Sramana Mitra: Talk about the data itself. What is in the data, and what are you doing to handle these big data problems?
Mike Byers: The data we manage and collect plays into an entirely new component of the business a fairly substantial opportunity that is in front of us today. The data we refer to is the individual component that makes up a medical plan, for example. You have a medical plan and there is a copay for an emergency room visit. That would be an element within the data set we collect and manage. Imagine an environment where you have 150-200 different medical plans or 30-50 different retirement plans. There are a lot of different components that make up all those different plans. Historically, within large organizations, that data was highly disaggregated across the business, meaning there was no central place where somebody could get access to that information. A lot of that information was in written form and in a binder.
Pulling that information together within one company is compelling. If I look at our new business opportunity, which is selling into the health insurance payer space, imagine an environment where you have something on the order or three million members who are receiving health insurance from you. What we are finding in the payer’s space is a very similar problem, but at a much greater scale, meaning that they historically hadn’t done a great job of aggregating all the plans they sell and all the data components that make up those plans into one system of records.
Our product is used in some situations – as a new market opportunity for us – that this data, either structured or unstructured, gets stored in one repository and then is being re-purposed to solve other related business problems. As an example, there is a component of the Affordable Care Act that requires something called a summary of benefiting coverage to be prepared every year and presented to a member of that plan. But if you don’t have your information in one place, it makes it extraordinarily difficult to create that document and provide it to a plan member on a timely basis. That is a big problem that HighRoads is solving. It truly is a big data problem, because the amount of information that a reasonably sized payer has is significant.
SM: Explain the details of your SaaS-based architecture and how it integrates with the existing infrastructure technology being used by payers.
MB: When payers use HighRoads as their plan system of record, plan information is stored as “poly-structured” data, rather than the more commonplace unstructured form, which is more difficult to leverage for both transactional and analytic purposes. Poly-structured data can be decomposed into a formal schema, but it can take a wide range of forms within that schema. Payers can access the plan data either in bulk form, e.g., through automated file transfer, or through the upcoming Web Services providing specific aspects of plan information in either an XML or JSON format. HighRoads provides authentication federation, enabling the SaaS access to behave as if it were part of the payer’s security domain.
SM: What are the trends you are seeing in your industry?
The trend we particularly see is in the insurance space. They are looking for ways to consolidate a number of sources of data into one perspective. Under the Affordable Care Act, they are limited in how much money they can spend on non claims–related expenses, so anything they can do to accomplish the following: reducing their IT spending, getting to a more managed environment, where they don’t have huge server funds, working with third-party vendors that are on the cloud, like HighRoads, etc.
They are also looking at the data they are collecting for greater analytics, meaning better understanding of the needs of their members and better defining plans to support the needs of the people they are selling insurance to. Whatever the data reflects relative to the populations they are selling to, they are looking closely to. That last piece is not an area we particularly play in, but the data we are collecting for them in order to reduce spending is to look for common areas within the health insurance plans to get a greater common plan that will then support the initiatives of the Affordable Care Act.