Big Data is now a proper noun Randy Olinger Optum 2016 MSST - - PowerPoint PPT Presentation

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Jul 08, 2023 110 likes •226 views

Big Data is now a proper noun Randy Olinger Optum 2016 MSST 5/4/2016 Introduction - Optum Largest (by far) health services company in US, probably the world. Parent company 2015 revenue $157B , Optum $67B. Exploiting the

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Big Data is now a proper noun

Randy Olinger – Optum 2016 MSST 5/4/2016

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Introduction - Optum

Largest (by far) health services company in US, probably the world.
Parent company 2015 revenue $157B , Optum $67B.
Exploiting the convergence of data and care models

– Outreach and Wellness Programs – Contract Claim Processing – Pharmacy Benefits – Optumhealth Bank (HAS) – Revenue maximization – General Consulting – Direct Care Delivery – Optum Labs

All of this is data driven, and compliant with a myriad of privacy and
ther regulatory statutes.
Strong Culture of innovation and “do it yourself”

SLIDE 3

Some Business Challenges

Multiple Identities of a constituent
Data regulations around privacy and

retention

Consolidation of the industry (500

acquisitions over 10 years)

Untapped value of integrated data

SLIDE 4

Greg’s Optum nurse works with him to understand his goals and help him manage his

diabetes. She shares Greg’s care plan with

his doctor to ensure they have the best plan of care for Greg and his lifestyle. Greg agrees to enroll in the Diabetes

program. The Care Advocate then looks
n her Dashboard to see the most

relevant offers for Greg and sees there is a Lower Cost Alternative for his current

medication. Greg saves money on his

prescription.

Clinical Synchronization Member Journey

Integrated data enables this experience

4

Greg was recently diagnosed with diabetes and he calls Optum to ask a benefit related question. Optum’s Care Advocate answers Greg’s question and lets him know that Optum has a program to help him manage his diabetes. She also finds out that Greg has depression and reaches out to a behavioral care advocate for a consultation Greg goes to his Optum Personal Dashboard to see personalized relevant content where he is able to find diabetic-friendly recipes and exercise tips to manage his weight and condition.

Greg is happy. Optum and his doctor see him holistically and consistently and are helping him manage his diabetes condition.

Hospital data Medical data Behavioral data Pharmacy data Lab data Health assessment

Optum identifies gaps in care and program opportunities. Optum combines all

pportunities, applies behavioral

segmentation and offer management’s decisioning engine to determine the best and most relevant offers for Greg.

Sync

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Centralizing Consumer Data to Enable Whole Person Care

Multiple activities need the same data! and Consumer Data needs to be in a central location to enable the delivery of whole-person integrated care:

Clinical Synchronization
Personalized Optum digital experience
Patient Center Care Model Technology

We do not have a holistic view of the consumer:

Unable to realize clinical integration
Client data is scattered across the
rganization
Unable to uniquely identify our

consumers

Unable to create a personalized

experience

TODAY

Each project brings in their own data elements into disparate sources resulting in duplicative capital spend and decentralization of consumer

data. We cannot get the holistic view
f a member

To improve the Consumer Experience and enable Clinical Synchronization, we are delivering the Optum Big Data Platform. BDP will centralize consumer data so we can see the whole consumer, personalize our interactions with them, improve clinical

utcomes and reduce medical costs
Advocacy
Offer Management
Preference Center

Increased Consumer Engagement Improved Clinical Outcomes Reduced Medical Expenses

