BLUE CROSS DISSECTS DATA TO IMPROVE CARE

Blue Cross and Blue Shield Association prides itself on providing quality patient care--anywhere. To deliver on that mission to 71.1 million subscribers nationwide, the confederation of health care providers is looking not to extend its medical team but to institute technology that maximizes its data.

Collecting information across BCBSA's 52 independent and locally operated companies is a delicate procedure, however. Each membership plan has its own IS staff and systems, so coordinating efforts has been difficult. That is, until about two years ago, when the companies found some common ground on which to start a data warehouse: The Blue Cross and Blue Shield Association FEP (Federal Employee Program), the largest private health insurance contract in the nation, with 3.7 million members.

BCBSA, acting on behalf of the independent plans, contracts with the U.S. Office of Personnel Management to provide health care benefits to active and retired federal employees. Data on these members, along with nationwide claims forms and provider information, is being fed into the FEP data warehouse, a centralized repository of information for the federal government that will grow to 3 terabytes and be active by year's end.

Using OLAP (online analytical processing) and vertical market software specific to the medical and managed care industries, the FEP data warehouse will allow participating BCBSA companies to navigate through data for help in decision-making. Ultimately, this will slash operating costs and enhance patient care, said BCBSA officials. The scope of the effort puts BCBSA in the No. 1 spot on PC Week's Information Management Fast-Track.

"It's enabling us to close the loop and feed information back into the business process, [allowing people to] modify and change how they do things to improve the business," said Bob Ormsby, team leader of data analysis at BCBSA, in Washington.

For instance, the analysis tools can help providers in the BCBSA FEP network find peer companies that treat particular illnesses more successfully and at a lower cost, allowing them to apply those same practices. Sounds simple enough, but "until this point, they couldn't get their hands on this information, " said Bob Rosecrans, managing director of IS for FEP, who is also based in Washington. Later this year, data mining tools will be added to the mix to help member plans slice and dice the data. More-sophisticated analysis will help BCBSA roll out new services, such as disease management.

BCBSA, which is the epitome of a decentralized company, can serve as a lesson to global organizations across all industries looking at data warehousing and data mining as ways to bring order and a competitive edge to critical business information spread across myriad systems and locations.

"People often don't know how to measure profitability and what is really important to customers," explained Herb Edelstein, president of Two Crows Corp., in Potomac, Md. "Today, there is so much data--the challenge is to make effective use of it and extract valuable information from it rather than continue to fly by the seat of our pants."

Sharing the Blues

A 20-member team, led by Ormsby, Rosecrans and Project Manager Kathy Puglise, began building the FEP warehouse, based on Red Brick Systems Inc. technology, in 1996. the team has completed loading the full membership data. The next step, already under way, is to enter three years' worth of claims and enrollment information. Access to the pilot data warehouse is currently limited to six business users, one of whom is Cheryl Neel. There are plans to open it up to 20 FEP employees by year's end.

Once the network is secured to protect subscriber privacy, the 52 membership plans will be able to tap into the FEP warehouse, which runs on two Sun Microsystems Inc. Enterprise 6000 servers, through the BCBSA's national data communication network, called BluesNet. The network is a TCP/IP-based public and private network connected by private lines, frame relay or ISDN through AT&T Corp. or IBM Global Network Services. Until this point, BluesNet had been used mainly as a vehicle to exchange claims forms and patient information among membership plans and subscribers, not as a way to perform and share data analysis or reporting.

FEP, which builds on the communications capabilities already inherent in BluesNet, fosters BCBSA's goal of providing individuals with quality health care wherever they may be. The company's BlueCard program, which entitles subscribers traveling outside of their local plan areas to comparable care from a BCBSA member in another state, relies on a proprietary interplan teleprocessing service. Similar to an electronic commerce application running on the network, the service enables the exchange of claims and financial information within the BlueCard data warehouse, which is based on IBM's DB2.

"The issue [for BlueCard and ITS] is how to simplify access for the people that need to get at the information," said Keith Grossich, executive director of IS system and technology services at BCBSA's Chicago arm, which runs BluesNet.

Unlike the FEP project, however, BlueCard is just an interface between plans--it does not support data queries and analysis. "Their sense [with FEP] is that they can cut down dramatically on requests and allow plans to do a lot of self-service based on their access to information and their ability to query," Grossich said.

The Red Brick-based FEP warehouse can be accessed with several data extraction tools. First, Brio Technology Inc.'s BrioQuery OLAP software delivers data query capabilities. MCSource, a vertical package specifically designed for the managed care industry from VIPS Healthcare Information Solutions, provides the underlying data structure to over 100 tables and navigates between each. And Episode Treatment Grouper, software from Symmetry Health Data Systems, provides diagnostic analysis, allowing users to dig into the data warehouse to identify relationships or episode treatment groups.

For example, a person visiting a hospital for a broken leg may also have bronchitis. The Symmetry software identifies all claims associated with bronchitis in the FEB data warehouse but filters out the broken leg as a separate episode. This gives health care providers a clearer picture of the costs associated with treating specific ailments.

"If Blue Cross Blue Shield [can use its data] to show this is what [an episode] should cost, then they have an advantage over other providers," said Dan Vogel, an analyst at Meta Group Inc., in Reston, Va.

With additional data mining tools for the warehouse, BCBSA and other providers launching similar efforts could branch out into specialized services such as disease management. Disease management takes a proactive approach to treating particular ills. Such a service would have procedures in place to allow health care providers to take precautions, providing the patient with better quality of life, lower treatment costs and, perhaps, ways to prevent the spread of some sicknesses.

From BCBSA's perspective, the FEP data warehouse is the first step toward larger analytical warehouses that could impact all of its subscribers. Ormsby and Rosecrans have a lot to prove, however; the success of the FEP program rests on their shoulders.

"It is viewed in this office as the [most] critical technology initiative. ... Every single department depends on what we are able to deliver," Rosecrans said. Given BCBSA's mission of leveraging data to improve medical care, so do the patients.