Transcription
Harnessing the Power of Data in Health Care:Data as a Strategic AssetChristopher Joyce, VP Enterprise Data SolutionsOctober 19th & 20th, 2017 - Symposium on Data Science for Healthcare (DaSH)
AbstractHarnessing the Power of Data in Health Care:Data as a Strategic AssetA big-data revolution is underway in health care, driven by an exponential growth in data from thedigitization of existing data and the generation of new data. With this data expansion, health careorganizations are harnessing the power of data to improve consumer & provider engagement, deliverbetter health outcomes, and drive down costs.Many organizations are finding success in using advanced analytics to deliver new value, but it is not allabout the analytic models. The growth and complexity of data created by and available to health careorganizations requires that data is managed as a strategic asset. This has put a greater emphasis ondata governance, data quality and integrated data solutions within health care organizations to ensure theycan continue to meet customer expectations, improve service delivery, and enable value creationopportunities through the use of advanced data analytics.In this presentation we will examine ways in which these rich data assets are being leveraged and whatorganizations are doing to manage this health care “data tsunami“.Copyright 2017 Anthem, Inc. All rights reserved.
A big-data revolution is under way in health careHealth care is experiencing exponential growth in data from the digitization of existingdata and the generation of new data2012500petabytesWorldwide health caredata is expected togrow to 50 times thecurrent total150%% of data available that isanalyzed for decisionmaking2202025,000petabytes73daystime it will takefor health care data to double31) Big Data in Health Care Hype and Hope. Dr. Bonnie Feldman, Business Development for Digital Health. October 20162) Cloudera. Mike Olsen, CTO. Big Data Day Presentation. January 30, 20173) US National Library of Medicine. Challenges and Opportunities Facing Medical Education. 2011Copyright 2017 Anthem, Inc. All rights reserved.3
Payers and Providers are digitizing their patient records at anincreasing rate Electronic Health Records have replaced traditional handwritten notes andfiling systemsIn 2009, only 16% of U.S.hospitals were using anEHR by 2013, that grew to80%1This translates into a culturalshift that will drive andadvance data-drivenmedicine, increaseconsistency in care andreduce cost of care1) Business Insider. Internet of Things in healthcare: Information technology in health. December 2016Copyright 2017 Anthem, Inc. All rights reserved.4
and consumers are generating new data through the use ofmobile apps and wearables for personalized health managementmHealth, freeing health care devices of wires and cords2/3In 2015,of Americans favored digitalhealth management over physical179%Willing to use a wearable device tomanage their health145%Willing to track symptoms via digitaldevice143%Willing to manage a personal healthissue or condition11) ITN Online. Two-Thirds of Americans in Favor of Digital Personal Health Management. February 2015Copyright 2017 Anthem, Inc. All rights reserved.5
The resulting “Data Tsunami” is an opportunity to evolveanalytics to aggregate, analyze, and act in powerful waysHindsightInsightForesightAnalytics 1.0DescriptiveAnalytics 2.0PredictiveAnalytics 3.0PerspectiveWhat has happened?What will happen?What should I do?LakesTRENDSScenariosLakesPREDICTINSIGHTThe health care industry could potentially save 300leveraging data and analytics1billionannually by1) Gartner. Market Trends: Applying Analytics in Health Care. March 2015.Copyright 2017 Anthem, Inc. All rights reserved.6
Harnessing the power of dataHealth care organizations are harnessing the power of big data through analytics toimprove patient outcomes, reduce costs, and increase revenueClaims EfficiencyValue-Based CareParticipatory Health CareImproving performance withcognitive analytics &robotics automationProactively identifyindividuals who benefit frompreventative care orlifestyle changesCollect data on medicalprocedures to help patientsdetermine the care protocolthat offers the best valueSupport Health InitiativesPredict & Minimize FraudUse mHealth to helpmanage care, locateproviders, and improvehealthAdvanced analytics for frauddetection and preventionand to check the accuracyand consistency of claimsCopyright 2017 Anthem, Inc. All rights reserved.7
Revolutionizing claims processing through robotic automationIndustry direction is to streamline claims processing and applying cognitive solutions tointelligently ingest, process, and route claims more efficientlyToday’s ChallengeA Cognitive Solution Paper and manual processes Intelligent OCR Best guess OCR Robotic Process Automation Time intensive process Intelligent Context Aware RoutingSavings & EfficienciesTraditional ApproachManual, InaccurateMethodologiesIncrease in automated claimsprocessing Reduction in hours spent adjustingscanned claims Reduction in payment penaltiesRules Base Opinions inOrganize &CategorizeCognitive AutomationAutomated, Efficient,& Streamlined Select KeyInformationIdentify GapsSearch forInformationCompile &ReviewPattern RecognitionIntelligentIngestionAccess CuratedDataReinforcement Learning10 DaysAnalyze & DecideExpress ion DeliveryFeedbackEvidence Based Conclusions in10 MinutesCopyright 2017 Anthem, Inc. All rights reserved.8
