5 Shades of Analytics - Presentation Version - Distributable Version

5 Shades of Analytics…………………………………………...

CIO, Xerox Insurance Solutions & StrataCare

Michael Josephs

© 2015 StrataCare, A Xerox CompanyAll Rights Reserved.

Xerox is a leader in providing data incursion and Software-as-a-Service (SaaS) solutions to support the timely, accurate, compliant and secure payment of medical bills for the largest payers of Workers Compensation related claims

Processes over 24M medical bills annually, representing over $20B in billed medical charges

Context – Xerox Insurance and WC Solutions

2

Workers’ Compensation (WC) are state-legislated programs (except for federal government

employees) created to provide compensation for employees suffering on the job injuries or illness

Key Players in the WC ecosystem

– Employer: required in most states to provide employee benefits for work related injuries/illnesses

– Insurance Company: affords claims management and wage replacement, rehabilitation as well as survivor benefits

– TPA (Third Party Administrator): manage state mandated benefits for self-insured or those employers with large deductibles/retentions

– Service vendors: e.g., Medical Providers, Data Incursion, Medical Bill Review, Managed Care, Loss Prevention


Context – Xerox Insurance and WC Solutions

3

Workers’ Compensation (WC) are state-legislated programs (except for federal government

employees) created to provide compensation for employees suffering on the job injuries or illness

Rule-Driven Configurability for Tailored Workflows

Supply Chain Connectivity

Decision Support Drives Workflow and

Supply Chain Optimization

– Balance Cost: Supports balancing level of near term operational costs with longer range outcome costs

– High Visibility: Provides illumination of operational efficiency levels and opportunities for improvement

– Ecosystem Refinement: Supports continuous improvement of supply chain efficiency

Data-Driven Decision Support

Xerox is a leader in providing data incursion and Software-as-a-Service (SaaS) solutions to support the timely, accurate, compliant and secure payment of medical bills for the largest payers of Workers Compensation related claims

Processes over 24M medical bills annually, representing over $20B in billed medical charges


$

Increasing levels of value, investment and complexity

Shades of Analytics Function Xerox Insurance Analytics Assets

Prescriptive Analytics Makes specific outcomes occur ˗ Network Optimizer (patent US 8,700,426 B2)˗ CONNECT™

Predictive Analytics Suggests what outcomes will occur ˗ SCORE ™˗ SCORERX ™

Interpretive Analytics(aka Diagnostic Analytics)

Insight in to why an outcome occurred ˗ Client stewardship reporting˗ PPO leakage tools˗ Fraud, waste and abuse ID tools

Descriptive Analytics (aka Metrics)

Describes what outcomes have occurred ˗ SaaS-based self-service reporting platform˗ Real-time dashboards for Operations and

vendor performance

Shades of Analytics

4

Scalable private cloud-based Infrastructure, providing secure, compliant custodianship for sensitive medical information

256M Medical Bills, 71M WC Claims (reflecting all domestic jurisdictions, procedure and diagnostic types)

4


But We Want More!!

5



Consumable Analytics Automates Making specific outcomes occur ˗ Pilots in progress or product planning







vendor performance


$



Vanilla – How Everybody Does It

6

Production Environment

Medical Bills Claims Admin Settings Workflow Rules PPO Network Mosaic

ETL

De-Normalization

Client Data Warehouse

Client Database

Mirror

Replication

MicroStrategyClaims Update

Bill In-take

Client or Client Vendor

Client Database

“Production”



Vanilla – How Everybody Does It

7



ETL

De-Normalization


Client Database

Mirror

Replication


Bill In-take


Client Database

“Production”



Where the Really Fun Things Happen

8


Client Stewardship & Support

. . . .

Customer Reporting

Network Optimizer

. . .Fraud & Abuse Detection

Network Leakage Detection

Analytics R&D

:

ETL

De-Normalization


Client Database

Mirror

Replication


Bill In-take


Client Database

“Production”


Enterprise Data Warehouse

ETLDe-Normalization

ETLDe-Identification











vendor performance

5 Shades of Analytics

9



$



Score

10

• SCORE™: Workflow management decision support capability which projects claim progression so that resources are applied strategically to at-risk WC claims

• SCORE

˗ Leverages neural network/predicative modeling techniques to assesses claim risk on a predetermined scale

˗ Leverages employer-specific (current and historic) data to develop models, then continuously scores each claim adjusting the score according per the clinical and medical bill updates

• SCORE’s Value to Clients

˗ Significantly impacting claim outcomes and reductions of care management expenditures overall.

