Cure for the Blues

The US health insurance industry is one of the more difficult economic sectors in which to compete. Even as health insurance premiums continue to increase at double digit rates, the stock prices of the largest health insurers have dropped by a third or more this year as rising medical costs take a bigger bite out of their revenue. Meanwhile many insurers are criticized for cutting back on coverage and customer service, while they continue to spend heavily to comply with federal health information privacy laws.

With an estimated $US1.6 billion in revenue this year, Blue Cross and Blue Shield of Kansas City (BCBSKC) is a relatively small player in this multibillion-dollar market, competing against companies more than 10 times bigger in a 30-county area in Northwest Missouri and the two most populated counties in Kansas that make up Kansas City. Nevertheless, BCBSKC is the largest health insurer in the region, providing coverage for 900,000 people and garnering a 42 percent market share.

CEO Tom Bowser wants to expand the company's customer base by as much as 300,000 by 2010, and he believes information technology will allow him to do it. But he wasn't always a hard-core believer in IT. As the company's chief operating officer during most of the 1990s, Bowser saw IT project after IT project fail.

Then company executives decided to invest $US50 million in a legacy systems upgrade, at the same time outsourcing applications such as data warehousing and electronic claims processing, as well as functions such as application development. Bowser calls the transition traumatic but worth it. In his view, outsourcing lowered the risk of future IT failures.

Bowser attributes much of BCBSKC's recent success to this strategy, which leaves the 200-person IT department under CIO Kevin Sparks to focus on integration projects that differentiate BCBSKC from its competitors and improve customer service. As a result of this strategy, Bowser says, between 2000 and 2005, the company

• served 15 percent more customers with 10 percent fewer employees
• decreased administrative expenses from 21 percent of revenue to about 13 percent
• provided the best customer service levels in the Kansas City metropolitan region, as ranked by doctors, hospitals, brokers, customers and other constituent groups
• increased its customer service scores from the bottom quartile to the top quartile among all 38 BCBS groups nationwide, as measured by criteria such as timeliness and accuracy when managing enrolment, claims processing and inquiries.

"These are all very tangible and meaningful measures of benefits we've received from our IT investment," Bowser says.

BCBSKC's IT department is the brains behind a pilot program launched in 2006 that is designed to help BCBSKC customers reduce their health insurance premiums — and help BCBSKC cut its costs — through customized wellness programs.

Under the program, called "A Healthier You", customers can save $US120 per year on their health insurance premiums. Individuals enrol online and provide their personal health information, including family medical history, data such as blood sugar and cholesterol levels, and any health concerns that may not show up in their medical records, such as depression or a nagging pain.

Once a certain number of individuals from a group (such as a company) are enrolled in the program, BCBSKC aggregates individuals' health information to identify common health problems within the group's population. Individuals within the group are given information on how to take care of the health risks BCBSKC has identified (collectively improving these problems means reduced group premiums). Meanwhile, BCBSKC electronically sends the information to the nurses and doctors who work with the individuals, so they can support the insurers' recommendations.

CIO talked with Bowser about his evolving appreciation of IT, his relationship with Sparks and his philosophy about how technology should support BCBSKC now and in the future.

Join the CIO Australia group on LinkedIn. The group is open to CIOs, IT Directors, COOs, CTOs and senior IT managers.

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