Value-Based Care: Better care, better health, lower costsRedesigning care delivery models to improve quality care, improve health outcomes, andreduce costs through integrated care management and risk stratificationAffinity & AttributionPayment InnovationPopulation Health ManagementMember enrolls in product andattributed to a VBC ProviderProviders participate in paymentarrangementsIdentify interventions & track Providerperformance (e.g., cost & utilization)Reporting & AnalyticsActionable insights on gaps in patient care,high risk patients, risk for readmissionsValue Based Care Program8 million attributed membersWhat’s next for Analytics: COGNITIVE INSIGHTS to build longitudinal member views based onstructured and unstructured data78k providers enrolled COGNITIVE ENGAGEMENT to personalize member care plans MACHINE LEARNING to train models and optimize programsCopyright 2017 Anthem, Inc. All rights reserved.9
Reducing fraud, waste and abuse through analyticsLeveraging analytics to identify fraud detection across member, provider, and to check theaccuracy and consistency of claimsData, Analytics, and Concepts InfrastructureClaims / Member /Provider DataExternal DataFW&A RulesConcept Development IntegratedAnalytics Layer“Data Fabric”DashboardCluster AnalysisText Mining AnomalyDetectionPredictive ModelLink AnalysisResults FeedbackLoop for ConceptUpdatingConcept Engine Concept LibraryConceptManagement DistributedProcessingReal timeMonitoringProgrammatic Interventions & GovernanceProgrammatic InterventionsClaims / Member / Provider DataAdjustmentsPre PayPost PayFraudRisk AdjAudit SuspectsFraudThe value: 80% savings from avoidance and 90% reduction in internal effortsCopyright 2017 Anthem, Inc. All rights reserved.10
Let’s consider the following about data .1)2)3)Incomplete & “Dirty Data” account for 62% ofquality issues.1Through 2015, more than 90% of businessleaders will view content information as astrategic asset, yet fewer than 10% will quantifyits economic value. 2By 2016, 30% of businesses will have begundirectly or indirectly monetizing theirinformation assets. 2By 2020, information will be used to reinvent,digitalize or eliminate 80% of business processesand products from a decade earlier. 2By 2020, 30% of data will be prescribedprovenance, business, security and valuemetadata at the time of its creation. 2By 2021, in 75% of large enterprises will havecentral data organizations seen as a missioncritical function, comparable to IT, businessoperations, HR and finance. 3CEB Tower Group, Operations Quality CouncilGartner, “Why and How to Measure the Value of Your Information Assets”Gartner, “How a Chief Data Officer Should Drive a Data Quality Program”Copyright 2017 Anthem, Inc. All rights reserved.11
What is driving many of our data challenges today?Increasing Data VolumesContinuous Data ChangesLeading ToData“Fr agm ent a tion”&QualityDegradationOver TimeComplex Data Supply ChainsActive governance & management of data is critical in the healthcare industry in order to identify& mitigate data issues; slowing the degradation of quality.Copyright 2017 Anthem, Inc. All rights reserved.12
Data as a Strategic AssetOrganizations are approaching management of data in various ways, but generally thethemes are consistentDATA GOVERNANCEEnterpriseDataGovernanceProgramData Governance Council or Chief DataOffice is accountable for defining &effectuating a data governance strategy& programDATA MANAGEMENTData QualityData Catalog/MetadataMaster DataMgmt.Operational Governance& Mgmt. ProcessesData management capabilities toenable a more integrated &collaborative data management &governance operating modelDATA FABRICData FabricThe Data Fabric is the central point ofintegrating and sharing uniform andconsistent data across the enterpriseCopyright 2017 Anthem, Inc. All rights reserved.13
Data GovernanceData Governance requires top-down management, but activation happens with those thatare closest to the dataStrategic(Council, ProgramOffice, Policy)Active Management(Data Owners, Stewards, DomainCommittees)Processes right 2017 Anthem, Inc. All rights reserved.14
Data ManagementIn order to leverage data as an asset, Data Management disciplines need to work in concertwith each other Measure and publish DataQuality Health Dashboards Monitor the quality of data Create searchable catalogsof data resources Capture relevant business& technical metadata toenable understanding & use(consistency, accuracy, etc.) Data balancing andcontrols Manage master datacentrally (Provider,Member, Product/Plan) Drive consistency inreference code valuesData QualityManagementMaster DataManagementMetadataManagementOperational DataGovernance Policy-based approach People, Process, Technology Identify & empower dataowners and custodians toactively manage data assetsCopyright 2017 Anthem, Inc. All rights reserved.15
Data Quality Management Measure and publish DataQuality Health Dashboards Monitor the quality of data(consistency, accuracy, etc.) Data balancing andcontrols Focus on business pain points and strategic initiatives where valuecan be realizedData QualityManagement Empower a Data Quality Center of Excellence to drive adoption oftools and practices Drive data ownership and accountability through Data Governancepolicies & roles Measure Critical Data Elements (CDEs) & publish via Data QualityDashboards & ReportsCopyright 2017 Anthem, Inc. All rights reserved.16
Meta Data ManagementCreate a searchable catalog of business & technical metadata to enable data discoveryMetadataManagement Create searchable catalogsof data resources Capture relevant business& technical metadata toenable understanding & useCopyright 2017 Anthem, Inc. All rights reserved.17
