Dental Insurer Bites Into BI


Of the benefits the insurance provider Delta Dental of Virginia has accrued from its use of business intelligence software, the biggest can't really be tallied in dollars and cents or other hard metrics. It's one of those squishy-soft people pluses.

"To be honest, I think the biggest benefit is the improvement in the culture here," says John Sheffield, director of software development at Delta.

Over the course of the last four years, Delta has spawned a culture of knowledge workers, thanks to the analytics, dashboard, and reporting capabilities it's employed. People don't just scan and then pass along reports anymore -- they actually read them.

"We're at a point now where they really understand the data sufficiently and can go in and analyze that data and come up with interesting concepts as to where the organization at large should be going relative to pricing or product offerings or things of that nature," Sheffield says.

This cadre of knowledge workers doesn't just hail from departments like the underwriting and provider relations groups that tend to draw more data-oriented people anyway. Now BI- and data-hungry folks live in all the operational departments, from claims processing to marketing, plus upper management, he said.

Seeing people actively engaged in figuring out how they can help make the business better is a wonderful thing, Sheffield says. "And now that they have the capabilities and the tools that let them readily do that, it's not this Herculean effort beyond mere mortals to get the information together and analyze it."

Delta has gone an open-source route for its BI initiative, using the Pentaho BI suite. Several capabilities have come out of the BI effort for various user constituencies. For example:

  • Underwriters can now run ad-hoc queries, build relational or dimensional models, analyze the information, and make more data-driven decisions. They might create a model to see how Delta is doing by group and how it could do better on pricing. "We might earn more people's business, or we might find where we're leaving a little bit of margin on the table -- you never know."

  • Provider relations personnel can monitor claims data via a homegrown tool that sits on top of the BI software and detects "abhorrent behavior" by providers that Delta reimburses as part of its network. "This is an attempt to reduce fraud and abuse and therefore save premiums for our groups and subscribers."

    The tool already has served Delta "extremely well," Sheffield said, citing a substantial fraud case settled this year based on data from the system.

  • The senior management team has just started to get off the ground with dashboards, getting near-real-time access to how the business is faring from operational and financial perspectives. Previously, business managers reported this information via Excel spreadsheets and in PowerPoint presentations. "Now it's all really just a click away, so to speak. They can go online and clearly see how the business is faring against KPIs set in place by the board."

    Additional enhancements, such as increased interactivity, will come in October, Sheffield said.

  • Software developers build the OLAP cubes needed for data mining but then step aside and let the underwriters run their queries at will, leaving themselves to focus on other business needs. "Before we had Pentaho in place, we were having to constantly run extracts that underwriters would then in turn import into tools like Access or, if the data was small, Excel. Now we don't have to be involved at all."

Self-service has become a mantra, and BI has become inculcated in the company's culture, Sheffield says.

"You can't go to a meeting from a strategic or analytical perspective where the word 'BI' isn't brought up -- and I can tell you for a fact that even as little as two years ago, that was unheard of. Nobody would even mention it."

People see the advantage of BI now that they've got the right tools in hand, he said. "We're getting into the essence of what we all understand as BI, where we're analyzing data for the good of the organization from a strategic, forward-looking view, as opposed to relying on static management reports, which are backwards looking."

Beth Schultz, Editor in Chief

Beth Schultz has more than two decades of experience as an IT writer and editor.  Most recently, she brought her expertise to bear writing thought-provoking editorial and marketing materials on a variety of technology topics for leading IT publications and industry players.  Previously, she oversaw multimedia content development, writing and editing for special feature packages at Network World. In particular, she focused on advanced IT technology and its impact on business users and in so doing became a thought leader on the revolutionary changes remaking the corporate datacenter and enterprise IT architecture. Beth has a keen ability to identify business and technology trends, developing expertise through in-depth analysis and early adopter case studies. Over the years, she has earned more than a dozen national and regional editorial excellence awards for special issues from American Business Media, American Society of Business Press Editors, Folio.net, and others.

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Re: Like the title and...
  • 10/12/2011 10:52:59 PM
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@ Sean, I agree. Analytics isn't not cold numbers but rather being able to see life in tiny detail. 

It seems Delta has ingrained into it's workers on how accessable this data is and how it is such an important tool.  I've seen in some companies were personel did have access, however didn't make the connection on how it could improve their jobs or make life easier. 

I love this part of the article: " Delta has spawned a culture of knowledge workers, thanks to the analytics, dashboard, and reporting capabilities it's employed. People don't just scan and then pass along reports anymore -- they actually read them."

When I'm reading and analzing reports and  sometimes go back to an employee and see their shock that "Yes, I actually do read them." 

 

P.S. Beware to health care providers because many insurers are implementing this type of fraud detection software. 

Dental
  • 10/12/2011 12:38:19 PM
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Beth this is awesome is so refreshing to see analytics being used to not only analyze the past but to drive the future!

Re: Like the title and...
  • 10/7/2011 12:51:45 PM
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Unfortunately, so much of what we do in this country is about bilking the system. Government contractors are another group that has long exploited inefficiencies and "look the other way" attitudes. But that's starting to change too, as government agencies, under pressure themselves, are beginning to demand evidence-based analysis of their contractors, as Shyam Desigan notes in his AllAnalytics.com post today.

Re: Like the title and...
  • 10/7/2011 7:17:38 AM
NO RATINGS

Yes, Shawn, and it's good that Delta wants to get a clear picture on this. Years ago I complained to Oxford insurance about a certain doctor's practice that tried to augment the flat rate paid for prenatal care by delaying the pregnancy diagnosis and billing for each of the early visits and the ultra-sound as separate items. They didn't seem to care to know about it. It was rather like a teacher who knows that students are cheating but prefers looking the other way rather than confronting them on it.

Re: Like the title and...
  • 10/6/2011 11:01:11 PM
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Ariella,

At the very least, you would expect that it can allow everyone to see the magnitude of the problem a bit better, like creating an effective model for your monthly household budget. It helps you see better where your money is going and, if you don't like what you see, can be the first step in correcting things.

Re: Like the title and...
  • 10/6/2011 10:55:54 PM
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Cordell,

Not  sure where we get the notion that numbers somehow abstract the real world or that they make things somehow detached and unreal. The fact is, as we see here, they can also help us see the world in new ways.

Fraud/risk management
  • 10/6/2011 6:03:33 PM
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Arielle, agreed. I think that is a valuable use of the BI capabilities. For the future, Delta would like to get even more aggressive on monitoring and stopping fraud. The tool it uses today is great at providing a lot of analytic capabilities, but Sheffield says it'll continue to enhance that with more algorithms that enable provider relations to discover abhorrent behavior even more quickly. He says it'll have to mine across a few more metrics to see if the provider is truly worth investigating, and build in more automation so it can look at larger sample sizes, get more accurate results, and probably integrate back to the transaction system to place providers on hold, as necessary. 

 

 

Re: Like the title and...
  • 10/6/2011 5:47:10 PM
NO RATINGS

I like the idea of monitoring providers to reduce fraud. There is so much fraud in insurance, which raises costs for all the honest folks.

Re: Like the title and...
  • 10/6/2011 3:40:27 PM
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I have to agree here too Shawn.  If generating data and metrics is the goal of the exercise then you've missed the point.  You want to unleash your employees creativity in the real world, not one they imagine to be true.  Data just describes what the world is. Hopefully employees will look at it and go "Really? I didn't know that? What can we do to make it better?" or "That's what I thought. I wasn't just imagining things. We need to fix this problem." 

Re: Like the title and...
  • 10/6/2011 1:57:30 PM
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Agreed!

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