Intelligent Design

BUSINESS INTELLIGENCE

Intelligent Design

With the warehouse in place, a BI solution has sped up processes.

Horizon Casualty Services always is seeking innovative technologies and approaches to achieve precision in meeting client-based performance metrics and to optimize workflows, notes Ilene Wachs, president of HCS, a subsidiary of Horizon Blue Cross and Blue Shield of New Jersey. “We recognize quality is a journey, and we always have opportunities to improve,” she says.

HCS had an older, metrics-based business intelligence solution, but Wachs points out the solution was not automated nor fully integrated with the carrier's systems and processes. “It was connected to individual processes but not presented in an integrated fashion,” she says.

When HCS made the decision to find a new BI solution, the insurer identified a few vendors, including @Global. “We found the [Allegro BI Portal] was flexible, more granular, and could be implemented on our servers,” says Wachs. “We were able to customize the application and operate in our own server environment.”

One of the pluses for HCS was the fact @Global has substantial experience in the insurance industry. “After extensive consideration and due diligence, we decided to move forward with @Global,” says Wachs. “In essence, what was most intriguing about @Global's approach is its high level of integration with HCS business processes in that data is live, available on designated users' desktops, and presented as one dashboard.”

There were no problems with the installation of the product or with training the business users, Wachs reports, because of the intuitive nature of the software. “@Global worked collaboratively with HCS in leveraging the power of its BI software to produce key process indicators representing performance metrics around key processes,” she says. “Once we were able to put it on [the users'] desktops, they needed just several minutes of training to understand how the KPI process worked.”

HCS began searching for a new BI solution at the beginning of 2008 and completed the installation at the end of the year. BI solutions are never really done, though, Wachs points out. “We are still developing it,” she says. “It continues to evolve.”

HCS is using the solution in medical bill operations to monitor the speed of payment of medical bills in accordance with contractual and legal requirements, explains Wachs. “We also are using it with certain types of claim activities related to medical necessity reviews that need to be turned around in a specific time period and for tracking time-sensitive medical management processes related to key events in medical utilization, claim inventories, and factors we need to monitor on a moment-to-moment basis.”

One challenge of implementing Allegro was the speed of the HCS server in calculating the data, indicates Wachs. “However, after implementing a dedicated data warehouse server, we were able to tune the database queries to the point where KPI data is speedy,” she says.

Now, HCS is in the process of further certifying the measures so all of the company's managers are comfortable the performance metrics are measured accurately and can be rolled out to the staff working in the trenches.

“Allegro helps us further mature our culture of focus on metrics,” says Wachs. “Rather than having people do ad-hoc access reports and other kinds of queries, the metrics become part of the day-to-day and moment-to-moment performance.”

The HCS data warehouse server has only a 10-second delay between the live data and the warehouse data, indicates Wachs. “So, in essence, [users] are seeing live data, and it really does kick up the level of expected performance,” she says. “As we know, if you can't measure it, you can't manage it, so [Allegro] really improved the overall management of our processes.”

The data warehouse solution is a server that works off the live data server. HCS was able to do KPI queries on the data warehouse server so it wouldn't slow down the production server. “That was a major benefit,” says Wachs. “The second benefit was we then could speed up the data warehouse queries because they were isolated.”

HCS is going to be expanding the key process indicators to more metrics. Right now, the HCS managers have KPI on their desktops. The company is looking to implement KPI on supervisors' desktops this year, and in 2010, it will be on employees' desktops.

In late 2009 or 2010, in addition to drilling down to the core workers' KPI, there will be hot links for the users, adds Wachs.

“Ultimately, users will be able to hit a hot link and go right to the claimant and solve the problem,” says Wachs. “They will have satisfaction in knowing how they stand in achieving their performance goals. That's really exciting for me.”

Robert Regis Hyle