EBA solution expands healthcare choices

by Terri Smith

As American businesses continue to confront double-digit increases in health insurance rates, some are simply dropping coverage altogether. For those companies continuing employee health benefits, annual cost increases of 10%-15% have taken a toll on the bottom line, forcing employers to shift an ever-increasing share of healthcare costs to their employees. In turn, healthcare payors are striving to provide more information to these employees to help them more effectively manage their choices.

Ken Kubisty

Unfortunately, a great majority of healthcare organizations don't have adequate technology in place to give them a single view of their members. BearingPoint and Teradata have teamed up with Phoenix Healthcare Intelligence to develop an Enterprise Business Analytics (EBA) solution, currently available in the United States. EBA integrates member data from across all areas of payor functionality, including case installation, finance, claims, network, sales and marketing, quoting and rating, billing and medical management.

The solution combines data consolidation and robust decision support to maximize the value of information, providing the payor with the analytics needed to respond to consumer-driven healthcare. For example, clinical analysis provides network physicians with the best clinical practice patterns in terms of outcomes and cost of care. Reducing the undesirable variations and improving the quality of care reveal opportunities for improvement in clinical efficiencies and member wellness.

With consumer-driven health care, each member has a set amount from his employer to spend on benefits. If the member hurts his knee, for instance, his physician probably will order an MRI or X-ray. EBA triggers an automated member communication educating the consumer on choices in terms of cost, giving the member the ability to choose how and where to spend his healthcare dollars.

All told, assisting members in making economically rational decisions shifts the focus from the physician to the consumer in an attempt to improve satisfaction and lower cost. EBA provides a more complete understanding of utilization and risk, enabling development of products consumers want to buy.

According to Ken Kubisty, BearingPoint's EBA program manager, "EBA allows payors to leverage legacy systems, using the power of current data from across the organization to drive intelligent decisions with enhanced product design, effective risk management and knowledge-driven pricing and profitability strategies."

Under the terms of the partnership, BearingPoint, Teradata and Phoenix Healthcare will provide strategic business consulting. BearingPoint acts as the system integrator and offers change management and business process reengineering consulting. Teradata provides decisionsupport consulting, database design and its Health Communication Management solution, which will enable the analytics produced by Phoenix Healthcare Intelligence's Health Information Gateway solution.

Pat Saporito, industry director for Healthcare, Insurance and Pharmaceutical at Teradata, notes, "We've received enthusiastic feedback to EBA from customers and prospects alike. EBA enables Teradata's healthcare customers to be industry leaders in implementing the integrated, proactive, predictive analytics that technology analyst firms like Gartner are advocating."

That's good medicine for everyone. T

Terri Smith is a Winston-Salem, N.C.-based public relations professional and writer.

© Teradata Magazine-September 2004