Providing Cost Efficient Care at Martin’s Point

Executive summary

Rising costs and increasing complexity are driving health care organizations to reassess what they need to do to keep patients - and business - healthy. Their challenge? Containing costs, while improving clinical outcomes, and at the same time meeting the increasingly complex needs of patients, physicians and other health care providers.

Founded in 1981 and headquartered in Portland, Maine, Martin’s Point Health Care serves approximately 88,000 members and patients. As both a health care delivery and health plan provider, Martin’s Point Health Care cares for its communities in two ways: by providing primary care through owned group practices and health care centers to patients in Maine and New Hampshire; and by offering health plans and wellness services to members throughout northern New England and northern New York. These health plans include: the Uniformed Services Family Health Plan (USFHP) for retired military personnel as well as active duty dependents; a Medicare Advantage plan, Generations Advantage; a commercial plan, Point Partners; and health management services for Maine employers.

As a physician-led organization, Martin’s Point strives to keep people healthy, provide excellent service and find innovative ways to make the health care system more efficient and effective. By measuring success through health outcomes, cost, satisfaction, service and performance, Martin’s Point fuels its constant process improvement initiatives, which in turn make it a stronger and more innovative institution.

In keeping with its goal of delivering effective and efficient care to its patients, Martin’s Point selected the IBM Cognos 8 Business Intelligence (BI) platform for a standardized, Web-based reporting system, easily accessible throughout the organization.

This case study will focus on how Martin’s Point uses IBM Cognos 8 BI to:

• Save time, improve customer and employee satisfaction and make better use of resources by eliminating its paper reporting requirements
• Transform a reporting process that used to take weeks into one that happens in a matter of seconds
• Identify patients at risk, and respond quickly to decrease their risks
• Answer tough business questions with only a few clicks of the mouse
• Create executive dashboards and scorecards that monitor vital business metrics
• Enable employees across the organization to make better decisions.

“As a nonprofit organization, we strive continually to improve the quality of the health care services we offer our members and patients,” says Jeff Guevin, Manager BI Administration at Martin’s Point. “IBM Cognos 8 BI enables us to identify health trends in our member/patient populations, and helps guide our quality improvement processes. The Cognos solution also provides our employees with resources that are easier to use.”

Reporting that brings value to the organization
“Because we are a nonprofit organization, we have to be conscious of delivering our services in the most cost effective way possible,” Guevin says. “We must also focus on the well-being of the patients and members we serve. Therefore, our true ROI is whether we can improve the clinical outcomes of members and patients. We need to make people healthier and drive down medical expense.”

With IBM Cognos 8 BI, Martin’s Point has improved the turnaround time for reports, which Guevin says is saving the company money. It is now able to measure its critical success metrics, such as the medical loss ratio, and publish these metrics to the appropriate audience electronically.

“Cognos tools have changed our whole paradigm at Martin’s Point Health Care,” he continues. “Prior to using Cognos software, a data request would take days or weeks for an analyst to process, given the nature of our older SAS system. Then, after we delivered the results, a change or edit might be needed. The request went back to the analyst for further work, and so the cycle continued.”

With the Cognos tools, that time is now measured in seconds, or clicks. In addition, the company now has a robust ETL process that can handle the many data sources. This adds up to happier customers – both external and internal.

“We are now able to improve service internally,” Guevin says. “With IBM Cognos 8 BI we can literally take our laptop into a meeting with our business users, ask them what they need to see and then drill down to different reports and analyze different aspects. The results are immediate. Questions are answered in a few clicks of the mouse and decisions can be made on the spot.”

“We’ve also saved time in terms of reconciliation to get to that single version of the truth,” he continues. “Instead of worrying about reconciliation, we consider what the numbers mean to the business. So it’s definitely a big shift in thinking.”

Innovations that support improved care
According to Guevin, quality improvement is backed by a commitment to staying at the forefront of technology. It’s about improving functionality through innovation.

Martin’s Point’s physicians and care managers experience the benefits firsthand. With IBM Cognos 8 BI, Martin’s Point is producing clinical profiles of its patients and alerting physicians about potential gaps in care. For example, if a patient with diabetes needs specific tests done in a timely fashion, a report can alert the member’s primary care provider that the missing tests should be scheduled.

“Cognos reports have become a ready tool in managing our chronic disease registry,” says David Hallbert, MD at Evergreen Woods Primary Care, a Martin’s Point practice. “We use them to track patients with such conditions as diabetes or heart disease - to make sure they have the follow-up they need to prevent complications. The registry is as easy as putting one word in the web browser and finding your panel of patients. We’re meeting our goals in qualifying for pay-for-performance through these tools.”

Martin’s Point also uses a third party predictive modeling product and integrates the output into its BI reporting. Care managers receive reports that help them determine which health plan members should be contacted first because they have a higher risk of future medical needs.

“Health care organizations have a responsibility to keep people healthy,” says Eric Place, Manager BI Reporting at Martin’s Point. “With the amount of patient information that we can get from the reporting tools, EHR and claims data, our customer care is improved. A doctor can single out his patients who are diabetic, and then find out if they are in control of their blood sugar. It might indicate that his office should contact that person to talk to them. So, patient care takes on a whole new meaning because specific risk factors can be analyzed.”

