Established in 2000 to provide affordable healthcare across eight South Florida counties, Community Care Plan (CCP) offers a wide range of health plans and local medical services to individuals and families. CCP is on a mission to promote healthier communities.
To maintain the highest possible quality standards and regulatory requirements, CCP has relied on analytics and metrics to stay compliant and continually improve its services. Whether it’s more timely claim authorizations or matching services to individual needs, the aim is to deliver proactive and personalized health plans with a heart and a sense of community.
Providing the business with the insights it needs to achieve its mission was proving difficult. Data was trapped in silos that made it hard to cross-correlate a member’s varying healthcare needs. Accessing claims details was taking too long because data sources were disconnected. Documents were manually entered into Excel spreadsheets or SAP Crystal Reports, and it was up to the IT department to manually compile the information that the various departments need.
The goal for CCP was to see the full picture of individual members, as opposed to one metric in one silo. Implementing a more powerful BI and analytics platform became a priority.
In the early stages of Business Intelligence development, Leon Mink, Senior VP and CIO, and Alvaro Reis, VP of IT, evaluated several tools, including Tableau, before choosing the Pyramid Decision Intelligence Platform. Although CCP is a Microsoft house, IT Director Terry Garzon found the drill-down capability of Pyramid superior to the Microsoft product. And having used the Pyramid Platform in a previous role, she was confident that it would be a good fit for the healthcare plan.
She knew that Pyramid would make light work of consuming data from the Clarity databases that integrated with its health information system; that it could do the transformation that would enable data to be surfaced in reports for insights. An OLAP cube was created within an architecture primed for Pyramid functionality and the rapid analysis of data; 15 licenses were bought for users across the finance, claims, and pharmacy divisions.
At the time, Pyramid was launching the latest version of its product and spent two weeks with CCP, fine-tuning the platform’s functionality and aligning it to the health plan’s unique needs. Data was presented to stakeholders at the outset to make the business case clear. “The Pyramid team was excellent throughout,” said Terry Garzon, “and always willing to go the extra mile.”
The Pyramid Decision Intelligence Platform has helped improve the quality of CCP’s service, giving its finance, claims, and pharmaceutical teams the visibility they need to optimize member engagement while meeting regulatory requirements. “In the past, they didn’t know the underlying information behind reports. By removing that layer, we’re giving them visibility of everything. That’s going to be a huge benefit for CCP going forward,” said Terry Garzon.
A huge service provider database that was sluggish to use can now be accessed more quickly, inputting search criteria like the National Provider Identifier, and correlating with other information using drag-and-drop filters. All of this is good news for CCP’s IT team. The Pyramid Platform has freed them up from time-consuming tasks, not just correcting bad data but attending briefings on report requirements and manually compiling data with spreadsheets. They are now able to focus on more business-critical tasks.
Pyramid’s self-service functionality provides instant insights that used to take weeks to assemble, delivered in sophisticated visualizations that super-users and management can drill down into and use to compile their own reports. The business units can now go in and correct source systems, as opposed to using pre-configured reports they assume are accurate.
Around 150 metrics have been created that can be used to calculate a range of costs relating to everything from the length of a hospital stay to the number of CT scans. If there are payment mistakes, the CFO will see them in Pyramid and can immediately request a review of the claims processed to determine the root cause of the issue.
“Pyramid shows when people are assigned the wrong line of business or when claims are paid to members who are not eligible for them,” explained Garzon. “We’re improving data quality and filling holes. Pyramid has become business-critical for CCP.”
The Pyramid team was excellent throughout and always willing to go the extra mile.
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