Why Analytics Makes Patient Care Better

New generations of technologies have made informatics professionals integral players in Horizon Blue Cross Blue Shield’s business strategies

With more than twenty years of experience in analytics and informatics, Jason Cooper, VP and chief analytics officer at Horizon Blue Cross Blue Shield of New Jersey, has been part of an evolution that has exponentially changed how analytics is implemented in numerous industries. Perhaps none is more significant than its role in the transformation of US healthcare and health insurance from fee-for-service to fee-for-value.

Cooper points out that the maturation of technology has fueled the recognition of data and analytics as both strategic assets and competitive differentiators. This has dramatically shifted the role of technologists in the workplace. “Beyond programming, math, and statistics, we now have to more deeply understand the business verticals we serve,” Cooper says. “If we work on clinical analytics, for example, we have to understand that language and be able to probe deeper to ask the right questions to put the underlying nuances, objectives, or business context into sharper focus.”

To accomplish this, his team has to focus on improving business acumen and relationship management, as well as acting as consultants. This places “analytics geeks” (a term Cooper uses with pride and affection) in new territory. As a result, they have learned how to prioritize analytics projects so that the most important information is summarized and placed in a longitudinal business context with other key performance indicators and benchmarks.

“Providing a spreadsheet with 300 different numbers is confusing. It’s important to present concise insights that can be understood quickly to help business leaders make fast, informed decisions,” Cooper explains.

The new role can also involve what Cooper refers to as “challenging conversations” to clarify which of many potential projects internal customers need to prioritize in order to produce the most value. “It can be difficult for business leaders to realize that we can only deliver on a portion of what they’re asking for, but it leads to higher value and very collaborative exchanges,” he says.

As roles change, Cooper also sees that chief analytics and chief data officers need to be able to provide guidance on topics that are often considered to be outside their core areas of expertise. They must translate critical information among the worlds of data assets, IT, analytics, and business utility.

“The more information we have about a member’s circumstances, the better able we are to connect them to the care and services they need.”

A prime example is Horizon’s OMNIA Health Alliance. The statewide partnership of five large, integrated delivery systems and a large multispecialty group provides a fee-for-value environment to many of Horizon’s members. The platform is supported by new bidirectional data-sharing capabilities, decision support systems via advanced visualizations, and high availability for disaster recovery and business continuity with an ever-present focus on privacy and security.

A key differentiator is clinically intuitive knowledge gained through the exchange of information between EHRs and certain administrative claims data. To facilitate these components, Horizon’s IT group and Cooper’s teams had to dive into data latency, the cloud platform, and providers’ workflows to optimize insights that improve care quality, lower overall costs, and improve the member experience. “We had to understand facets on the technical, clinical, and administrative sides in order to identify the right analytics protocols and support tools needed to serve the operational and clinical needs of all stakeholders,” he explains.

Initiatives like OMNIA will continue to make Cooper’s job and the responsibilities of the analytics department more complex. Previously, analytics data, such as drug and diagnosis codes, was typically highly structured. But new technical capabilities enable the analysis of unstructured data, such as clinical case notes or recorded customer service calls.

Cooper explains that these new technical capabilities and the ability to further integrate data have opened tremendous new possibilities for advancing healthcare. For example, having an address and knowing that a member has transportation challenges can help coordination with his or her healthcare professional or community resources to increase access to care. “The more information we have about a member’s circumstances, the better able we are to connect them to the care and services they need,” he says.

As the templates for care delivery and reimbursement evolve, so too has Horizon’s business model. Its technology teams have been heavily involved in the redesign of the company’s website, mobile app, and other digital assets to be more consumer-driven. “We’re thinking less like an insurer and more like a consumer-centered company,” Cooper says. “That means letting customers drive the interactions and needing to connect with them in different ways and on different platforms.”

As analytics continues to transition into fulfilling its new and much more strategic role, Cooper predicts that it will shed its reputation as a cost center. “If you spend millions on analytics, you should be able to show three, five, or even seven times that amount coming back annually to the organization and its stakeholders,” he says. “That’s just table stakes. Analytics is evolving into being a value center.”