Advanced analytics gives health benefit company competitive edge

To remain competitive today, health insurers must help their partners tackle budget pressures and increasingly complex member care. In many cases, the information is there for the taking; the problem is achieving the necessary insight in time to make it useful.

BlueCross BlueShield of Tennessee (BCBST) has tackled the problem head-on with a new client surveillance application, called Spotlight, which is designed to empower account executives, underwriters, pharmacy and medical directors with financial and clinical management and budget impact information.

“This solution is designed to create a platform for proactive sharing of information — a major shift from ‘reactive’ as traditional mechanisms and solutions offer,” says Maureen Lowe, director of advanced analytics and client solutions at BCBST.

Spotlight has earned BCBST a CIO 100 Award in IT Excellence.

The proactive shift

BCBST is an independent, not-for-profit health benefit company headquartered in Chattanooga, Tenn. It serves more than 3.5 million people and 11,000 companies through a network of more than 20,000 health care providers.

The organization and its partners generate a dizzying array of data, which in the past made it difficult to identify unexpected spikes or declines in enrollment and financials before they happened. Before Spotlight, business partners had access to self-service sources, standard reporting and consultative packages, and access to on-demand ad hoc reporting for more detailed needs. Lowe explains they weren’t lacking for information, but neither were they able to get “ahead of the curve” insights. That left them stuck in a reactive stance.

“The initial opportunity identification came from those closest to the issue: Our client-facing account management teams,” Lowe says.

Lowe says these teams were clear that partners needed better visualization and more immediate alerts of variances in enrollment and financials that required action, as well as immediate access to the answers to frequent questions such as drivers of ER use and high-cost conditions.

It didn’t take much effort to garner support for the Spotlight project, as Lowe notes it coincided with the existing vision of BCBST’s executive leadership.

“This solution is one component of a three-year strategy already vetted to expand use of advanced analytics throughout the enterprise,” she says. “Since our leadership is knowledgeable of client focus on proactivity of partnership, the solution was aligned with their goals.”

Lowe and her team started by engaging directly with account team management members in the Sales and Marketing department to ensure Spotlight would align with the needs and challenges of the people that would provide the solution to partners. The project team also included Underwriting department leads, development team members, a support team aligned to provide guidance on data management, and a testing team tasked with confirming the quality of output and reconciliation with other reporting systems. In addition, BSBST’s HIPAA and Legal team provided guidance and signed off on content.

The team developed Spotlight as an interactive and drill-down enabled surveillance application. It can be used to identify drivers of ER use and high-cost conditions, including the ability to drill down to specific diagnoses that may impact cost and the prevalence of those conditions among membership. For example, users can select a ‘high-cost threshold’ and identify all participants in that range with detailed insights and drill-down capabilities to identify conditions, providers, usage settings and patterns. The application also helps internal users model expected network changes, which gives decision-makers and support teams the ability to proactively measure savings and disruption.

Lowe notes that the drill-down capabilities did introduce performance challenges that had to be addressed, but the biggest challenge was the interface itself.

“One challenging aspect is designing a graphical interface that is highly intuitive for professionals not normally in the analytics space of our business. Additional challenges were introduced with the breadth and depth of information desired and creating efficient update processes to address all needs,” Lowe says.

Business impact

The key to the project, Lowe says, was future paid data processing improvement in data availability, which provides insights on claims not yet paid. That differentiates Spotlight from most other analytic applications in the space, which rely on monthly data feeds with a lag on claims paid.

Lowe says Spotlight has helped BCBST improve client trust because underwriters and account executives are now able to model the impact of future network changes immediately, providing better cost assessment and communication. Additionally, account executives and medical directors can now assess current and future high-cost scenarios to provide budgetary guidance and proactive care management and intervention strategies.

“Once the tool was deployed with the first target use cases, we found the demand vastly expanded for additional teams who wanted access with their own additions to content. The impact has been major efficiencies in several roles processes, and insights and alerts available more quickly,” Lowe says.