Nathan Moore, vice president of IT, Centene
Features
Case Study: Centene
Less Cost, More Care
Centene uses data to lower costs while improving patient outcomes.
by Colleen Marble
Insurance companies have long faced the challenge of providing adequate coverage for policyholders while maintaining competitive pricing and reasonable profit margins in the face of rising costs, an aging population, and an increasing under-insured or uninsured population. Feeling the pain as acutely as anyone is Centene, a St. Louis, Mo.-based multi-line healthcare enterprise that administers state health plans to over 1.5 million members, most of whom are underprivileged or previously uninsured.
The firm has long turned to data to help lower costs while improving outcomes for members, but it lacked a robust business intelligence (BI) solution that could foster these efforts and keep pace with the top-line revenue growth trend of at least 15% over the next several years.
"We’ve seen a real savings in a number of areas, and we expect the solution to deliver 100 percent ROI within the first 12 months."
— Nathan Moore, vice president of IT, Centene
An ideal solution would not only track and analyze claims but also help Centene understand member demographics and their impact; interpret lab results to suggest appropriate treatment and prevention programs; and use data from health-risk screenings, claims and more to identify high-risk members before they require costly long-term care or experience life-threatening crises.
“It’s the right thing to do, but it’s also the cost-effective thing to do,” explains Nathan Moore, Centene’s vice president of IT. “That’s our vision—better outcomes at a lower cost.”
A Healthier Solution
Centene launched an Oracle data warehouse in 2006 but soon realized it couldn’t keep up with burgeoning system requirements and developing solutions. “We were achieving many of our goals, but we were kind of running out of gas,” Moore recalls.
“We started to see significant performance degradation,” he continues. “It just didn’t perform at the speed we needed, and as a result we topped out our usage. Our business was growing, but we were worried we wouldn’t get the adoption we needed among new health plans and internal stakeholders.”
In 2010, the company turned to a Teradata Data Warehouse Appliance, which delivered the performance Centene was looking for and supported both existing and emerging business, all while producing a clear value/price advantage.
“We did a proof-of-concept and found that we could enjoy a significant performance improvement while delivering a significant return to the organization,” explains Moore. “It’s also a function of partnership—we wanted not only a vendor, but a partner, and that’s what Teradata is.”
The Custom Innovation
With the system up and running by December 2010, the firm created Centelligence, a three-pronged solution that handles hundreds of thousands of transactions (claims inquiries, eligibility verifications, alerts, etc.) each month to power a range of programs that deliver a strategic, competitive advantage:
- Centelligence Foresight uses predictive modeling to identify high-risk patients, recommend an appropriate course of action to physicians and patients alike, and suggest follow-up care to ensure the best possible result. “We use evidence-based medicine and Centene-specific algorithms in our analysis,” Moore says. “We can tell if a 12-year-old with asthma has a prescription for a rescue inhaler that is still sitting at the drugstore. We can contact the parents and the doctor, either proactively or reactively when they call in for, say, a new ID card. Encouraging the patient to use an inexpensive inhaler is much less costly than a several-hundred-dollar ER visit and obviously has a much better outcome for the patient.”
- Centelligence Insight employs analysis to manage the company’s network of providers. By identifying the most effective providers, Centene can give members a better level of care while reducing overall costs. “If we have a doctor who over-prescribes a drug compared to peers, even after we adjust for demographic factors, then we can let that doctor know and recommend alternative treatments. Our objective is to help them understand what their peer group is doing and how that affects outcomes for our members,” explains Moore.
- Centelligence Negotiator helps Centene more effectively negotiate contracts with providers based on historical data. “Any time we’re in negotiations, we can quickly review years’ worth of data, which allows us to respond quickly with alternatives and ideas for developing a new plan,” Moore says. “We become armed with as much as or more data than they have.”
The Next Level
“The intelligence is critical. It differentiates us in the market,” says Moore. “All healthcare, ultimately, is local. What we do in one market is different from what we do in another, but the benefit of a centralized BI system is that it helps us create leverage for our business as we continue to grow.
“We’ve seen real savings in a number of areas,” Moore adds, “and we expect the solution to deliver 100 percent ROI within the first 12 months.”
In the future, Centene’s primary goal is to continue to support business growth while developing data-driven programs. “We expect significant increases in mobile delivery of information,” Moore says. “The average age of our membership is under 25—they are more likely to have a mobile phone than a landline. We want to adapt so we can communicate more efficiently and effectively with them.” Taking that idea to the next level includes exploring mobile apps. Other initiatives will target provider communications and case management.
Understanding that these activities will generate substantial amounts of information and place new demands on the system, Centene has plans to upgrade to the new Teradata Active Enterprise Data Warehouse. Says Moore: “Usage is growing on every dimension, and meeting those service levels required us to move to enterprise-class capabilities. In the end, this enables us to continue to build on our legacy of innovation.” The healthcare leader’s success is being noticed. Centene ranked No. 22 in the 2011 InformationWeek 500, which recognizes the most innovative business technology companies. No wonder, then, that over the long term, Centelligence will continue to be at the center of everything Centene does.
“We don’t have airplanes in a hangar or products on a shelf—everything we have comes down to information assets and customer service,” Moore says. “Centelligence is critical to delivering a high level of customer service and protecting and managing those assets. It’s at the core of our strategy, and it’s our belief that Centelligence is our future.”
Colleen Marble has been writing about business, marketing and information management since 1996.
Photography by Greg Kiger