Meridith Levinson

CIO (U.S.)

Two years ago, John Ounjian, senior vice-president and CIO of Blue Cross and Blue Shield (BCBS) of Minnesota, managed to convince General Mills Inc., a US$8 billion consumer goods giant, to join his regional health plan on the basis of a promise: He would soon be installing a Web-based customer service system that would let subscribers manage their health benefits online. Subscribers would be able to select health plans tailored to their individual needs and wallets, calculate their own contributions to their coverage, research information on prescription drugs and other treatments, locate participating physicians, and check the status of their claims.

Selling a product that didn’t exist was the easy part. The hard part, Ounjian says, was planning and building a CRM system that would live up to the assurances he gave executives at General Mills. To implement that system, he had to install a brand-new infrastructure to integrate his Web and call center operation and to provide timely, accurate information to customers. And he had to migrate millions of bytes of data stored in back-end databases to the Web front end — massaging and reformatting the data so that consumers could understand it.

Ounjian pulled it off. As a result of the online customer self-service system his IT staff finished implementing in January 2002, BCBS of Minnesota has not only met the specifications of General Mills, but the $5 billion plan has also managed to beat national providers Aetna, Cigna and Humana out of several very large accounts such as 3M, Northwest Airlines and Target.

Ounjian says his company’s membership grew by 10 per cent, or 200,000 new members, in 2002, largely because of its online customer self-service system. Even more remarkable, BCBS of Minnesota experienced that growth in membership at a time when several national insurers lost millions of members. Cigna, for instance, lost 10 per cent of its membership in 2002 due in part to a botched customer self-service system implementation.

“We all have to have this capability; that’s not what’s going to differentiate us,” Ounjian says. “It’s how you execute these functions, how you bring the customer on board that makes all the difference.”

Doing It Right

There isn’t an industry better suited to online customer self-service than health insurance, which can intimidate and confuse even the savviest consumer. What patient wouldn’t forgo her provider’s cumbersome toll-free number – with its long hold times – in favor of a Web-based solution that allows her 24/7 access to all kinds of health-care answers?

In addition to offering a viable solution to customer problems, Web self-service also provides the necessary foundation for delivering health plans tailored to individual consumers’ needs – a direction in which the industry is moving to cut managed care costs.

But implementing such a sophisticated online system required Ounjian and his staff to overcome some head-scratching hurdles that have hobbled the efforts of national insurers. The difference, Ounjian likes to think, was in the planning. To begin with, he and his staff realized they’d have to lay down a whole new infrastructure, or “chassis” (Ounjian is fond of automotive metaphors), for automating interactions with consumers that had previously taken place over the phone. And in the process of automating transactions, they’d have to devise a sound data management strategy to overcome the problems that arose when they tried to move raw data from back-end systems to the Web front end. If they didn’t come up with a cohesive plan for moving data back and forth, they risked having customers looking at information that was out-of-date, inaccurate, or that varied across the Web and call center channels.

Ounjian says building an online customer self-service system without a data management strategy is like building a bridge without support. “If you don’t have a data management strategy, then you’re only building half the bridge,” he says.

The actual infrastructure for BCBS of Minnesota’s website and customer service system is made up of Aspect Communications’ communications platform, Kana’s e-business platform, BEA’s WebLogic application server and Oracle databases. The Aspect platform provides the computer telephony integration, the interactive voice response unit, the Web interaction technology and the queuing engine that directs calls to the appropriate call center agent. In addition to the e-business platform, which integrates with the communications platform from Aspect, Kana provides e-mail management software as well as an application to track communication between call center agents and customers so that BCBS of Minnesota knows who called, when they called and whether their issues were resolved.

Ounjian is using Oracle databases on the front end to reassemble and synchronize back-end data so that consumers find consistent, timely information regardless of whether they use the Web channel or the call center channel. Ounjian says he’s using different vendors for the various components of the Web self-service architecture because there’s no one vendor that supplies everything one needs for an integrated CRM system. He wanted the flexibility to layer different applications and functionality from different vendors on top of his infrastructure.

