Accenture Information

Management Services

Helping Helsana achieve high

performance through improved
claims data management
and business intelligence
Helsana Versicherungen AG (Helsana) is
the leading health payer in Switzerland,
providing coverage to nearly 2 million
individuals, families and organizations
across the country. In 2007, the company
reported revenues of US$4.8 billion.
Business challenge
Accenture’s experience and ongoing
High Performance Business research
initiative have revealed that leading
companies set themselves apart
by developing hard-to-replicate
capabilities in critical areas of their
business. For health payers, few areas
of the business are more important
than claims management and
marketing. Companies that master this
functional area are better positioned
to outperform their industry peers over
the long term. What is their secret?
Accenture’s experience suggests data
warehousing can play a major role.
Specifically, the most successful payers
excel in several key areas, including
capturing and analyzing critical data,
and making that information available
to claims and other systems to
support greater product diversity and
complexity, regulatory scrutiny and
demands for faster service.
While Helsana understood the data
management imperative, its existing
data warehouse was no longer up to
the task. The infrastructure struggled
to handle the volumes and types of
data needed by Helsana’s staff and
by the Swiss government, which had
recently introduced new information
standards and detailed reporting
requirements. In addition, the aging
infrastructure was increasingly
unstable and not well suited to support
new applications. The data structure
was inflexible and did not easily
accommodate the creation of new
reports. Data quality and data mining
capabilities were lacking. Finally, the
system offered limited possibilities
for decentralized data analysis.
Helsana wanted to implement a
new data warehouse that could
address these limitations, satisfy new
legislative reporting requirements
and contribute to a reduction
in claims related costs. For help
in bringing its data warehouse
solution to life, the carrier turned
to Accenture. Accenture provided the
unique combination of technology
and business experience needed
to design and implement a data
warehouse that would more
effectively support Helsana’s business
processes. In addition, the company
brought deep industry skills, leading
systems integration experiences and
information management expertise,
as well as a proven record of helping
health payer companies achieve high
performance.
How Accenture helped
To help Helsana design and launch
its new data warehouse, Accenture
assembled a team of consulting and
technical experts, as well as resources
highly skilled in data management and
business intelligence who form part of
Accenture Information Management
Services, a global organization
dedicated to delivering information
management solutions. As a first
step, this team worked with Helsana
personnel to define the organization’s
data requirements and the components
of a successful business intelligence
capability, including the conceptual
data model, data warehouse
architecture, data migration approach,
implementation plan and business
case.
Accenture carried out an unbiased
evaluation of a number of software
packages and database solutions that
would support Helsana’s information
management objectives. Based on
the evaluation findings, Helsana
selected a database solution from
Teradata, data mining and analytics
applications from SPSS Clementine,
and business intelligence software
from Cognos. The team relied on
Accenture Delivery Methods, as well
as Accenture’s longstanding global
alliance relationships with Teradata
and Cognos (an IBM company) to
help manage the data warehouse
design and development processes,
build a proof-of-concept technical
infrastructure and establish a new
reporting environment.
The cornerstone of the data warehouse
is a two-terabyte database integrated
with relevant software; reference data
from government and national health
department sources; Helsana’s core
data source systems; and a number
of Helsana’s existing applications.
An important feature of the new
data warehouse is a customized
interface that provides easy access
to department-specific product lists,
which had previously been maintained
using standalone spreadsheet
applications. Having product lists
integrated and available within the
data warehouse environment makes it
possible for Helsana’s various business
departments to more quickly create
the reports they need.
As the data warehouse was being
rolled out, Helsana decided to
establish a dedicated business
intelligence unit that would
concentrate all of the organization’s
reporting, data mining and analytical
activities in one place. Once
again,Helsana asked Accenture
for help—this time to develop a
governance structure for the new
unit, as well as new processes,
responsibilities and role-based data
access rights for the department’s
super users, report creators and data
analysts. This effort marked the first
of many additional projects that
Helsana has awarded to the company.
Today, based on the success of its data
warehousing and business intelligence
work, Accenture serves as a strategic
advisor, program manager and systems
