Information Builders Case Studies FirstCare Health Plans Uses WebFOCUS to Manage Rapidly Growing Business

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	FirstCare Health Plans Uses WebFOCUS to Manage Rapidly Growing Business Information Builders

FirstCare Health Plans Uses WebFOCUS to Manage Rapidly Growing Business

Information Builders

Technology Category	Analytics & Modeling - Predictive Analytics Analytics & Modeling - Real Time Analytics
Applicable Industries	Healthcare & Hospitals
Applicable Functions	Business Operation Quality Assurance
Use Cases	Predictive Maintenance Real-Time Location System (RTLS)
Services	Data Science Services System Integration
Challenge	FirstCare Health Plans was facing a challenge due to its reliance on two different claims systems and data warehouses, disparate reporting systems, and a lack of Key Performance Indicators (KPIs) for finance, in-patient care, sales, pharmacy, and other functional domains. The company was experiencing a growing volume of claims that required manual intervention due to the expansion of its membership with new plans for the Texas Health Insurance Exchange. The company was looking for a solution that would not require an increase in internal staff members to support the growing workload. Read More
About Customer	FirstCare Health Plans is a healthcare provider that has been serving the healthcare coverage needs of members across North, West, and Central Texas since 1985. The organization offers a wide range of HMO, PPO, ASO, and ancillary products through a variety of programs, including small and large employer plans; state, federal and teacher plans; government programs; new private market plans; and the health insurance marketplace. The company is committed to providing access to high-quality, affordable healthcare. Read More
Solution	FirstCare Health Plans implemented Information Builders’ WebFOCUS business intelligence (BI) analytics environment to streamline its healthcare reporting systems to meet government guidelines. The company used WebFOCUS to create BI dashboards reflecting current claims volume, revenue, membership, expenses, medical loss ratios, and other important variables. The BI team also created key performance indicators (KPIs) that tie annual goals to revenue, membership, and administrative expenses. By incorporating goals into the dashboard gauges, managers can see how their departments are performing in relation to those goals. Red, yellow, and green indicators help them spot trends at a glance. An executive summary provides a high-level view broken down by department. Read More Log in to view content
Contents

Technology Category

Analytics & Modeling - Predictive Analytics

Analytics & Modeling - Real Time Analytics

Applicable Industries

Healthcare & Hospitals

Applicable Functions

Business Operation

Quality Assurance

Use Cases

Predictive Maintenance

Real-Time Location System (RTLS)

Services

Data Science Services

System Integration

Challenge

FirstCare Health Plans was facing a challenge due to its reliance on two different claims systems and data warehouses, disparate reporting systems, and a lack of Key Performance Indicators (KPIs) for finance, in-patient care, sales, pharmacy, and other functional domains. The company was experiencing a growing volume of claims that required manual intervention due to the expansion of its membership with new plans for the Texas Health Insurance Exchange. The company was looking for a solution that would not require an increase in internal staff members to support the growing workload.

About Customer

FirstCare Health Plans is a healthcare provider that has been serving the healthcare coverage needs of members across North, West, and Central Texas since 1985. The organization offers a wide range of HMO, PPO, ASO, and ancillary products through a variety of programs, including small and large employer plans; state, federal and teacher plans; government programs; new private market plans; and the health insurance marketplace. The company is committed to providing access to high-quality, affordable healthcare.

Solution

FirstCare Health Plans implemented Information Builders’ WebFOCUS business intelligence (BI) analytics environment to streamline its healthcare reporting systems to meet government guidelines. The company used WebFOCUS to create BI dashboards reflecting current claims volume, revenue, membership, expenses, medical loss ratios, and other important variables. The BI team also created key performance indicators (KPIs) that tie annual goals to revenue, membership, and administrative expenses. By incorporating goals into the dashboard gauges, managers can see how their departments are performing in relation to those goals. Red, yellow, and green indicators help them spot trends at a glance. An executive summary provides a high-level view broken down by department.

Impact #1	With WebFOCUS, FirstCare has increased the efficiency of claims processing and other internal activities, driving greater satisfaction and loyalty among members and providers.
Impact #2	The BI team finds itself responding to fewer requests for ad hoc reports. This frees up team members to work on new types of projects.
Impact #3	Reports and data that were previously gathered from disparate areas have been brought together into one cohesive view.

Impact #1

With WebFOCUS, FirstCare has increased the efficiency of claims processing and other internal activities, driving greater satisfaction and loyalty among members and providers.

Impact #2

The BI team finds itself responding to fewer requests for ad hoc reports. This frees up team members to work on new types of projects.

Impact #3

Reports and data that were previously gathered from disparate areas have been brought together into one cohesive view.

Benefit #1	At the outset of the BI project, FirstCare had a pending inventory of 80,000 claims. After automating its claims reporting process, it reduced that number to 6,000.
Benefit #2	The company's adjusted inventory was more than 60,000 appeals from providers, generally for claims that they felt had not been paid correctly. This was reduced to close to 10,000.

Benefit #1

At the outset of the BI project, FirstCare had a pending inventory of 80,000 claims. After automating its claims reporting process, it reduced that number to 6,000.

Benefit #2

The company's adjusted inventory was more than 60,000 appeals from providers, generally for claims that they felt had not been paid correctly. This was reduced to close to 10,000.

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Overview

FirstCare Health Plans Uses WebFOCUS to Manage Rapidly Growing Business

Operational Impact

Quantitative Benefit