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 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 other regulatory statutes. • Strong Culture of innovation and “do it yourself” 2
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 3
Clinical Synchronization Member Journey Integrated data enables this experience Greg was recently diagnosed with diabetes and he calls Optum to ask a benefit related question. Pharmacy data Hospital data Greg goes to his Optum Personal Dashboard to see personalized relevant content where he is able to Lab data Medical data find diabetic-friendly recipes and exercise tips to manage his weight and condition. Optum’s Care Advocate Health assessment Behavioral data answers Greg’s question and Optum identifies gaps in care and lets him know that Optum has a program opportunities . Optum combines all program to help him manage opportunities, applies behavioral his diabetes. She also finds out segmentation and offer management’s that Greg has depression and decisioning engine to determine the best reaches out to a behavioral and most relevant offers for Greg. care advocate for a consultation Greg’s Optum nurse works with him to Greg agrees to enroll in the Diabetes understand his goals and help him manage his program . The Care Advocate then looks diabetes. She shares Greg’s care plan with on her Dashboard to see the most his doctor to ensure they have the best plan of relevant offers for Greg and sees there is Sync care for Greg and his lifestyle. a Lower Cost Alternative for his current medication. Greg saves money on his prescription. Greg is happy. Optum and his doctor see him holistically and consistently and are helping him manage his diabetes condition. 4 4
Centralizing Consumer Data to Enable Whole Person Care To improve the Consumer Experience and enable Clinical TODAY Synchronization, we are delivering the Optum Big Data Platform. Each project brings in their own data BDP will centralize consumer data so we can see the whole elements into disparate sources consumer, personalize our interactions with them, improve clinical resulting in duplicative capital spend outcomes and reduce medical costs and decentralization of consumer data. We cannot get the holistic view of a member Increased Consumer Engagement Improved Clinical Outcomes Rx Reduced Behavioral Medical Medical We do not have a holistic view of the consumer: Expenses • Unable to realize clinical integration • Client data is scattered across the Multiple activities need the same data! and Consumer Data needs to be in a organization • Unable to uniquely identify our central location to enable the delivery of whole-person integrated care: consumers • • • Advocacy Clinical Synchronization Unable to create a personalized experience • • Offer Management Personalized Optum digital experience • • Preference Center Patient Center Care Model Technology 5
Consumer Data Strategy Integrated 360 ° View of the Consumer SEGMENTATION: SOCIOECONOMIC MEDICAL: BEHAVIORAL: Propensity to Engage, Diagnosis, Symptoms Inpatient CONTACT INFO Health Ownership Programs, Labs, Outpatient ID #s, Name Segmentation Imaging, Biometrics Diagnosis Phone, Email Notifications Lifestyle choices Address PHARMACY: Assessments Substance Abuse PREFERENCES Prescriptions, Rx fills Opt-In/Opt-Out Medication reviews Do Not Call Contraindications Communication Lower Cost Alternatives Retail to Mail DEMOGRAPHICS VISION and DENTAL Ethnicity, Gender CLINICAL OPPORTUNITIES: Gaps in Care EMPLOYER HISTORY Clinical Program Referrals Wellness Opportunities PROVIDER HISTORY Risk Scores Lifestyle Changes BENEFITS INFO: CAMPAIGN HISTORY / Benefit Plans CONTACT HISTORY: Eligibility Letters, Digital Enrollment PCP DIGITAL ACTIVITY: Optum ID, Web, Mobile Activity HEALTH FINANCES: CLINICAL OUTREACH HISTORY HSA, FSA, Incentives Activity Tracking, Progress, Alerts Billing Work Queue Status Deductibles HEALTH & WELLNESS COACHING Appointments, Conversation, CLAIMS: OTHER FINANCES: Enrollment Cost Credit information IVR TOUCH SOCIAL MEDIA CUSTOMER SERVICE Utilization POINTS ACTIVITY 6 6
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. 7
Common Foundation Across Transformation Programs Drive a common Big Data Key Enterpr pris ise Progra rams s (Products and Applications) Platform build to accelerate Clinic nical al Synchro roniz nization tion (A4Me, Advocacy, Rx Touchpoints, MBI, Total key enterprise transformation Population Health, Telephonic Coaching) ENABL ABLING NG programs and maximize Consum umer r Engage gement nt (Personal Dashboard, Rally, Marketing KEY Y ENTER TERPRISE SE capital Campaigns & Offers, Optum Market) PROGRAMS and Patient nt Centered d Care Model l (PCCM) NEW CONS NSUMER Rx Integra gration tion EXPERIENC NCES ANA NALYTI TICS & INSIGHTS TS ID/STRAT | Segmentation | Progra ram Tools ls Modeling Facts | Opportunities | Risks | Scores | Segments INTE TEGRATE TED VIEW W OF CONSUMER Consum umer r 360 Contact Services | Clinical Services | Claims Contacts | Medical | Behavioral | Rx | Provider Individual ID | Eligibility | Enrichment | Indiv dividual idual MDM Consumer/Provider | Golden Record Provid vider r MDM Common member identifier. Common provider Identifier DATA MANAGE GEMENT Data Fabric ric, , Data lake Intake | Standardization | Quality | Storage | Access All Data 8 8
OBDP Reference Architecture Consumer Interaction Channels In-Bound Interactions Out-Bound Interactions Messaging Letters Voice Portals Chat Letters eMail Chat Mobile App Fax Voice Fax Mobile App Campaign Management eMail Single Sign On (SSO) Multi Factor Authentication Call and Voice Authorization Identity Management Optum ID Services Optum ID External Identity Integration Optum Cloud Branded Identity Enterprise Applications/Services Context Based Rules Continuous Monitoring Real Time Alerts Event Driven Campaigns Continuous Analytics Consumer ID Customer ID Provider ID Consumer 360 Provider 360 Customer 360 Big Data Platform Internal Internal Consumer ID Optum ID Optum ID Internal Provider ID Optum ID Customer ID Survivorship Rules Internal Consumer ID Internal Provider ID Internal Customer ID Survivorship Rules Survivorship Golden Record Preferences Preferences Golden Record Preferences Rules All Data All Data All Data Golden Record Reporting Data Lake Data Charts Warehouse Sources Images Data Notes (X-ray, CT Scan etc.) Medical RX etc. Clinical Lab Eligibility Other Claims Claims Unstructured/Semi-Structured Data Structured Data 9 9
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