Making Data Sense

Ounjian’s biggest headache was devising a tactical strategy for moving data and transactions from the front end to the back end and vice versa. Making millions of bytes of back-end data available and understandable to users on the front end is one of the biggest challenges for any successful CRM project, regardless of industry. If you can’t get accurate information to your customers in a format that they understand, they won’t use your system. The number of records (100 million) that Ounjian and his staff had to migrate made the task even more daunting.

Explanations of benefits, for example, were stored as codes that were meaningless to consumers. Those codes needed to be put in terms end users could understand. Ounjian says his staff built a data dictionary for all the codes that included their equivalent English definitions. It essentially matches up raw back-end data with the appropriate translation for consumers on the front end.

In the past, when mail the insurer had sent to customers was returned because the address it had in its files was no longer correct, BCBS of Minnesota actually entered “bad address” into the address files on its legacy systems and would fill the ZIP code field with 9s to denote that the address was no longer correct. But now that its back-end data is customer-facing with the new customer self-service system, BCBS of Minnesota can’t risk having a customer see “bad address” or 99999 as his ZIP code when he pulls up his file. So these days, whenever the company has mail returned, it immediately corrects the address in its legacy systems.

In addition, ZIP codes stored in back-end databases had been compressed from nine digits to eight in order to save money on storage. Ounjian and his staff had to expand those ZIP codes back into their nine-digit form for consumers on the front end.

Ounjian believes the reason why so many CRM projects – not just in health care but across industries – run into problems or fail altogether is because they aren’t grounded by an underlying plan for transferring data that originates in one system and in one form to another system in a different form.

Once Ounjian and his staff ironed out the data issues and developed a prototype of the new website, they invited customers to test it in a focus group. During those initial trials, they found the site wasn’t all that consumer-friendly. For example, they discovered that they needed to change the organization of the pull-down menus that guide viewers around the site. The engineers changed the arrangement of pull-down menus so that it better reflected how laypeople move around the site.

On Jan. 1, 2002, Ounjian finished the first phase of his company’s new customer self-service system. Phase one consisted of redoing the infrastructure and offering such online services as a provider directory, the ability to check one’s membership information, view claims and contact BCBS of Minnesota’s customer service department via e-mail. Phase two was completed on Jan. 1, 2003, and consists of a product called Options Blue, which lets customers obtain explanations of their benefits, calculate contributions to their health coverage, and check their deductibles and out-of-pocket maximums online. Customers can now also order prescriptions by mail, estimate the costs of prescriptions and medical procedures, order new ID cards, and find participating pharmacies.

One customer that came on board because of the new self-service system is Northwest Airlines, which switched over from Cigna on Jan. 1, 2002. Tim Meguinnes, vice president of employee benefits, says his company is happy with the way the online system is running. “It is a wonderful little tool,” Meguinnes says. “Our employees can look up claims information, get access to information about their maladies and order new ID cards.”

The system is currently being used by 61 employers with 450,000 individual employees, according to Richard Neuner, chief marketing officer of BCBS of Minnesota, who is excited about the new service. Neuner and Ounjian hope to grow that number in the coming year.

Unable to resist yet another car metaphor, Ounjian concludes, “We have the chassis on which to build our investments from year to year. If my transmission needs to move from a three speed to a five speed, I don’t have to redesign the whole car.”

Executive Summary

Blue Cross and Blue Shield of Minnesota’s new Web-based customer self-service system has led to a 10 percent growth in customer base and attracted major clients away from competitors. The system’s critical success factor was linking back-end and front-end systems and data migration. Customer data stored in databases needed to move to the Web front end, where it had to be reformatted to make sense to consumers. A data dictionary for all the specialized coverage codes matched each to equivalent English terms. ZIP codes, compressed to save money, were modified so that consumers wouldn’t be perplexed by the shorthand. BCBS then invited prototype testing. Case analyst Wendy S. Close says the attention to data migration and reformatting with the consumer in mind were two of several best practices BCBS used.

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