Operational Data GovernanceActivities relating to the use, management and protection of data. An effective programincludes a governing body, defined processes and policies. Defines the responsibilities and rights of keyroles in the governance of dataOperational DataGovernance Policy-based approach People, Process, Technology Identify & empower dataowners and custodians toactively manage data assetsPeople Details the accountabilities and decisionmaking authority of data governance roles Provides structure to implement effectivedata managementPolicy Establishes guidelines and principles forenforcing data management standardsProcess Defines the detailed data managementactivities for respective roles ensuringgovernance policies and standards arecomplied with across the organization Administer & manage technologies, vendorsand systems involved in the management ofdataTechnology Interfaces between data management tools,end users and associated systemsCopyright 2017 Anthem, Inc. All rights reserved.18
Master Data ManagementIn large organizations, a member or provider can have interactions (or transactions) withmany business areas (and systems) that could result in multiple unrelated records Manage master datacentrally (Provider,Member, Product/Plan) Drive consistency inreference code values The unique identifier is the key that tells us that both Jane Doerecords belong to the same person and that Jane Doe has a dentaland a medical plan.Master DataManagement Master Data Management solutions provide the ability to capture keyinformation about a customer and the identification of a singlecustomer across many business areas and systems.Source ASource BJane J. Doe125 Bell StSpringfield, MA617 765-4292Medical PlanJane Doe125 Main StSpringfield, MA617 765-4292Dental PlanUnique Identifier 123Copyright 2017 Anthem, Inc. All rights reserved.19
Enterprise Data FabricHealth care organizations will benefit from establishing a “Data Fabric” in order to: Simplify the data ecosystem by creating a central point of collection, conformance & distribution thatintegrates new data types with existing “administrative” data Modernize using open source and low cost scalable technologies Govern data and its quality, focusing on points of data creation, collection, conformance andconsumptionThe Data Fabric becomes the central point of integrating and sharing uniform andconsistent data across the enterprise.Copyright 2017 Anthem, Inc. All rights reserved.20
In the age of data & digital disruption Organizations need to develop new capabilities that harness the power of data whilepreparing to evolve existing capabilitiesTraditional FocusThe New Data WorldRetrospective AnalysisInsights & ForesightUse of descriptive analytics & reporting todescribed “what happened”Advanced Analytics for “what will happen”(predictive) & “what should I do” (perspective)Batch Data ProcessingReal-time insights & decisionsDaily, weekly and monthly processing cycles tied torigid business processesIngestion and processing of data pipelines toenable quicker and more relevant insightsFunctional Data SilosIntegrated Data AssetsData imbedded in tightly coupled functionalapplicationsIntegrated “data fabric” to enable enterprise gradedata operations & analyticsPassive Data MonitoringActive data governanceManagement of data at rest without monitoring endto end data lifecycleProactive data management and data qualitycontrols for use and distribution - ‘Fit for Purpose’Change is NOT a choice but an imperative; organization must innovate and deliversolutions, faster, to meet market demands. This requires a fundamental shift in how wemanage these strategic data assets.Copyright 2017 Anthem, Inc. All rights reserved.21
Thank You!Christopher JoyceVice President Enterprise Data SolutionsAnthem, Inc.Christopher Joyce is vice president of enterprise data solution at Anthem, Inc. He oversees enterprise-wide data platforms including datawarehouse strategy and technical development, semantic data layer integration and design, data management and development, advancedanalytics platforms and business intelligence capabilities.Christopher is a leader in the technology team that is charged with providing one of the industry's most comprehensive data analytic platforms bybuilding the engine that will help deliver improved and more relevant health care outcomes. Christopher’s team is constructing a fully integratedenterprise data fabric and analytic capability, built on a best-in-class data infrastructure, to support the operational, advanced analytics andreporting needs for Anthem.Prior to joining Anthem in May 2014, Christopher served as managing director of Enterprise Data for TIAA-CREF, where he was responsible for thedelivery and operations of the firm’s data assets and capabilities. In this role, he focused on strategic leadership for the company’s datatransformation program and execution of its data strategy. He also played a key role in delivering the organization’s data governance andmanagement practices.Christopher's career spans almost 25 years in information technology management, including architecture, governance, analytic platform design &development, and operations. He has held various roles at several companies including JP Morgan, Bear, Stearns & Co. and AT&T. As atransformational leader, Christopher has led global teams focused on collaboration and delivering business value through innovative technologysolutions and architecture-based initiatives.Christopher has a Bachelor of Science in Management Information Systems from Penn State University and a Master of Business Administrationfrom Seton Hall University. He also serves on the Board of Advisors for the New Jersey Institute of Technology (NJIT) College of ComputingSciences.
Analytics 2.0 Predictive Analytics 3.0 Perspective Hindsight Insight Foresight What has happened? What will happen? What should I do? TRENDS PREDICT Lakes Scenarios Lakes INSIGHT The health care industry could potentially save 300 billion annually by leveraging data and analytics1 1) Gartner. Market Trend
