You have heard, and probably have even used, the phrase: "Time is of the essence." No one knows that better than insurers answering requests from customers who want their information now. Hence, the real-time phenomenon in the industry.After discovering customer data wasn't easily accessible, executives at Sioux Falls-based South Dakota State Medical Holding Co. Inc. (Dakotacare) decided the company needed a business intelligence tool to retrieve claims data from its database of 140 million records.
"Even though we had a lot of our data consolidated into a SQL server data warehouse, it wasn't giving us the rapid response and quick answers to the questions we needed to ask," says Mark Tracy, director of management information systems at Dakotacare.
Dakotacare reps relied on IT for custom reports that would address a number of questions from clients. Retrieving information to answer those questions was a manual process and required a number of time-consuming steps, including custom programming, Tracy says. Their requests were placed in a queue, then prioritized, with the resulting reports coming days or weeks later.
As a result, "we decided we needed a business intelligence tool that would enable us to make decisions in a timely manner and access a very rich data set that we weren't really being able to tap into," says Tracy.
ACCESSIBILITY OF THE SOFTWARE
To find that tool, Dakotacare did its homework-researching other online analytical processing (OLAP)-based business intelligence software packages before choosing QlikView, from QlikTech North America, Radnor, Pa., a little more than a year ago.
Unlike traditional database tools, Windows-based QlikView has an interface that is not focused on tables or forms, reports. It gives the user various presentation interfaces to suit the needs of a particular circumstance. Dakotacare chose QlikView for several reasons, according to Tracy.
"We're not a large company, and it was obvious to me in researching all of the different tool sets out there that QlikView did not require a large staff for deployment," he says.
Another factor in Dakotacare's decision was the accessibility of the software. Dakotacare downloaded the software before even buying it.
"I would've been skeptical had it not been for our ability to download the software for free. We nearly deployed the whole [package] before we ever committed to purchasing it," says Tracy.
"The best way to understand what QlikView can do is to see it yourself," says Rick Pitts, CEO of QlikTech U.S.
"Anyone can get a free 15-day trial copy of our full developer's tool, QlikView Enterprise. It is not unusual for people to start building their own applications on the first day, so people can see right away how QlikView can turn data into action," he says.
Dakotacare's data was fairly normalized, Tracy admits. Larger companies with more data from a number of different sources would have a more complex task.
"We had QlikView up and running with some test data the same day we downloaded," he says. "So, for us, it was not only the lowest price point, it was the lowest cost of ownership because of its low cost to deploy and maintain."
Tracy also credits QlikView's flexibility. Based upon patented technology called Associative Query Logic (AQL), QlikView removes the need to define complex dimensional hierarchies and to generate cubes. Indexes are not required, making every field available as a search field without any performance penalty.
"It truly has the ability to work completely with your data set," he says. "And there are no preset reports that you have to know how to manipulate."
It only took a couple of weeks for Dakotacare to implement Qlikview, with one minor challenge. "Because QlikView automatically associates data, we had to make sure our field names were identical," says Tracy.
"For example, if you've got an identifier in one table-a master ID-and another table has a slightly different spelling, QlikView will have a problem with that."
Now, the company keeps finding more ways to tap into our data, he adds. "We're still implementing, if you will. But we were up and ready and learning about our data in just a couple weeks-and that was with just two staff members working on it."
AN AUDIT TOOL
After the initial implementation, QlikView became an audit tool, according to Tracy.
Dakotacare found anomalies in its data and was able to fix a lot of processes, such as setting up a new client.
Every plan is different, and every client has different benefit structures, Tracy explains. "So there are literally hundreds of different codes, and QlikView allows us to browse that data, and it points out our errors in our set-up right away, instead of us finding them a month later." Previously, the company had to go through every record manually for verification.
"It allows us to quickly and effectively audit our setup before we go live, and it takes all the manual intervention out of it-so we can get our checks out correctly the first time instead of finding out we have an error three weeks into the process," he says.
Despite the improvements, Tracy admits initially the call center reps didn't like the new software. "Number one, they didn't like it because it's change, and sometimes change takes a little bit of time," he says. "Number two, they were used to just being spoon-fed their data."
Prior to implementing QlikView, the reps would make a request, such as verifying claims status for a provider, and Dakotacare IT staff would program it. About a week later, the reps would receive answers, but not the ones they wanted. IT would go back to the drawing board to recalculate the result.
"[The reps] didn't have to understand the data. They just needed their questions answered," says Tracy.
Now, reps are asked to understand the data. "We've gone from having people who write reports based on a question to having users who call us and go through the question with us," he says.
"They explore the data and, over time, they gain independence. Our end users control their own destiny with respect to asking questions in their own timeframe."
QlikView has also freed up IT time for Dakotacare, according to Tracy. "We spent a lot of time spinning our wheels programming code," he says.
In the past, Mike North, Dakotacare's vice president of underwriting and risk management, spent a lot of time trying to research an issue, such as suspicious rating ratios, with the static reporting tools, Tracy explains. Many times, the issue was too complex, so he wouldn't waste his or the programmers' time trying to get the data he needed.
For example, North recently received comments from Dakotacare agents that made him wonder if the company's age/gender rating ratios were askew. Normally, that kind of a study would be a full-blown project that would've taken weeks of IT time that could result in finding no problem, Tracy explains.
But with QlikView, North was able to pull up the ratios quickly, and within a few hours, he realized there was undoubtedly an issue that needed to be addressed.
DRILLING INTO THE DATA
What's a company to do with all this new information? In addition to ensuring the data is accurate, Dakotacare is also using QlikView for customer service," says Tracy. In one minute, a rep can pull up a document that contains 90% of the data for a claim.
"Imagine that the front of the screen displays the total bill for all of the claims in our entire system, and it's real time," he says.
"So if I go over to the members tab and click on 'members who live in South Dakota,' that dollar amount changes. Now I'm looking at all of the claims for people who reside in the state of South Dakota."
Tracy can then go to the age section and type in an age, and the dollar amount changes again. "Now I'm looking at all the dollar amounts and all the claims for people who live in South Dakota who happen to be over 50," he explains. "And, if I go to the details tab, it will show me every claim down to the transaction level."
This kind of data availability enables Dakotacare to provide more information to its customers.
For example, a provider called to complain that the company was taking too long to pay a claim. The Dakotacare representative asked the provider for his ID or provider name.
"The rep quickly looked up that provider, and [QlikView] showed the average number of days it took for us to pay the claim from the date it was received," says Tracy. "We had paid all of that provider's claims in 2005 within 3.3 days, and we had them in the mail within 15 days."
What's more, the company rep then asked the provider for his e-mail and sent him a spreadsheet with every bill the company had received with its paid date, its received date, and its check date. Says Tracy, "This was a three-minute phone call, and it really blew the provider away that we had an answer for him on the spot and on the fly like that."
AT A GLANCE
Company: Dakotacare
Location: Sioux Falls, S.D.
Business: The managed care insurer counts the South Dakota Medical Association and more than 98% of the state's physicians and pharmacies among its providers.
Employees: 130
Revenue: $34 million in total statutory assets, statutory net worth of approximately $18 million, and annual combined revenue of $90 million.
At Issue: Processing and communication with care providers took too much time.Solution: QlikView uses an associative database to enable Dakotacare to retrieve and provide requested information quickly.
