Tricia Trebino, CIO, Tufts Health Plan A quick visit to Tufts Health Plan's Web site - www.tuftshealth.com - and you can see that the Waltham, Mass.-based healthcare plan with $2.3 billion in revenue is busily forging partnerships to provide ever-greater services and products to its members, employers, brokers and providers. As CIO of Tufts, Tricia Trebino looks for technologies that enable the organization to forge these partnerships quickly and painlessly, and she is eager to identify new ways to leverage legacy core systems to provide better service to Tufts' 747,000 members, 85 hospitals and 20,326 physicians.
I&T: What are the major components of Tufts' technology strategy?
Trebino: Tufts is interested in partnerships and taking advantage of niche products available to the healthcare industry. To support that strategy, we focus on making sure that we have the infrastructure in place that enables us to launch products or partnerships within one or two months rather than taking an extended time to do so. For example, we are looking at consolidating data into an operational data store using an Oracle (Redwood Shores, Calif.) database so we can share data with partners more readily. We also are using an enterprise application integration (EAI) engine from TIBCO (Palo Alto, Calif.) to surround our core systems with common rules and data so we can quickly integrate new products or partnerships.
I&T: In what types of partnerships is Tufts engaged?
Trebino: One initiative is an alliance with CIGNA HealthCare (a division of Philadelphia-based CIGNA Corp.; $1.4 billion in 2004 net income) that will enable us to offer national provider discounts to our member companies that are based in Massachusetts but have employees located throughout the U.S. Also, we just did a partnership with American Healthways (Nashville) to offer disease management to self-insured employer groups. We wouldn't have been able to do that partnership without the ability to send data back and forth. We've got many of these types of partnerships - it makes sense to use an already competent company or product so you can bring initiatives to market more quickly than if you developed them in-house.
I&T: What is Tufts doing in the area of consumer-directed healthcare?
Trebino: We've had a suite of consumer-directed products for some time. Our Liberty Plan is a partnership with Destiny Health (a subsidiary of New York-based Guardian Life Insurance; $39.5 billion in assets) that we launched in early 2004. Our other consumer-directed products include Navigator and Advantage, both of which we developed in-house.
I&T: Are you working on electronic medical records?
Trebino: There is a local group that is studying electronic medical records, and we participate in that group, but we are not actively pursuing electronic medical records. That initiative is more active on the hospital side than on the insurer side. To succeed, electronic medical records need to be driven by industry collaboration. It is very difficult to engage different organizations in electronic medical records without common standards and common software.
I&T: What's the role of the e-business strategic planning team that Tufts created in 1999?
Trebino: I chair the e-business team, but it's really a cross-functional team consisting of eight to 10 vice presidents or senior vice presidents who represent various aspects of the business, such as sales, strategy and planning, and finance. In addition to focusing on customer-facing technologies, the team also works to improve internal efficiency, such as driving a Web enrollment product that is customer-facing but also allows us to reduce administrative costs.
I&T: What types of initiatives has the group spearheaded?
Trebino: We are working on a broker portal that allows brokers to get automatic online quotes for small businesses. It's an efficiency play for us, plus it allows brokers to get a quote much more quickly.
On the member side, we continue to provide a lot of information on our member portal. We've always had a lot of content and transactions online, but we are adding benefit summaries, claims history, referral history and the like. Our emphasis is to make the portal very accessible to the member.
On the provider side, we are doing a lot with provider reporting. We've had provider transactions out there for a long time, and now, we are working on Web reporting so our providers can have access to our data and use it to understand their utilization and their practice patterns. For the provider, our main emphasis is on medical management initiatives and doing what we can to lower the costs for medical services.
I&T: Tufts is involved in the eRx Collaborative, a pilot to promote and enable the adoption of electronic prescribing. What challenges did the eRx Collaborative face?
Trebino: It's always a challenge to get a group of people to agree on selecting a single vendor and defining the scope of work. In this case, everybody was very motivated. The biggest challenge may be yet to come. Right now, the plans involved in the collaborative - including Tufts, Blue Cross Blue Shield of Massachusetts (Boston; $7.8 billion in revenue) and Neighborhood Health Plan (Boston; a not-for profit health maintenance organization) - finance the collaborative. But down the road, if this gets adopted in a widespread way, we may need to find a new way to fund it. We haven't resolved how to handle that, and it will present a challenge.
I&T: What emerging technologies will have a significant impact on the insurance industry?
Trebino: Perhaps electronic medical records, but I think that technology is more than three to five years away from being viable. The big shift will be in technologies such as Web services that enable us to get at the data that supports consumer-directed products. Right now, the industry is in a period of experimentation as we try to move members into understanding their healthcare and the costs and engage them in managing those costs.
I&T: Any secrets to keeping and motivating staff?
Trebino: We're doing interesting work and that helps. We're making an effort to show staff the contribution that they are making - that they are not just off in a corner coding, but are doing work to improve healthcare affordability.
I&T: Do you outsource?
Trebino: We have about 250 internal IT staff, and we do have a partnership for some application development outsourcing with Keane (Boston). Most of that work is done in Nova Scotia. We started outsourcing about four years ago, and it's been extremely successful.
I&T: Any hardware or software that you consider outstanding?
Trebino: TIBCO really has changed the way we think about our technology strategy because it allows us to support multiple core systems in a more efficient way. In the past, if you were CIO and you had three systems, you wanted it to be two. If you had four systems, you wanted it to be three. Now, I don't think about systems in that way as much because a lot of the logic is in layers that surround the core. You integrate only one time with the layer and not three times with the three systems.
I&T: Are you looking at retiring any legacy systems?
Trebino: Not at the moment. It's a huge investment and a huge risk to move to another core system. The market has changed somewhat in that there are fewer large core systems being built and more niche products that you can buy. You can buy a stand-alone enrollment billing module. You can even buy a stand-alone pricing module. These products weren't available several years ago. Instead, you had to buy the whole core. EAI permits us to expand functionality without the significant disruption of a core system replacement.
I&T: What has been your greatest accomplishment at Tufts?
Trebino: I've been here 11 years - I have a wonderful team with which I've worked very closely to build a customer-focused organization with consistent, repeatable processes that reduce errors. We never do anything for the sake of introducing a new technology. We have very strong IT capabilities and work side by side with our end customer.