Case Study 1

A mid-size regional Administrative Services Organization based in Midwest USA. They offer multiple product lines: Health Plan, Network Services, Care Management and Pharmacy. They have a member base of nearly 125,000.

The ASO has invested in building Enterprise Datawarehouse and Dashboards

Business Challenges:

The business is leveraging the Dashboards for

• Reporting ASO performance to their customers
• Identify and track high cost Claimants
• Report on Consumption Metrics

The account management team had to back track reports sent to their customers because of Data integrity issues in Claims. The Business had stopped leveraging the Dashboards and was asking the IT for raw data in Excel sheets for them to manually process information to report to their customer. IT team was struggling to put a Data Governance and Data Quality process to improve Data.

JBS leveraged their Healthcare Knowledge and Technology expertise in building the approach. The key issues that needed to be resolved were:

• Making the business understand that Data Governance and Data Quality management is an Organization wide initiative, not just IT
• Helping business understand the issues in Data Ingestion, poor quality of data at source systems
• Creating a Data Governance process, nominating Data Stewards for each business area
• Building an exception process to identify poor data and extracting them before reaching downstream systems
• Creating business rules for key business issues regarding Demographic, Claim and Eligibility data.

Business Outcome

• Built an integrated approach between Business and IT for handling Data
• Improved data accuracy to over 98% in 6 months
• Reduced false positives to less than 5%