How Data Empowers the Member-Centric Enterprise (AHIP Presentation)
Download as PPTX, PDF2 likes810 views
The document discusses the transformation of healthcare towards a member-centric approach, emphasizing the use of data for better engagement between providers and payers. It highlights the importance of technology, analytics, and social media in enhancing the healthcare consumer experience and fostering informed decision-making. Additionally, it outlines barriers to effective data utilization and the future need for healthcare providers to adapt to a consumer-oriented marketplace.
How Data Empowers the Member-Centric Enterprise (AHIP Presentation)
- 1. How Data Empowers Member-Centric Transformation Getting to the 7Vs of C2B
- 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
- 5. 5 As the world changes, industry must adapt
- 6. 6
- 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
- 12. Claims data Enrollment data Sales & marketing data Billing data Care management data HRA data Do you need Dewey to derive insights?
- 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
- 14. 14
- 15. 15 And did you know… Healthcare is a “social” service it revolves around people, their lives and their communities
- 16. 16 84% Millennials Buying decisions influenced by user-generated content1 40% healthcare consumers Report social media influences health decisions2 40% chronic condition sufferers Use social media communities to cope3 41% physician selection Choice affected by social media4 1 – DC Interactive Group 2 - Media Bistro 3 – Healthcare Finance News 4 - Mashable “Social” is essential
- 17. 17 Embed social web into the enterprise for complex insights
- 18. 18 empowering meaningful member engagement With insights come answers
- 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
- 24. 24 How could you use viscous data?
- 25. 25 by meaningfully engaging with individuals Achieve C2B with viscous data, provide accountable care for populations
- 26. 26 Three Questions • What do you know about your members? • What could you know about your members? • What are you going to do with it?
- 27. Thank you Contact information: • Andy Arends: andrew_arends@dell.com • Mandi Bishop: mandi_bishop@dell.com
Editor's Notes
- #4: 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?
- #5: 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)
- #6: Andy’s slide
- #7: Andy’s slide. UPS has adapted insanely well.
- #11: 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?
- #12: Let’s assess the mess – data supporting the member journey in the old model, siloed, intractable
- #13: Self-explanatory. Data without viscosity – integrated and interoperable – is still just another data silo.
- #14: Volatility Verifability Vitality Andy discusses this slide – Mandi picks up once Andy introduces “Viscosity”. Viscosity’s the nirvana of the C2B enterprise!
- #15: 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….
- #16: …and did you know, social is NOT OPTIONAL?
- #17: 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.
- #18: Andy slide - How Dell technology enables meaningful member engagements through viscous data
- #19: 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?
- #21: 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?
- #22: 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.
- #23: Want to visualize these barriers somehow – this should be dialogue b/w Mandi/Andy, not bullets
- #26: Meh?