How Data Empowers Member-Centric TransformationGetting to the 7Vs of C2B

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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 500technology 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, 310kitems 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

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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

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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

Co

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Ad

van

tag

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Mat

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Plan Listen Engage Act

Claims, Sales & Marketing Data Big Data & Social Analytics Innovate

The differenceis in the data

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As the world changes, industry must adapt

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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

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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

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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

Do you have data you need to engage……is it instantly actionable?

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Data in the old model

VelocitySlow, batch processes

Volume(Relatively) small volume

VariabilityMostly structured data

ValueSiloed within organization, low external value

Plan Systems

Lead MgmtMember /

Billing Platform

Network Mgmt

Care MgmtPlatform

Reporting Tools

Core Admin System

Sales & Enrollment BillingMedical

ManagementClaims

Claims data

Enrollment data

Sales & marketing

data

Billing data

Care management

data

HRA data

Do you need Dewey to derive insights?

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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?

VelocityReal time / near real time

VariabilityMix of structured and unstructured

VolumeVery large data sets

VulnerabilityGreater need for security without impeding access

ValueUnlocked across the organization

VolunteeredProvided by members as well as by contracted entities

7Vs

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And did you know…Healthcare is a “social” service

it revolves around people, their lives and their communities

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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 Group2 - Media Bistro3 – Healthcare Finance News4 - Mashable

“Social” is essential

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Embed social web into the enterprise for complex insights

18empowering meaningful member engagement

With insights come answers

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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

Co

mp

etit

ive

Ad

van

tag

eA

do

pti

on

Mat

uri

ty

Plan Listen Engage Act

Claims, Sales & Marketing DataBig 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

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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?

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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…

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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

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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

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How could you use viscous data?

25 by meaningfully engaging with individuals

Achieve C2B with viscous data,provide accountable care for populations

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Three Questions

• What do you know about your members?

• What could you know about your members?

• What are you going to do with it?

Thank you

Contact information:

• Andy Arends: andrew_arends@dell.com

• Mandi Bishop: mandi_bishop@dell.com