Medical Behavioral Rx

SLIDE 6

Consumer Data Strategy

Integrated 360° View of the Consumer 6

CONTACT INFO ID #s, Name Phone, Email Address SEGMENTATION: Propensity to Engage, Health Ownership Segmentation PREFERENCES Opt-In/Opt-Out Do Not Call Communication EMPLOYER HISTORY PROVIDER HISTORY MEDICAL: Diagnosis, Symptoms Programs, Labs, Imaging, Biometrics Notifications Assessments BEHAVIORAL: Inpatient Outpatient Diagnosis Lifestyle choices Substance Abuse PHARMACY: Prescriptions, Rx fills Medication reviews Contraindications Lower Cost Alternatives Retail to Mail CLINICAL OPPORTUNITIES: Gaps in Care Clinical Program Referrals Wellness Opportunities Risk Scores Lifestyle Changes BENEFITS INFO: Benefit Plans Eligibility Enrollment PCP CLAIMS: Cost Utilization HEALTH FINANCES: HSA, FSA, Incentives Billing Deductibles IVR TOUCH POINTS CUSTOMER SERVICE ACTIVITY HEALTH & WELLNESS COACHING Appointments, Conversation, Enrollment CLINICAL OUTREACH HISTORY Activity Tracking, Progress, Alerts Work Queue Status CAMPAIGN HISTORY / CONTACT HISTORY: Letters, Digital DIGITAL ACTIVITY: Optum ID, Web, Mobile Activity SOCIOECONOMIC SOCIAL MEDIA OTHER FINANCES: Credit information VISION and DENTAL DEMOGRAPHICS Ethnicity, Gender

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New Solutions – Building the Foundation

Migrate the hard core analytics to parallel open source systems (Hadoop,

Spark, R, Kibana)

Significant investment in visualization capabilities

– Detect data quality problems sooner – Find lost revenue opportunities – Geographically represent cost or other trends

Deduplication of identities

– Also called Master Data Management, or “The Belly Button ID” – Consistent identifier over the lifetime of the patient or other entity

Longitudinal and comprehensive consumer data record

– All ingested data transformed into a canonical model, matched to the MDM, and stored in a data lake – Transformed data also stored in a NoSQL document oriented database with data level security. – Data can be used for any legitimate need in the organization, such as interventions, gaps in care closure, or the digital experience. – Ultimately consolidate over 20 disparate warehouses resulting in reduced complexity, improved customer experience, and lower costs.

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Common Foundation Across Transformation Programs

Key Enterpr pris ise Progra rams s (Products and Applications) Clinic nical al Synchro roniz nization tion (A4Me, Advocacy, Rx Touchpoints, MBI, Total Population Health, Telephonic Coaching)

ENABL ABLING NG KEY Y ENTER TERPRISE SE PROGRAMS and NEW CONS NSUMER EXPERIENC NCES

Progra ram Tools ls

ANA NALYTI TICS & INSIGHTS TS

ID/STRAT | Segmentation | Modeling

Facts | Opportunities | Risks | Scores | Segments

Consum umer r 360

INTE TEGRATE TED VIEW W OF CONSUMER Contact Services | Clinical Services | Claims

Contacts | Medical | Behavioral | Rx | Provider

Indiv dividual idual MDM Provid vider r MDM

Individual ID | Eligibility | Enrichment | Consumer/Provider | Golden Record

Common member identifier. Common provider Identifier

Data Fabric ric, , Data lake

DATA MANAGE GEMENT Intake | Standardization | Quality | Storage | Access

All Data

Drive a common Big Data Platform build to accelerate key enterprise transformation programs and maximize capital

8

Consum umer r Engage gement nt (Personal Dashboard, Rally, Marketing Campaigns & Offers, Optum Market) Patient nt Centered d Care Model l (PCCM) Rx Integra gration tion

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Structured Data

OBDP Reference Architecture

Optum Cloud

Interaction Channels

Medical Claims RX Claims Clinical Lab Eligibility

Data Lake

Optum ID Services

Data Warehouse Out-Bound Interactions In-Bound Interactions Portals Voice Letters eMail Fax Mobile App Chat Messaging Letters eMail Chat Campaign Management Fax Mobile App

Consumer Enterprise Applications/Services

Context Based Rules Continuous Monitoring Event Driven Campaigns Continuous Analytics Real Time Alerts Voice  Multi Factor Authentication  Identity Management  Branded Identity  Single Sign On (SSO)  Call and Voice Authorization  External Identity Integration  Optum ID  Internal Consumer ID  Preferences  All Data

Consumer 360

 Optum ID  Internal Provider ID  Preferences  All Data

Provider 360

 Optum ID  Internal Customer ID  Preferences  All Data

Customer 360 Consumer ID

 Internal Consumer ID  Survivorship Rules  Golden Record

Provider ID

 Internal Provider ID  Survivorship Rules  Golden Record  Optum ID

Customer ID Data Sources

 Internal Customer ID  Survivorship Rules  Golden Record

Unstructured/Semi-Structured Data

Images (X-ray, CT Scan etc.) Charts Notes etc.

Other

Reporting

Big Data Platform

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