY

Information should be highly accurate with regards to regulatory

and operational standards

SSN or TIN
Address

WIP

SSN or TIN is standardized based on Federal

Standards
Address is standardized based on USPS
Standards

Name

Name is standardized based on Data

Governance Policies

Phone

Phone is standardized based on Data

Governance Policies

Email
Date of Birth
Gender

Email is standardized based on Data

Governance Policies
Date of Birth is standardized based on Data
Governance Policies
Gender is standardized based on Data
Governance Policies

WIP

20

MDM Implementation Data Statistics:

Member and provider consolidated, standardized and
cleansed across all lines of business and market segments,
email addresses centralized

21

MDM Provider Data Statistics:

Identifying Par and Non-Par Provider across lines of business
and market segments; Par and Non-Par Provider by networks

22

MDM Member Data Statistics:

Identifying Members across multiple line of business will enable
us to track them across products and market segments when
MDM includes Group and Plan data in Phase 2 a key
requirement of Health Care Reform and Exchanges

23

MDM Provider - Exclusion Statistics:

Provider /Practitioners Omitted from MDM
Based on Exclusion Rules by Source System

24

Horizon Solution:
Multi-Domain MDM Hub as a Solution
Disparate Data Reliably Resolved

Compliance

Marketing

Sales

Consumerism &
Health Exchanges

Customer
Service

Enterprise Master Data Hub

Provider

3rd Party
Organization

Customer

Employee

Provider Data
Management

Broke
r

Product

Kate
Kate Smith
Smith
452
452 Second
Second Street,
Street,
Newark,
Newark, NJ-07105
NJ-07105

Joseph
Joseph Braverman,
Braverman, M.D.
M.D.
Jbraverman@email.com
Jbraverman@email.com

Portals

Member

Medical
Claims

Medicare
Advantage

ICD-10

Pri: Medicare B
Sec: PPO 20/150/40

Dental

Data
Governance

Medicaid

25

Industry Benchmarks
Direct ROI for MDM Implementation
ROI Impact Item

P&L Impact

Industry Benchmark Improvement

Reduced Data Management Costs

IT Costs (Opex)

10%

Reduced Costs of Reporting through Automation

General
Administration Costs

15%

Reduced costs in Managing Data Completeness

IT Costs (Opex)

10%

Reduced costs of Regulatory Non-Compliance

Opex

5%

Reduced Marketing Reach Costs

Sales & Marketing

Costs

12%

Reduced Costs through enhanced efficiency in

management of Business Processes like Claims
Adjudication, Member Eligibility, Contracts
Management, Provider Management, Network
Management etc.

Cost of Revenue

5-10% for various Business

Processes

Increased Cross Sell/Up Sell

Revenue

5%

Increased New Member Enrollment

Revenue

5%

Increase in Amount of Insurance Premium

Collected

Revenue

2%

Increase in Share of Wallet and Margins

Profit

5%

26

Horizon is part of a leading trend in

advanced information management
Top Trends in the Global Information Management Space

Top Master Data management Trends & Challenges that have

emerged over the last 2 years* are:
By 2013, 30% of the total companies implementing MDM
programs may run into challenges due to insufficient MDM
Strategy
By 2014, 66 percent of Fortune 1000 organizations will
have deployed two or more MDM solutions to support their
enterprise MDM strategies
* Source - Gartner, MDM institute

27

Enabling the Consumer 360

Using Multi Domain MDM
Integrating customer related data from internal and external sources is a key enabler with MDM
Consumer 3600 View - Data Elements
Member Information

Products & Benefits

Data

Data

Basic
Preferences
Extended
Prospect/Lead
Broker
Health Risk
PHR
Provider, PCP
Alternate Programs (e.g., ACO, etc.)
COB & other Ins.

Product
Benefit
Renewal
Ancillary Product
Wellness & Disease
HSA/FSA/HRA

Interactions

Transactions

Interaction Data

Interaction Data

Service Requests
Messages
Care Messages
Correspondence
Payment
Member Provider Interactions

Claims
Pre-Cert & Pre Authorizations
Care Management
Appeals & Grievances
Billing
Delegate Partner Data
EOB

Questions and Answers

How can you help?
Thank you

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