Data Analytics Can Help Fix a Dysfunctional Healthcare System

An insurance executive talks about how IT can help transform healthcare.

Rob Geyer, senior vice president of customer quality at Blue Shield of California, talks with Martha Heller about how IT can help deliver--and transform--healthcare.

What technology initiatives are affecting customer engagement at Blue Shield of California?

Working with our CIO, Michael Mathias, we've spent a huge amount of energy on an integrated enrollment and claims system, our 800-pound gorilla. For the past 30 years, Blue Shield operated in a legacy mainframe environment; now we're migrating to a more modern platform. Michael's and my team worked together to implement over 200 enhancements to dramatically improve our claims processing systems.

We've seen an increase in our auto-adjudication rate, which in our world is the critical metric. Our customers may not notice our improved ability to process claims, but we know we've reduced the probability of their having to make a call. When our customers are getting great healthcare, and they can't see us, that means our internal processes and technology are working.

What are the attributes of a CIO who can help drive this kind of change?

The CIO needs to be both collaborative and demanding. Collaborative because everything is integrated--Michael needs to be sure that our business architecture maps to an enterprise architecture. But he must also be demanding about his expectations so that we won't begin a project until the business requirements are sufficiently defined.

Do you have any advice for CIOs on building a positive relationship with their business partners?

Whether they listen to customer phone calls, sit with claims processing teams, or go out into the field, a CIO should walk a mile in the customer's shoes.

A good CIO should also deliver a clear flow of information. Michael regularly sends me formal dashboards, but one of the best things he does is give me a call. He'll say, "This system is broken; here's how it's affecting customers, and here's how we're dealing with it." If that's all he did, it would probably be enough.

What impact will technology have on the healthcare customer experience in the future?

There are so many people entering the healthcare system for the first time in their lives. We need to enroll them, track them, and make it easy for them to interact with a complex system. In California, we have thousands of providers being flooded with new patients. We need to make sure our technology can handle that spike and deliver great treatment to every customer.

What technology innovation are you most excited about?

I am interested in machine learning and how computing power, independent of human touch, can unveil major insights. We are getting an early taste of this, and the insights have been staggering.

We've been working with a partner to look at claims data. We thought we knew what we were providing to each other, but when we put the data together, we realized we were both blind. We were holding the trunk, they were holding the tail, and neither of us knew we were hanging on to an elephant.

There's so much potential in the data that resides in multiple parts of this dysfunctional system we call the U.S. healthcare system. If we can analyze that data together, we can transform the system.

Martha Heller is the author of The CIO Paradox and is president of Heller Search Associates, a CIO and senior IT executive recruiting firm. Follow her on Twitter: @marthaheller.

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