It’s a universal truth that a start-up idea can be born anywhere, anytime. But explosive success requires that the entrepreneur unlock the door to his or her own passion for the idea to really shine. A benefit plan manager himself, Paul Bogumill was utterly frustrated over the lack of risk management tools available to employee benefit plan managers. He perceived that data could be analyzed to reveal emerging risk, so he began collecting and storing data while managing a municipal self-insured plan in the US Northwest. Finding initial success, he then went on to form what today is known as DataSmart Solutions, an exciting, progressive data integration and analytics firm with singular focus on improving healthcare quality at lower cost for self-insured health benefit plans.
DataSmart and its predecessors have been improving healthcare quality for last two decades by accurately identifying individuals at greatest risk of imminent health deterioration and by following up with proactive, skilled intervention. Working together for 20+ years, DataSmart’s core team has refined online analytical and workflow tools to support population risk management programs for clients throughout the US. The customers of DataSmart enjoy a significantly lower cost-per-unit-of-risk than national averages. Well-known for best-in-class risk indexing, integrated work flow tools, and mastery of both claims and non-claims data files, DataSmart is a responsive, client-driven company that transforms data into actionable and valuable plan, provider, and healthcare recommendations.
Poised for Growth – A Team with All the Necessary Skills
To take DataSmart to the next level, its parent company recruited Jonathan Prince as CEO in 2015. Jon brings 35 years of business administration experience to the U.S. healthcare industry. As the CEO for DataSmart Solutions, he is responsible for seeing that DSS fulfills its mission to help raise the quality and significantly lower the cost of U.S. healthcare through predictive analytics. Prior to joining DataSmart, Jon worked 30+ years in financial markets with experience in sales, trading, management, business redesign, and client relations.
Enabling Digital Transformation
DataSmart does not drive digital transformation; rather, it enables the process. The firm provides the basic fuel (i.e. clean, integrated data and health risk indexing) for healthcare and technical professionals to be more effective and more efficient at what they do. DataSmart enables rapid transformation by delivering output in one of three specific forms; (1) machine-accessible integrated data (API), (2) powerful analytical reports, or (3) fully-integrated healthcare solutions that are put in place with a single handshake. DataSmart’s flagship product is the “CST” (Client Solutions Tool), a webportal that rests above DSS’ vast database of current medical and RX claims data and other non-claims data elements. Users enjoy an easy-to-use platform that integrates clinical, financial, and workflow data into a complete risk management system capable of reducing costs and improving healthcare quality. Useful to actuaries, providers, and insurance professionals, the CST summarizes data at both the plan and the participant level and is the only online tool that converts non-claims data into risk scores comparable to Johns Hopkins ACG® risk scores. The CST also features user-defined population control, filtering and sorting, and complete data exportability. Standard CST reports include plan evaluations, member analyses by risk and disease cohort, plan analysis and recommendations, concurrent and prospective member risk scoring, care density analysis, and a detailed analysis of key cost drivers. Priced on a formulaic, per-employee-per-month basis, the DSS CST provides users with everything needed to manage down the annual healthcare spend.
Leading the way in a crowded field
DataSmart outsmarts its competitors in two ways. The first relates to its analytics. “Many healthcare analytics companies make both claims and nonclaims data available to their clients, but to the best of our knowledge, DSS is the only firm that features a dashboard option to include nonclaims data (e.g. biometric data, blood screen results, etc.) in risk scores that are comparable to traditional Johns Hopkins ACG® risk scores. This is a crucial difference because at any point in time, 10-20% of the members in a health plan are not significant users of healthcare resources and do not generate observable claims,” Jon asserts. Yet, in many cases, this informationally silent minority often accounts for many of the high-cost participants in the following plan year. “DSS’ analytics not only detect, but also prioritize, these emerging highrisk plan participants, relative to other participants in the pool. In short, our competitors are reporting historical information on only 80-90% of a population and, in effect, are driving by watching the rear-view mirror,” he adds. “Thanks to a proprietary codevelopment relationship with Johns Hopkins, DataSmart is looking ahead at the emerging health of all plan participants.”
A second way DSS distinguishes itself is by simplifying its analytics. Rather than asking the managers of small selfinsured plans to become clinical care coordinators, DataSmart has simplified its output and encourages the use of competent clinical care coordination teams to ensure that action is taken. DataSmart also embeds bundled solutions (analytics plus care coordinators) into complete selfinsured benefit packages. This is why DataSmart is named, DataSmart Solutions, rather than DSS Analytics. Analytics, alone, are not enough.
Initial Challenges along the Way
Listing the initial challenges that DataSmart faced, Jon states that simplifying the output for customers was an important hurdle to overcome. The original tools produced rudimentary reports that were best interpreted by individuals who, like Paul, had a working knowledge of benefits, medicine, and the economics of healthcare. Using these tools was somewhat like asking children on a playground to interpret complex electronic schematic diagrams. Over the years, advances in visualization, web-access, and experience made the tool internet-accessible, simple, and easy-to-use. “Along the way we also encountered challenges in matching member IDs. As we integrated large data sets, we found that we needed to develop our own algorithms to produce nearly error-free ID matching,” Jon recalls.
Motivating Clients to Strive for Cost Control and Quality Healthcare
DataSmart sits atop an excellent “crow’s nest” of information – observing the plan performance of all of its client groups. By expressing plan performance in a common metric (e.g. cost per unit of risk), DataSmart can compare and spot over-achievers and under-achievers among clients and provide such anonymous rankings and benchmarking data to clients for their own performance monitoring. This feedback is essential, as it informs clients and motivates them to strive for higher levels of cost control and quality healthcare. DataSmart also urges clients to use its analytics in connection with competent care coordinators, either within packaged products or independently. The company’s analyses can save money and improve health only if acted upon, and entities occasionally fail to take this final step. Lastly, DataSmart prides itself in being highly responsive to client needs. Since DataSmart is comparatively small, relative to some competitors, Jon notes that DataSmart can turn on a dime (and does) in order to meet the technology and information needs of clients.
Looking ahead, DataSmart is committed to remain a leader in moving the industry from fee-forservice contracts to a value-based healthcare paradigm. “What places us in excellent position to do this is our mastery of the related data. We routinely quantify the financial and health impact of factors such as facilities, providers, medications, sitesof- care, procedures, and benefit plan variables like deductibles, copayments, and co-insurance. Regardless of national healthcare policy, data will open the door to its optimization, and DataSmart will be there,” he concludes.