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Less of the Menial and More of the Meaningful at BCBS NC
Name: Sarah Golnik
Title: Data Engineer
Company: Blue Cross Blue Shield North Carolina
Overview of Use Case
The Operational Analytics team at Blue Cross Blue Shield North Carolina (BCBS NC) was tired of spending significant time and resources fulfilling ad-hoc data requests and decided to take action. They built and deployed Alteryx workflows and within 10 months, they reduced ad-hoc requests by 80% and dropped wait times from 17 business days to minutes.
Describe the business challenge or problem you needed to solve
The Operations Analytics team at Blue Cross NC handles all aspects of enrollment, customer service, and claims processing for BCBS members which results in a tremendous amount of data. To put that in perspective, there are over four million members, and in 2017 they drove 7,018,940 calls and 53,113,237 claims. Each call has thousands of lines of data, which speaks to the volumes of data they are managing.
The Operational Analytics service desk manages end to end BCBS member data, including but not limited to, enrollment, membership, demographics, group data, and provider data. The team wanted to spend more time on analytic work and less time on ad-hoc requests. They needed to find a way to provide self-service alternatives, so they could spend more time on insightful projects.
Describe your working solution
The Operational Analytics team granted all BCBS users access to the data that they need—this was titled the “Mega Query.” This query allows users to search for claims through certain inputs. Users input a date range, whether it's service date range, pay date range, or receive date range. It allows them to search for specific codes, diagnosis, or even providers. The query gave users the option of selecting what fields they want to display in the output. They could either leave it with all the variables, or they could just pick and choose what they wanted to display.
BCBS leveraged Alteryx Server to enhance data governance at their organization. Workflows and apps were deployed to the BCBS gallery so that the Operational Analytics team could control who has access to the data. Alteryx Server is now acting as the one source of data truth for users at BCBS.
Describe the benefits you have achieved
The BCBS Operational Analytics Team was able to transition all ad hoc requests to the business so that the analysts can focus on the especially complicated or impactful analytic requests. This transition occurred by October of 2017, less than 10 months after starting the Alteryx journey.
Server & Governance
Just like the rest of the healthcare industry, BCBS is constantly faced with issues surrounding HIPAA and data privacy. The team used the gallery on Server to enhance data governance at the organization. The BCBS gallery now requires people to have internal access to the system. It cannot be accessed externally at any point in time. Additionally, the team was able to control who had access to which data collections and tools.
To further enhance data privacy, the team utilized the functionality of adding hyperlinks to tools. They added links to their privacy office website. They put a disclaimer on the website that each person using the tool is responsible for knowing who has the rights to receive the data, which put the data responsibility back on the end-user.
Before Alteryx, it took the team 14 business days to turn around a claims query. Those same queries can now be run in less than 5 minutes. They estimate that they saved over $41,000 in resource savings, for just the time that they were doing ad hoc querying. The business is now able to run over 80% of the ad hoc query needs through these tools.
Mass Claims Adjustment Tool
BCBS has a mass claims tool that was used to adjust a large number of claims if an issue was uncovered. There was a lot of manual work required, and it was hit or miss.
The team used Alteryx to build a tool that allows them to take that list of claims they're going to run through the mass claims adjustment tool and it shows them exactly how the claims were adjusted and the difference in payment. This was extremely helpful for Compliance and Legal teams as they must report back on these claims adjustments.
In the first month that this Alteryx tool was deployed, it saved the company $3 million. An employee had run a query that adjusted over 40,000 claims, and they had forgot to allow for limiting criteria, like excluding claims that had already denied for timely filing. BCBS would have incorrectly paid out $3 million in those claims from just that one batch. With the new claim adjustment tool in Alteryx, the team can review the claim values and look for inconsistencies. With Alteryx, it takes the team five minutes to review the raw data, and all of claims are readjusted within the same day. Now, the team is able to be proactive, rather than reactive, when dealing with claims issues and adjustments.
Claims Processing system
The team at BCBS continues to move up the analytics curve. As an example, they used Alteryx to do a deep dive into the claims processing system. With Alteryx, they were able to create custom macros to standardize all production reporting. The team is also building a data lake where there is a complete 360-degree view of the claims process.
That brings us to the future. Where is the BCBS going? The Operational Analytic team is working on incorporating spatial data at the enterprise level. Sales and Marketing have historically leveraged spatial data, but this is the first time the Operational Analytic team is able to leverage spatial information for insights.
For example, there was a recent tornado that went through North Carolina, where most of their customers reside. The team is building a tool that ties into the severe weather alerts and FEMA's declarations of emergencies to determine if customers are going to be negatively impacted in advance.
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