E-Fusion 2008
them together and we take a look at what’s the most effec- commissions and other operating expenses and ultimately
tive way to display them. Sometimes there are different coming up to our pre-tax income.
approaches to this but often this ends up building some
kind of prototype and then kicking the tires on that and
I talked about the drivers earlier so lets talk about some of
seeing how it really plays in real life. And then, as I men-
those drivers. Unfortunately I won’t be able to show you
tioned before, it’s building that performance management
this live. But if I were you’d see that as I move these slid-
infrastructure so that we can build out additional iterations
ers on the bottom of the screen, what would happen is the
either for this area or for other areas.
blue content above would actually move. So we’re doing
scenario analysis live in the dashboard and as we would
I’m going to give you an example of what one of the met- move those we’d be able to see the impact of increased or
ric trees looks like. This is a claims one. This is one I’ve decreased growth rate of our persistency, of our average
used with a few customers and this could be used for a premium, of any of the rest of the drivers – our loss ratio,
property/casualty company or a health insurance com- our commission rate and other operating expenses. I know
pany. So, I’m looking at the cost of claims processing and that Mark is going to show you some real life examples of
we talked about this is not the cost of the claim when I ways that they have used dashboards and scorecards and
say claim this isn’t the indemnity portion of the claim this other reporting at The Hartford following me.
is what is costs to process the claim itself. There are two
approaches, either a manual or auto adjudicated and of
Let me sum this up by saying some of the critical success
course it costs less to process automated claims handling.
factors – these are the reasons why we’ve seen customers
So if we’re talking about – for example – workers compen-
succeed at this. They’ve aligned those analytics with their
sation, medical bills can be pushed through some kind of
strategic initiatives. They’ve had high adoption through
a medical bill review program and auto adjudicated. Or if
using those metric frameworks in those role-based use
we’re talking about a health insurance claim it would be
cases. Meaning what’s in it for me? If I’m using the metrics
a similar approach. There are two routes, so on that auto
how do I do my job better? How do I get rewarded? We
adjudication one, it depends on the claims type, maybe
talked about that – the right information to the right user,
the claim source – meaning how did it come in for work-
the right format, the right time. There are also consistent
ers’ comp? Is it coming in via EDI? That certainly helps
drivers in metrics and again we talked about the data
push that process. What about the system availability? Is
– what happens when you have silos is that people will
our system up or down? Those are some of the things that
have different definitions for their metrics. And of course
will affect the auto adjudication rate or how many claims
we want to have consistent metrics and also consistent
can be pushed through. On the other side, it’s the manual
drivers. Companies look at their information as an asset.
turn around time, manual adjustment. Depending on your
They are also looking at that data integrity. Not just the
claims processing policy – meaning what types of claims
data integrity, but it’s also security and also that the sys-
do you want to have a human being touch and review?
tems can perform. And one of the trends that we’re seeing
Obviously large, clearly catastrophic claims are going to
is pushing these dashboards outside of the organization.
require intervention and manual. But we’re also looking at
Going out to agents to other business partners such as
the claims value. The number of people you have. If they’re
providers. They’re high engaged. They need communities,
training, etc. And then there are influencers – the under-
meaning that they’ve got senior management support and
writing policy, maybe the business mix. We talked about
also support within the business units that are adopting
the EDI enablement, so are those providers that are sub-
it. So it’s just not coming down from the top but really a
mitting claims EDI enabled.
passion for it in those areas. And then last, but not least,
it’s part of an overall program in it’s approach in a modular
Then at the bottom we’re looking at some of the dimen- and scalable way. So, with that note I would be happy to
sions, so you can read those as well as I can by product, turn this over to Lee to pass to Mark.
business line, procedure, CPT code, the inventory, how
many claims we have, why they’re pending – those are all
McDONALD: Wonderful presentation, Pat. Paul has a
different dimensions. And we look at what would help us
question that he’d like to address at this moment.
analyze in more detail later. So, that’s an example of what
a tree looks like. I won’t go through the use case with you
TINNIRELLO: Pat, super slides. Love it. You hit all the key
but one of the things that I would like to go through is just
issues that I was thinking about. One in particular you had
show you an example of the power of dashboards. I think
mentioned that I had started to talk about and that is col-
we’re all familiar with income statements – or P&Ls. If you
lecting the right information. When it comes to the metric,
think about the typical tabular income statement where
setting aside the tools that you’re actually using to show
you’re taking your revenue first or your premium being
the information, what do you recommend to organizations
your written premium. Here we’ve broken this down more
for them to choose the metrics that are most meaningful
graphically into new and renewal premium and then as you
to them as a company? Meaning, you don’t get out of it
can see it comes over to our earned premium. We’re also
unless you really put something into it. And the something
looking at the effect of investment income, our claims or
you put into it is really identifying how they need to mea-
benefits incurred. We’re also looking at our expenses – the

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