Information technology in the healthcare industry should not be rocket science. That's the opinion of a former aerospace engineer, Charles C. Emery, Jr., who is senior vice president and chief information officer for Horizon Blue Cross Blue Shield (BCBS) of New Jersey.

"We don't have the resources to create (technology) just create something new," says Emery. "One of our main goals is to lower costs so more people can afford healthcare because access to care is what we provide."

Emery oversees an IT staff of approximately 600 with an annual budget of $135 million for Horizon, which is headquartered in Newark, N.J. The company is the state's largest health insurer providing coverage to 2.9 million people.

The Universal Customer Service Workstation (UCSW) is Horizon's latest IT initiative. Using healthcare software from Siebel Systems Inc., San Mateo, Calif., the system recently won a 2003 "Best Practice Award" in the customer relations management category from the Technology Managers Forum, a New York-based professional association.

Consolidating data

The UCSW consolidates information from multiple legacy systems, integrates data and business rules and regulatory requirements related to that data, and provides customer service representatives with a single view of members' claims with Window-based applications.

Emery says the technology has resulted in a 50% reduction in call-waiting times (from up to 200 seconds to an average 20 to 30 seconds), and fewer transfers to other claim areas. Call-handling time also has been reduced by 10%.

Emery recently spoke to Insurance Networking News about UCSW and other IT initiatives at Horizon.

INN: Why do you believe the UCSW has been so successful?

Emery: The UCSW has solved a number of customer service issues. The training process (with the old system) depended on the application the call center reps were using. With five processing systems, it was cumulative. A rep might need 11 weeks on one system and 10 weeks on another system. So for that customer service rep to handle two lines of business, they needed 20 or more weeks of training. With the UCSW training, reps can handle any of the product lines with only eight days of training.

The system also addresses technical issues that include finding data easily in multiple sources and integrating data and business rules. As people use the UCSW and see more capability, or see different kinds of problems as products change, we will extend the applications. It is a constant work in progress.

INN: Explain your decision to purchase a packaged solution vs. building the application in-house.

Emery: We did look at a lot of packages and we did consider building it ourselves-but that's always our last choice mainly because it is an expensive process and usually the slowest. After we ruled out building it ourselves, we looked at several packages.

What swung us to Siebel was the power of the tools and the shell they had for healthcare. We knew we couldn't use their application directly out of the box, and there was a lot of customization work we had to do, but we felt the tools lent themselves well to what we had envisioned to be the application. It took 18 months to launch and implement the system.

INN: What are the primary CRM benefits of the system and how has customer service improved?

Emery: A major benefit is a single database for all the customer-related information. Now, from the initial sales to servicing the customer, all the information about that contact is in one place.

In addition, in the same CRM databases, we integrated the customer service information so the sales person and the customer service rep have access to all information about that person and that account.

We now have faster resolution of customer calls, and a lot of continuity in between calls-any rep can now handle a follow-up call.

The reps are getting better at learning how to use the data. For example, they're starting to use it in an anticipatory fashion by looking at how much customer contact they have received from their various accounts and using that information proactively.

INN: Describe some of the "best practices" implemented with the switchover to the UCSW.

Emery: The biggest challenge in the begINNing was getting reps comfortable with the switch from a "dumb" terminal to Windows application software and understanding its processes and procedures. This was a major change in behavior and process because of the image the reps could now see, as well as logging information about calls and navigating through the system.

We did some macro training ahead of time to introduce the system and introduce the process change. As it got closer to the time of launch, the reps had more in-depth, hands-on training. This was done out of our learning development group, which is partnered with human resources and the service division.

Our IT staff established data accountability through controls and balances that ensured that data was being transferred between systems correctly. IT maintains one central model for change management and, as we do with all our systems, we use small regression tests as well as full systems tests.

INN: What is the ROI from this project and how is it measured?

Emery: We can do a lot more volume with the same number or fewer people. We anticipate a $21 million savings in staff reductions. Training new hires is another big benefit-going from 32 weeks to 8 weeks. The turnover rate is probably the highest in the customer service area because it is an intense job, and we've reduced that turnover rate to about 15%. Although it's hard to give attribution specifically to the UCSW, it has been a contributor.

INN: Describe your IT philosophy with regard to system implementation and new applications.

Emery: I have a strategy that says, 'get things for free, get things that someone else has already done, modify what someone else has done and only build it as a last resort.' When I apply technology, I want to see a demonstrable benefit or at least the promise of it.

Frankly, you can't do everything with an absolute ROI at the begINNing, and that is the black hole of information technology research.

Some ROI is in the eye of the beholder and some is a "no brainer" like the UCSW where you can perform discrete calculations. Other technologies, such as the Internet, are not implemented on an ROI basis. Some of it is done on a competitive basis or a wish-and-a-hope basis.

I like to see a mixture of applications-some where there are discrete, finite financial benefits and some applications of technology where there is hope for differentiation.

INN: What are your plans for using the Internet?

Emery: We view the Internet as another channel. Every constituent, from an employee to a broker, can access our company from the Internet. So the questions are: How broad do you make your Internet presence? How much capability do you give a broker? How much capability do you give a member?

Our findings over the last two or three years show that the providers and the brokers have an appetite for lots of capability, and we've met that appetite and we continue to meet it.

We have nearly 3 million members and not everyone wants access to their health information or claims via the Internet. We're trying to figure out how to segment our membership so we meet their wants.

Our customer service reps have an average answer speed of 19 seconds. If it takes members longer than 19 seconds to log on, they won't call in, especially if they are casual users of the Internet.

On the other hand, if a member has a chronic illness, such as cancer, they are in the health care system a lot and deal with a lot of claims. We need to support their desire to get information about their claims and payments very easily.

INN: What are Horizon's short-term IT goals?

Emery: Our nearest short-term goal is to finish the consolidation of three of our engines into one. We started the process several years ago to consolidate the claims processing systems, and it is almost done. Once it is finished, we will be sure it is very stable and it will help drive costs down. The lower our costs, the better people can afford healthcare.

In addition, we have the Siebel UCSW sales and marketing portal, member portal, and provider portal, which will be enabled by the latest upgrade to the Siebel system-version 7.5. Both short-term goals will be reached by mid-year.

INN: What are your long-term goals?

Emery: The big future opportunity for us is business intelligence. Now that we have and continue to collect a lot of information about our customers, we can join that data with our claims experience data and start to design better products and better service models for the customer.

We have enormous amounts of information. We need to do a lot of data mining and interpretation so we can use what we have. We need to turn the data we collect as a result of customer service, paying claims, signing up new members and so on, into a business and clinical intelligence so we can be proactive for people who could use preventative service, for example.

We need to use these vast databases we have created to help people stay healthier, and when an incident does occur, to get them the right care at the right time.

The other piece of that is to use the information and intelligence that we have to build the right products . . . to keep the costs and cost increases at a reasonable level so more people can afford healthcare insurance.

That's the greatest opportunity the industry has in general. Right now, we are data-rich and information-poor. It will take us a couple of years, but we'll start to see some of the benefits in 2004.

Tina Tapas is a business writer based in Prospect Heights, Ill.

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