Thanks to IBM Cognos 8 BI, getting that information is fast and simple. “Before, it took a week,” says Place. “Now, the information is available upon request. In health care, there are thousands of diagnoses, and many things that affect the health status of a patient. It is so easy for a physician to just open up a dimension in Cognos, select the diagnosis of interest, and find the required information. It’s unbelievable compared to what we used to do to support our clinician’s requests.”

“Every time I show our health care providers the power that is at their fingertips to create these secure reports, analyze the data and deliver different output formats, their eyes just light up,” Guevin adds. “They are amazed.”

Business background and case for change
“We needed to reduce time spent on creating reports for managers and providers by standardizing our reporting on a scalable, Web-based system,” says Jeff Guevin. “Before, when the typical report request came in, the analysts would code it and then send the report back to the user for additional refinements. In all, it was frequently a two- to three-week reporting system process.”

Frustrated by the time it took to produce usable reports, Martin’s Point was looking for a user-friendly business intelligence tool that enabled its users to “point and click” for strategic reporting. After evaluating both Cognos and Business Objects, the organization chose Cognos, appreciating its simple integration process, ease of use and capability for aggregating and analyzing data.

“We needed fast, all-in-one BI software that put the answers to key strategic and business questions in the hands of our users with only a few clicks of the mouse,” Guevin says. “We have found this in IBM Cognos 8 BI.”

“Five years ago, our existing data warehouse had no real reporting functionality,” says Eric Place. “Working with Cognos partner Integration Management Incorporated (IMI), we built an ETL process in Microsoft ® SQL Server®. They recommended IBM Cognos software and the solution has grown from there.”

During the initial implementation, Martin’s Point deployed IBM Cognos Series 7 products into its Microsoft Windows Server 2003® operating system and SQL Server 2000 environments. They later used IBM Cognos PowerPlay® and IBM Cognos ReportNet® to aggregate data and provide a drill-down facility. In March 2006, the organization upgraded to IBM Cognos 8 BI and in April 2007, Martin’s Point moved to IBM Cognos 8.2, which has enabled a significant increase in analysis speed.

With IBM Cognos 8 BI, Martin’s Point was able to merge both the ReportNet and PowerPlay environments quickly into one common framework. This consolidation enabled users to access only one Web site, as opposed to the two separate sites they previously needed to work with.

The capacity for company-wide access and information sharing was also a huge incentive for Martin’s Point. “Most of our information today is now shared through portal pages,” says Guevin. “We create these reports and put them out on one of the portal pages. As an administrator, I’m able to control and actually add these portal pages to other users’ environments. Sometimes we’re dealing with nontechnical folks, so it’s a huge benefit for me to use IBM Cognos 8 BI to go behind the scenes, add the key portal pages that the typical user needs, notify them with a quick phone call and then allow them to scroll through the report with a click of a button.”

Today, Martin’s Point’s 80-plus trained users run about 300 reports on a weekly basis – touching all departments, from frontline workers up to the CEO. IBM Cognos BI 8 has also allowed Martin’s Point to create two executive dashboards and a scorecard that monitors corporate strategic goals for health plan enrollment.

The right tools for the job
In the future, Martin’s Point will continue developing dashboards and scorecards for the rest of the management team, including directors. It also plans to automate more processes by leveraging the watch rules and alert capabilities of IBM Cognos BI 8.3. With these capabilities, the organization will be able to better focus on reports when there is a significant change to the data, since there is often no use reviewing or delivering reports when the data has not changed over time. Watch rules and alerts save users’ time. The platform will also be extended to the committed Microsoft Excel® users on the Finance team by dynamically linking their Excel spreadsheet data with Cognos BI cubes via Cognos Analysis For Excel (CAFÉ). Ultimately, the team will expand functionality to meet the needs of the human resources department as well.

“Who knows what tomorrow will bring?” Eric Place asks. “Our job is to make sure we’re ready to meet needs as they arise. With the many different tools we have with IBM Cognos 8 BI, we can do that, but it’s important to use the right tool for the right situation. We are very fortunate that we have Informatics staff who can identify and translate our medical directors’ requests and then come back and deliver the results.”

It’s all about being cost-efficient. According to Jeff Guevin, IBM Cognos 8 BI has given Martin’s Point a set of tools that makes it easy for users at all levels within the organization to focus on the organization’s goals and mission. “We are able to not only keep an eye on the efficiency, but also improve the well-being of our members and patients by quickly identifying opportunities for intervention that lead to positive outcomes for their health.”

About IBM Cognos BI and Performance Management
IBM Cognos business intelligence (BI) and performance management solutions deliver world-leading enterprise planning, consolidation and BI software, support and services to help companies plan, understand and manage financial and operational performance. IBM Cognos solutions bring together technology, analytical applications, best practices, and a broad network of partners to give customers an open, adaptive and complete performance solution. Over 23,000 customers in more than 135 countries around the world choose IBM Cognos solutions.

For further information or to reach a representative: www.ibm.com/cognos