Rick Shoup, Tufts Health Plan senior vice president and CIO. In this era of managed healthcare, insurers are under tremendous pressure to deliver employers low-cost services along with high-quality care. Employers are struggling with spiraling healthcare costs that are predicted to average 7.5 percent over the next two to three years and are switching to the lowest cost providers. These trends are creating a new market opportunity for health plans that can provide services at the lowest price by keeping patients healthy and out of hospitals.

Tufts Health Plan, based in Waltham, Massachusetts, has taken advantage of this opportunity and is now one of the fastest-growing HMOs in New England. The company serves more than one million members in its HMO, POS, PPO and other plans through a network of 135 hospitals and 18,700 physicians in Maine, Massachusetts, New Hampshire and Rhode Island.

At Tufts Health Plan, we credit our success to our caring spirit for members who have chronic diseases or are overdue for an exam. Through educational programs and closer management of these patients, we are fostering an environment where high risk doesn't necessarily equate to high cost. This formula seems to be working because employers are switching to Tufts Health Plan at an ever-increasing rate. In the HMO business, this kind of growth is what leads to long-term success.

Divine Warehouse Intervention

At Tufts Health Plan, data warehousing is proving that a gigabyte of data can equate to more than an ounce of prevention. In the face of rising cost pressures, we built one of the most accessible, intelligent data warehouse systems in the industry and have used that newfound intelligence to launch programs that help patients stay healthier longer. The data warehouse has enabled us to launch a portfolio of innovative preventive care services focused at our higher risk members. These services reach out to asthma patients, members with diabetes and mammography candidates overdue for an exam.

Our data warehousing technology, based on Red Brick Warehouse from Informix, provides a tool to assist with patient intervention. It is probably the best strategic advantage we have.

Pioneering Warehouse

Tufts Health Plan is one of the first healthcare organizations to deploy data warehousing technology, providing users with rapid access to vast amounts of data. In 1993, we reached a point where we had a backlog of 1,200 work order requests from staff who wanted information about members, while hundreds more continued to flow in monthly.

It was taking us months to generate reports for our customers. In many cases, they gave up trying to get the information they needed to make decisions because we couldn't deliver it. After looking at other products, we selected Red Brick Warehouse from Informix with Forest & Trees from PLATINUM technology as the front-end query tool. Informix Red Brick Warehouse was selected because it was consistently 10 times faster than the others.

Finding the right technology to support our business and technical requirements provided the most significant challenge to implementing our vision of putting information in the hands of data analysts and, ultimately, users. Many data engines and on-line analytical tools existed at the time. However, most of these tools did not support the large number of dimensions and large reference tables we required. Four dimensions reflecting only product, geography, business unit and time were standard in the industry. But we wanted more. We required 15 business dimensions to support our users.

Vendor product integration proved to be another significant challenge. The implementation occurred just when standard middleware technology was introduced. Informix Red Brick Warehouse allowed us to achieve common connectivity between the front-end vendor and the middleware vendor.

Since implementing the initial data warehouse in 1993, requests to IS have dropped nearly 70 percent, and monthly more than 4,000 queries are run by 250 users with an average response time of six minutes. Recently an employer's finance manager said she'd been able to access the same information in 15 minutes with Tufts Health Plan that took three weeks with her old HMO.

Currently the data warehouse supports more than 350 users and contains over 190 gigabytes of claims data. The warehouse consists of more than 200 tables containing over 300 million rows of data on claims, membership, provider, pharmacy and employer information. Our Informix Red Brick Warehouse resides on an HP 9000 K580/4 UNIX server.

The warehouse provides valuable services to the medical community as well. The Tufts Health Plan representatives responsible for supporting hospitals and physician groups can query the data warehouse to respond to questions about hospital and physician services. The information allows the medical community to monitor how care is being delivered and make improvements. Also, marketing and sales representatives access and report on information, allowing employer groups to monitor the quality of care and customer service provided to its employers, such as BankBoston and Compaq.

We now disseminate standard reports via an intranet with a Netscape Communications Navigator browser to internal business units and senior management and are studying the possibility of giving corporate benefits managers access to reports over an extranet.

We have also deployed a Web-based decision support and on-line analytical process tool that delivers an executive information system to senior management, disseminates information automatically to employer groups as well as provides physicians and medical groups with direct, secure access to selected information.

Providing secure, Web-based inquiries will increase the value of the system exponentially as more users gain access to more information with tremendous ease and immediacy.

Our data warehouse proved to be the perfect remedy for what was ailing Tufts Health Plan. We're now in the enviable position of being able to rely on our data warehouse to keep us healthy and a step ahead of the competition. Now that's preventive medicine.

The following are some recommendations before starting a data warehouse implementation:

  • Decide what business problem you are trying to solve. Have a good business issue.
  • Acquire an executive sponsor to make it happen and support the project.
  • Get someone who understands the relational technology and can develop a data model for the particular data warehouse you want.
  • Create quick wins. Ensure that people can demonstrate clear value ­ for example, a reduction in the number of reports generated.
  • Continue to demonstrate positive results with the data warehouse implementation, no matter what the project is.
  • Survey the users to make sure they are finding value in the technology.
  • First develop a concept and start small.
  • Bring in other specialists if you don't have the resources or capabilities to build a data warehouse.
  • Deal with data integrity problems. You will find that when you are putting a data warehouse together, it will be obvious if you have operational data problems.
  • Make sure you have many champions. You want people in specific departments to praise the technology and talk about it. Take it on the road internally. For example, make joint business/IS presentations.
  • Building a data warehouse must be led by the business and supported by IT.

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