Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

Forget "Big Data"

The Foundational Challenges

of Conquering "Little" Data

Remain "Big" for Most

Corporations

Every Feel Like you are Stuck in an Endless Stream of Big Data Infomercials?

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I’d Like a Chicago Hot Dog with the Worksand a Side of Big Data

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Meanwhile Back in Corporate America

• Sourcing Data - lost in transition

• Which Data-mart, which table, which field?

• Lack of data dictionaries let alone record formats

• Why are there 14 different join keys? Which one do I use?

• The DBA who defined the Tables left 2 years ago

• Wrestling with the data – what does it mean?

• Exec Inquiry: Why am I given 3 different answers to the same question

• Why do field reports not match HQ reports

• Correlation versus Causality

• A/B Testing – what’s that? (let along Fractional Design!)

• Building a house with a hammer

• ACCESS = no “access” to the right tools, but hey, the price is right

• You have SAS why do you need (Fill in the blank)?

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I started off doing statistics which then became Data Analytics

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In Fact, I find myself oscillating between these two “realities”

I am now a Data Scientist hanging out in a Cloud of Big Data

which then became Business Intelligence

Data / Information / KnowledgeWhere is Your Company Located?

Comprehensive

Disconnected

Silos

Little Definitional

Uniformity

Fragmented

Single Source(s)

Of the Truth

Data Governance

& Uniform KPIs

“End” State“Beginning” State

One-Off Market Ready

?

?

?

?

Analytics / Segmentation / OptimizationWhere is Your Company Located?

Pro-Active

Informational

Out-Sourced

“Shared”

Re-Active

Actionable

Proprietary

Correlation Causality

Ad-Hoc Additive

“Beginning” State “End” State

?

?

?

?

?

Health CareAn Industry in Sea Change Transition

Aetna, Inc.one of the nation's leading diversified

health care benefits companies

• Founded in 1850 by Judge Eliphalet Adams Bulkeley

• Aetna serves people with products, services andresources to help them make better informed decisions about their health care, including:

• medical, pharmacy, dental, behavioral health, group life and disability plans

• medical management capabilities

• Medicaid health care management services

• workers' compensation administrative services

• health information technology services

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Aetna Provides Benefits to Individuals and Through Employers in all 50 States and Internationally

• Membership:

• 22.2 million medical members

• 14.2 million dental members

• 14.1 million pharmacy members

• Health care networks:

• More than 1 million health care professionals

• More than 600,000 primary care doctors and specialists

• More than 5,400 hospitals

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The Vision from the TopAetna in Transition

• “We’re heading toward a consumer market” “The health insurance market will soon come to resemble the home and auto insurance markets

• “Consumers want choice. They want it to be simple and they want it to be about them and right now, we don’t have a system that does that for them.”

• “Aetna needs to be more of a retail-based company”

• “The U.S. needs to switch to a “fundamentally different” system that pays for the quality of care rather than the quantity”

• “Doctors have been socialized to practice as specialized practitioners, rather than as a team of doctors to help an individual get back to being a productive member of society”

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Challenges of Moving from B2B to B2C

• “New” leadership mindset

• Speaking a new language

• Evangelizing a new mindset

• Risk Taking

• Re-tooling the enterprise infrastructure

• Data architecture – easier access to complete/real time data

• Operations – digital, paperless, 1st contact resolution

• Service support (e.g. Creating new contact channels and re-defining existing ones)

• Fostering enterprise-wide change in culture

• Walk the Talk

• Imbuing a sense of urgency to everything we do14

Aetna is 164 Year-Old CompanyLots of Legacy and Lots of Legacy Systems

• 8+ Business lines running semi-independent of one another

• Different databases

• Different operational processes & reporting needs

• Different terminology:

Groups = Customers = Cases = Clients = Plan Sponsor

• Residual 20th Century solutions for 21st Century business

• Group (employer) rather than subscriber/member focus

• BTW: Highly regulated business– both at federal & state level

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The Big Bang of Big Data in Health Care

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Aetna “Touches” its Members & Providers 1 Billion + Times in 2013

* Source: IBM Big Data Web Site

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Executing on the Fundamentals

1. Leap-Frogging Legacy Systems

2. Single Source(s) of the Truth

3. Rigorous Data Governance

4. Moving up the Analytic Continuum

5. Disciplined Execution and Iterative Refinement

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Leap-Frogging Legacy Systems

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Leap-Frogging Legacy Systems

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1. Leap-Frogging Legacy Systems

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This But Also This

• DB2 Data Warehouse

• SQL Based Applications

• Crystal Reports

• Business Objects

• SAS

• ACCESS

• AGILE

• Netezza

• Hadoop

• Virtual Servers

• Tableau

• NOSQL

1. Leap-Frogging Legacy SystemsPuts Business Owners Back in the Driver Seat

Enlightened Support from IT means

• Equipping the businesses with the data, tools,

horsepower and flexibility they need to get done

In turn, this results in

• Faster application development

• Ability to quickly analyze large volumes of data

• More informed and nimble decision making

• Faster speed to market

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2. Building Single Source(s) of the TruthCreating a 360o View of the Individual Business

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Application

Data

Underwriting

Data

Finance

Data

Claims

Data

Competitive

Data

Product/Plan

Data

Enrollment

Data

Demographic

Data

Individual Product 360o Data Mart

3. Rigorous Data Governance

• Transitioning to Single Source(s) of the Truth

• Creation of Unique Member ID – CIF Key

• Enterprise-Wide Data Governance Committee

• Setting standards for Definitional uniformity

• Build QC up-front. Not correcting down-stream

• Automated ETL to insure high levels of data accuracy and consistency

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4. Moving Up the Analytic ContinuumGartner Analytic Ascendancy Model

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PrescriptiveAnalytics

PredictiveAnalytics

DiagnosticAnalytics

What

happened?

What will

happen?

How can we

make it happen?

Why did it

happen?

DescriptiveAnalytics

VA

LU

E

DIFFICULTY

4. Deploying Data Visualizing Tools - Tableau

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5. Disciplined Execution

• Lead with data driven insights from which to understand and tweak the key drivers of success

• Link producers of analytics with producers of outcomes

• Iterative Refinement – Test and Refine, Test and Refine

• Fail fast……and often……and better

• Learn from everything we do - don’t make the same mistake twice

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5. The Basic Math of Disciplined ExecutionConsumer Directed

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• Predictive analytics are not an end, but a beginning

(40%) (40%) (20%)

• LIST + OFFER + CREATIVE = RESPONSE

• “Response” varies by Industry

• for retail = respond/buy

• for credit cards = respond/approve/activate/revolve

• for health care = respond/enroll/fund

• “Response” varies by Channel

• Knowing who to target is not the same as changing behavior

Using Big Data at Aetna

Key initiatives for improving outcomes through better analytics

• Medication adherence

• Generic substitution

• Reduction in hospital re-admission rates

• Medicare Intervention Goals (Star Ratings)

• Care management solutions

• Costs of Treatment – early intervention

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Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

Thank You