Transforming Data Into Intelligence That Works

In today’s world of information overload, finding the right data strategy can be a critical and daunting task. For health plans, the challenge balloons. More so than other types of businesses, managed care organizations collect massive amounts of information. With that challenge comes a commensurate opportunity to organize and use the data constructively.

Yet on average, health plans tap just 10% of their information resources, which include not just conventional databases, but also faxes, Word files, and other documents used in the course of business. What’s more, healthcare data strategies often fail. Why? No one clearly established how the information would be used to improve the company. Good business intelligence (BI) is about more than just capturing a flood of data in a coordinated and logical process. The real key to success is transforming that data into relevant and useful information, which then can be applied to advance the organization and help consumers negotiate their healthcare decisions. BI is only useful if it drives process improvement. This way, every business decision is an informed one, with real impact on productivity and effectiveness. 

In healthcare, BI is already a $6 billion industry. Increasingly, executives understand they need accurate, real-time data to thrive amid stiff competition. The Sarbanes-Oxley Act, which Congress passed in 2002, holds the management of publicly-owned companies accountable for the quality of accounting reports. However, financial statistics are just one way to measure performance. Today, BI systems are used to track both financial and operational progress across an enterprise. As healthcare transforms from a wholesale to a retail market, effective BI solutions are crucial to achieving greater collaboration among health plans, doctors and consumers. This technology must include the infrastructure to support such a change, the environment to maintain protected information, and the accessibility of a broad range of data for the consumer.

The best BI solution is a combination of the right software, administrative processes, and resources to ensure delivery of critical information to the decision-makers who need it, when they need it. BI is about being able to drill down to more specific information at the speed of thought, so that questions can be answered as soon as they arise. Without the intelligence to address them, projects or decisions can get derailed.

Ultimately, the right BI solution is practical, fast, visionary, evolving and customizable. It also should be deeply integrated with core administrative and legacy systems. Plans extract the greatest value from a specialized BI solution, which is built specifically for transforming volumes of data into useful intelligence.

For many health plans, researching a BI solution starts with an assessment by a trusted and experienced technology partner. Look for a vendor that’s already invested in upfront research and development on data strategies and software that work.

Health plans face several universal issues when it comes to data collection and reporting. First, there is a need for making volumes of data accessible and useful to business users, and now, the actual healthcare consumer. Second, health plans must manage the growing demands of the business with IT resources that are often already spread too thin. Next, there is a need to identify the right software to assist in data interpretation. And, finally, executives consumed by day-to-day operations and immediate concerns may be focused on what BI can do today, without investing much thought in the future.

As health plans continue to incorporate technology into business operations, there is a larger context beyond simply selecting the right software. Technology today is evolving at an exponential rate, and unless it’s your full-time job, staying current is a daunting, if not impossible, task. With multiple-year impact and the power to drive your bottom line, your BI solution should be a strategic decision.

Building a full-scale data warehouse all at once can be prohibitively expensive and time-consuming. For many organizations, an incremental approach is more effective. Data marts serve particular departments or business groups, like finance, and create separate areas where data is gathered and stored. These specialized data marts pull information from various sources, catalogue the information, and disburse it quickly. The underlying data management solution should focus on capabilities that arm consumers with information to help them make better decisions from a benefits and financial standpoint.

Case History

One of TriZetto’s customers, MVP Health Care, a full-service health plan located in Schenectady, NY, needed a practical and speedy BI solution that factored in several concurrent challenges. These included providing employees with readily accessible operational reports and giving top management the ability to monitor the health plan’s long-term performance.

TriZetto took an incremental approach to building MVP’s BI solution. It designed, constructed and implemented two data marts and a system capable of generating dozens of multi-tiered, specialized business-intelligence reports. These are used to track trends such as the financial performance of a particular line of business; the number of claims denied or resubmitted; or, for HIPAA purposes, a privacy log of how a member’s information was disseminated.

The organization realized immediate benefits from customized operational reporting. For example, employees throughout the company now can generate their own reports; previously, IT staff assistance was required. The BI solution has also reduced reporting costs, increased turnaround times, and given the organization unparalleled control over the delivery and management of massive amounts of data.

MVP Health Care’s data-collection and reporting system meets the company’s short-term needs and puts MVP Health Care on a path toward developing long-range information-management strategies. The foundation has been laid for development of additional data marts that can be joined together to create a total picture of the health of the enterprise.

Ron Schrimp has more than 15 years of experience designing and developing enterprise data warehousing solutions. He is vice president of Business Intelligence for the TriZetto Group, Inc., a healthcare information technology company that serves more than 400 customers, representing almost 40 percent of the U.S. insured population.