integration provider on a number
of projects, ranging from claims
department reorganization to post-
merger integration.
High performance delivered
With Accenture’s help, Helsana has
created a robust data warehouse, a
superior data management capability
and a dedicated business intelligence
unit that fully supports the carrier’s
data management requirements.
Helsana’s new approach to
information management has
created the type of distinctive
and hard-to-replicate capability
that sets high performers apart.
Helsana has experienced
improvements in a number of areas.
For example, the new data warehouse
uses an enterprise data model that
boosts data quality, enables more
effective data mining and supports
daily data loads from source systems.
It also allows Helsana to carry out
better, faster and more consistent
reporting. In fact, reports can now
be generated daily. This stands in
stark contrast to the weekly or
monthly reporting schedule that
was the norm with Helsana’s previous
data warehouse. The frequency of
reporting today means Helsana
gains more accurate insights into
its business. Personnel can access
more detailed information—and use
that information to make quick and
meaningful decisions and to act
swiftly on sales opportunities and
claims. Importantly, the new reporting
capabilities have allowed Helsana
to meet the Swiss government’s
requirement for detailed reports.
In the area of analytics, the business
intelligence unit—supported by a
robust governance structure and
new business processes—is able to
apply sophisticated analytical tools
to gain insights that would previously
have remained hidden. For example,
analytics now help Helsana identify
instances of insurance fraud and
abuse more quickly, assess the quality
of care providers more accurately, and
examine claims data in tremendous
detail. In addition, because the
database stores historical data
records, Helsana staff can review
information as it was at any point
in time.
These information management
improvements are helping position
Helsana for high performance.
Executives can now use the data
at their disposal to react to business
and market changes more quickly.
Sales and marketing teams use
the data to improve their lead
identification activities. They also
are able to achieve higher closing
ratios, which is especially important
during the crucial renewal season.
Perhaps most importantly, improved
data quality and visibility—along with
access to new analytical tools—have
helped Helsana reduce its claims costs
by more than US$10 million per year.
These improvements are setting the
stage for long-term success. According
to CEO M. Manser:
“ Helsana now has a strong, future-
oriented business intelligence and
data warehousing capability that
supports our core business processes.
Accenture, with its deep technical
and business experience, has helped
us develop a data infrastructure
that is fast, scalable and reliable.
That infrastructure, in turn, helps
us understand our business and the
risks of our insureds more clearly. It
contributes to improved operational
and financial performance. And it
enables us to deliver better products
and services to meet the needs of
our customers.”
About Accenture
Accenture is a global management
consulting, technology services
and outsourcing company.
Combining unparalleled experience,
comprehensive capabilities across
all industries and business functions,
and extensive research on the world’s
most successful companies, Accenture
collaborates with clients to help
them become high-performance
businesses and governments. With
approximately 177,000 people serving
clients in more than 120 countries,
the company generated net revenues
of US$21.58 billion for the fiscal year
ended Aug. 31, 2009. Its home page
is www.accenture.com.
Copyright © 2009 Accenture
All rights reserved.
Accenture, its logo, and
High Performance Delivered
are trademarks of Accenture.
About Accenture Information
Management Services
Accenture Information Management
Services is a global cross-industry
organization focused on bringing
clients solutions to better manage
their business, interact with
customers and make strategic,
financial and operational decisions.
Working across Accenture’s service
lines and industry groups, this
network of 16,000 professionals
specializes in information
management services including
business intelligence, portals and
content management and data
management and architecture. For
more information about Accenture
Information Management Services,
visit www.accenture.com/information
management.
About Accenture’s Health
Industry Practice
Accenture’s health service group
provides innovative solutions to
both the private and public sectors
of the health care industry, including
integrated health care providers, health
insurers, managed care organizations
and public health organizations. The
company has thousands of resources
dedicated to helping organizations in
the health industry achieve and sustain
high performance.
For more information about how
Accenture can help your organization
achieve high performance please
contact:
Glenn L. Gutwillig
Executive Director, Accenture
Information Management
Services–Products, Global
glenn.l.gutwillig@accenture.com
David J. Pierce
Senior Director, Business
Intelligence, Global
david.j.pierce@accenture.com