˗ Senior management’s ability to obtain a snapshot of the total risk exposure of all open claims


Consuming the Score

11

Client Database

Mirror

Replication

Claims Update

Bill In-take


Client Database

“Production”

Model Deployment and Execution● Daily updates of identified SCORE parameters are loaded to staging DB● Updates are applied to the models● Updated claim “SCORE” made available

Client Database

Mirror

SCORE Staging DB

ETL

SCORE Models

11


Consuming the Score

12

Client Database

Mirror

Replication

Claims Update

Bill In-take


Client Database

“Production”

SCORE Staging DB

ETL

“Score” made available via Web API

1.“Score” made available for consumption by Xerox client platforms 3.“Score” delivered via e-mail

Multiple “SCORE” Delivery options: 2. Made available via the financial validation workflow

3. Delivered via e-mail to a specific resource (or resource group)

1. Consumption by client’s Nurse Case Management (NCM) platform

WorkflowConfiguration

SCORE Models

AdjusterPortal

2.“Score” made available to Financial Validation










vendor performance

5 Shades of Analytics

13



$



Network Optimizer

14

• Xerox has patented (US 8,700,426 B2) an analytical tool (the Network Optimizer) which allows it’s clients to quickly evaluate different medical networks used in their workers compensation programs while delivering significant bottom line savings

• The Network Optimizer is an interactive, prescriptive analytics tool that provides an objective comparison of multiple Preferred Provider Organizations (PPO’s) and Specialty Network Configurations using a clients historical bill data

• Utilizing StrataCare’s Book of Business (BOB) to develop metrics by state, PPO network, provider and specialty class, alternative PPO network mosaics are identified for the client, optimizing PPO savings state by state

• Use of the Network Optimizer by Xerox clients has resulted in an average of 8-10% of additional medical savings


Diagnostic

Client Database

Mirror

Replication

Network Optimizer



Analytics R&D

:

:

C

B

Network Optimizer

15



. . . .

Customer Reporting

Client Database

“Production”


ETLDe-Identification Network Optimizer

Network A

ETLDe-Normalization

Client Database

Mirror

. .

Yesterday: PPO Network Analyst researchdescriptive and interpretive analytics to determine how to achieve outcomes, and updates mosaic


Financial Validation Supply Chain Connectivity


Prescriptive

Client Database

Mirror

Replication

Network Optimizer



Analytics R&D

:

:

C

B

Network Optimizer

16



. . . .

Customer Reporting

Client Database

“Production”



Network A

ETLDe-Normalization

Client Database

Mirror

. .

Today: PPO Configuration Administrator leverages results of Network Optimizer and updates mosaic




Client Database

Mirror

Replication

Network Optimizer



Analytics R&D

:

:

B

D

Network Optimizer

17



. . . .

Customer Reporting

Client Database

“Production”



Network A

ETLDe-Normalization

Client Database

Mirror

Adaptive Updates

Adaptive

Tomorrow: Mosaic updates are made by the Network Optimizer, automatically and adaptively




Composable Analytics provides an analytics

platform based on some intuitive data-flow

tools and services

Enterprise Analytics Marketplace

• Platform provides for rapid app authoring and data encapsulation

• Facilitates creation of an enterprise marketplace both data and analytics for consumptions by users and processes

(1) GE Global Software and Analytics Research, W.A. Ruh, M. Grabb

GE’s Global Research labs are establishing

solutions for the prediction and execution of

required maintenance of physical assets

“Digital Twins”

• Leveraging next generation thermodynamic simulations to create a “digital twin” of real physical assets

• These models allow for a view of the asset’s future by observing how its digital twin performs in a wide variety of situations, including where the asset may break for buckle

Optimization and Continuity: GE is focusing on predictive

and adaptive maintenance to eliminate downtime and optimize assets to deliver maximum value over their lifetimes

This is News! – Advancing Adaptive Analytics

Composable Analytics2GE – Predictive Maintenance1

Allows disparate

stakeholders to explore,

discover and leverage

analytical work for application consumption

(2) Composable Analytics – Data Flow Intelligence, January, 2015

18


Summary – What Are We Doing?

19

Expanding our adaptive platforms

that can readily consume intelligence

Optimize Human Assets

Continued investment in analytical value creation

and harvesting for consumption

5 Shades of Analytics - Presentation Version - Distributable Version

Documents

Transcript of 5 Shades of Analytics - Presentation Version - Distributable Version