Q&A: Delta Dental of Va. puts BI tools into the hands of the masses


Delta Dental of Virginia, a benefits provider based in Roanoke, collects mountains of claims data, but until recently the company did not have business intelligence tools for non-technical employees to quickly turn the data into a competitive asset. When John Sheffield joined the organization as director of Software Development four years ago, he began implementing open source BI technology, which underwriters, provider-relations specialists and marketing professionals can use on their own. In an interview with FierceCIO, Sheffield discussed why he opted for open source, what insights have surfaced since the BI tools were deployed, and how the organization's culture has changed since the technology was put into the hands of the masses.

FierceCIO: What were the main drivers for deploying business intelligence tools that are easily accessible to non-technical users?

John Sheffield: We've experienced some tremendous growth here. We needed to go from an organization that runs purely off anecdote to one that's more data-driven. We needed to get to a point where the business has information at its disposal. The real driver was to convert the culture here.

[The implementation] was driven somewhat holistically. We said, hey, we've got all this claims data--we've got to be able to do something useful with it. It was a daunting issue. A claim is simple until you start digging into it and realize it's got all these different aspects to it. 

FCIO: How much data are we talking about?

Sheffield: We're almost at 100 gig. We've got probably close to 15 million to 20 million claims, going back seven years.

FCIO: When did you start using open source for business intelligence? 

Sheffield: We had [other BI technology] when I started. It was a great tool, but we were having a difficult time getting traction from a development perspective and a business user perspective. We wanted to look for an alternative that was a little easier to develop in. 

FCIO: What have been the main benefits of using open source for BI?

Sheffield: The value proposition was certainly there, but I don't want to make it all about cost. It is a tool that we've been able to readily find outside talent to assist us with. It is something that we can readily get up to speed on internally. It was not a complex beast to deal with. The community at large was really good.

FCIO: What information, in particular, were you looking for in deploying BI technology?

Sheffield: At its core, everything we do here revolves around a claim, but there are a lot of aspects to that. Pentaho [BI Suite] is our BI platform, and from there we developed four verticals--for lack of a better term--that we go after. The first is being able to report to our groups their utilization of the dental services we offer. Up to this point, we really didn't have a reporting solution to do that because it wasn't scalable with the growth we had. We needed something that was web-accessible and scalable. 

The second one was trying to manage around our cost of goods, reimbursement rates and aberrant behavior. We used the Pentaho software to build fraud and abuse tools so we could monitor providers' claims submissions and see if their behavior was in the norm. The fraud and abuse system has an internal use, but there's a sentinel effect to be had as well. We can look at all the providers, and we can present them with the information that we're looking at so they can judge for themselves how they are doing compared to their peers.

The third component is to look at the claims data to monitor trends over time to improve efficiencies. Can we do this better, or can we price this differently? This allowed more self-service for [non-technical users] to understand what operational changes they could make to the business.

The last leg was the summary information, which we call the dashboard capability. We can leverage what we had done in the past and start to present data as key performance indicators.

FCIO: Can you give an example of how the tools have uncovered insights that created value?

Sheffield: There were a handful of providers who were really out of the norm. There are metrics that our provider relations group has come up with--things like you shouldn't have procedure B followed by procedure A, or you shouldn't be submitting a lot of procedure C claims because the population doesn't dictate [the need for them]. When we used the tool to find where their behavior was out of the norm and talked to them about it, their behavior shifted--it was like night and day.

Also, we've gotten into some real head-to-head competition in bringing in new members. We go up against some big, great firms, and we've been able to win. 

FCIO: Who in the organization is using the technology the most?

Sheffield: In order of usage, it's underwriting, provider relations, and then marketing. Our operations folks use it as well, but probably more from a reporting perspective than an analysis perspective. 

We've hired a few people on the business side who are analyst types, but the community that existed did a lot of this work already--it was just an extremely arduous task before. A lot of them were extremely intimate with how the data was structured, but it wasn't the easiest task to do without a powerful tool that sits between them and the data. 

We've been trying to push things back to the user community because it is their data. We're just enablers. Now we don't even hear from them unless there's something that needs to be added. They do all this on their own, and they do it very quickly. 

FCIO: How was the training? 

Sheffield: It wasn't an overnight thing. You can probably surmise that if we've been at this for four years or so, it has not taken us four years to develop. We're just to the point now that we have people comfortable using the analyzer and the dashboards. You can imagine the cultural shift. We started with reports. Everyone understands reports. It got a little bit more involved when we got to the fraud and abuse component. 

For executives, this is as radical of a paradigm shift as it was for us. To get information at the speed of thought is certainly something new to them. To make a request and have the answer the same day, it's like, really, are you sure?

FCIO: What aspect of the technology has made the greatest impact, from the management perspective?

Sheffield: I think it's primarily speed. I think we probably moved at almost a glacial pace before. I think that's probably been the biggest wow factor. The fact that we can get information this quickly has kind of taken people aback a bit.

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