Excellus BCBS Implements Insurance Technology to Streamline Actuarial Efficiency

By Madhubanti Rudra
TMCnet Contributor

Excellus BlueCross BlueShield is a nonprofit independent licensee of the BlueCross BlueShield Association. It is part of a family of companies that finances and delivers vital health care services to 1.7 million people across upstate New York. In addition to high-quality, affordable health coverage, Excellus BlueCross BlueShield provides access to valuable health-related resources such as cost-saving prescription drug discounts and wellness tracking tools through the company’s Step Up program. The company wanted to provide its actuarial team with more time to analyze data and predict future membership trends and medical claims expenses. To implement this plan, Excellus BCBS turned to SAS (News - Alert), the undisputed leader in business analytics software and services. According to Excellus BCBS, since the SAS implementation, the company has experienced a 70 percent decrease in the time it used to take in processing data. Excellus BCBS worked with SAS partner d-Wise to implement the data integration solution.

Being the largest nonprofit health plan in upstate New York, Excellus BCBS has to deal with huge data relating to member and claim records. Excellus BCBS uses this data to forecast medical and membership trends that it needs when setting health insurance premium rates for the upcoming year. Before the SAS implementation, the company used Microsoft (News - Alert) Office Access databases with which the employees were left with little time for analyzing data after spending chunk of their time on scrubbing, extracting, transforming and loading data. According to Excellus BCBS, in the post-SAS period, the employees are getting adequate time for analyzing the data. The SAS implementation has helped the company achieve an automatic process flow in the data analysis.

“In a typical year, we deal with more than 100 million member and claims records. The amount of data is too large to manage with Microsoft Office Access databases. With SAS, you can just kick off a process flow and work on something else while waiting for the results,” Joseph Randazzo, Excellus BCBS manager of actuarial services, said.

“We were in an environment where we spent 70 to 80 percent of our time scrubbing, extracting, transforming and loading data – with less than 30 percent of time spent on analysis. With SAS, in many instances, those numbers have flip-flopped,” Randazzo further explained.

It will be worthwhile to mention here that SAS’ comprehensive solutions for health insurance enable organizations to align actions with business strategy, improve operational efficiency and increase bottom-line results. SAS solutions address customer intelligence, operational intelligence, health plan reporting, health plan intelligence, health insurance fraud, health informatics intelligence and disease management. Other health insurance plans that use SAS include Horizon BCBS of New Jersey, CareSource and Highmark.