1. 5 Shades of Analytics
…………………………………………...
CIO, Xerox Insurance Solutions & StrataCare
Michael Josephs

2. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Xerox is a leader in providing data incursion and Software-as-a-Service (SaaS) solutions to support the timely, accurate,
compliant and secure payment of medical bills for the largest payers of Workers Compensation related claims
Processes over 24M medical bills annually, representing over $20B in billed medical charges
Context – Xerox Insurance and WC Solutions
2
Workers’ Compensation (WC) are state-legislated programs (except for federal government
employees) created to provide compensation for employees suffering on the job injuries or illness
Key Players in the WC ecosystem
– Employer: required in most states to provide employee
benefits for work related injuries/illnesses
– Insurance Company: affords claims management and
wage replacement, rehabilitation as well as survivor
benefits
– TPA (Third Party Administrator): manage state mandated
benefits for self-insured or those employers with large
deductibles/retentions
– Service vendors: e.g., Medical Providers, Data Incursion,
Medical Bill Review, Managed Care, Loss Prevention

3. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Context – Xerox Insurance and WC Solutions
3
Workers’ Compensation (WC) are state-legislated programs (except for federal government
employees) created to provide compensation for employees suffering on the job injuries or illness
Rule-Driven Configurability for Tailored Workflows
Supply Chain Connectivity
Decision Support Drives Workflow and
Supply Chain Optimization
– Balance Cost: Supports balancing level of near term
operational costs with longer range outcome costs
– High Visibility: Provides illumination of operational
efficiency levels and opportunities for improvement
– Ecosystem Refinement: Supports continuous
improvement of supply chain efficiency
Data-Driven Decision Support
Xerox is a leader in providing data incursion and Software-as-a-Service (SaaS) solutions to support the timely, accurate,
compliant and secure payment of medical bills for the largest payers of Workers Compensation related claims
Processes over 24M medical bills annually, representing over $20B in billed medical charges

4. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
$
Increasing levels of
value, investment
and complexity
Shades of Analytics Function Xerox Insurance Analytics Assets
Prescriptive Analytics Makes specific outcomes occur ˗ Network Optimizer (patent US 8,700,426 B2)
˗ CONNECT™
Predictive Analytics Suggests what outcomes will occur ˗ SCORE ™
˗ SCORERX ™
Interpretive Analytics
(aka Diagnostic Analytics)
Insight in to why an outcome occurred ˗ Client stewardship reporting
˗ PPO leakage tools
˗ Fraud, waste and abuse ID tools
Descriptive Analytics
(aka Metrics)
Describes what outcomes have occurred ˗ SaaS-based self-service reporting platform
˗ Real-time dashboards for Operations and
vendor performance
Shades of Analytics
4
Scalable private cloud-based Infrastructure, providing secure, compliant
custodianship for sensitive medical information
256M Medical Bills, 71M WC Claims
(reflecting all domestic jurisdictions, procedure and diagnostic types)
4

5. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
But We Want More!!
5
Scalable private cloud-based Infrastructure, providing secure, compliant
custodianship for sensitive medical information
Shades of Analytics Function Xerox Insurance Analytics Assets
Consumable Analytics Automates Making specific outcomes occur ˗ Pilots in progress or product planning
Prescriptive Analytics Makes specific outcomes occur ˗ Network Optimizer (patent US 8,700,426 B2)
˗ CONNECT™
Predictive Analytics Suggests what outcomes will occur ˗ SCORE ™
˗ SCORERX ™
Interpretive Analytics
(aka Diagnostic Analytics)
Insight in to why an outcome occurred ˗ Client stewardship reporting
˗ PPO leakage tools
˗ Fraud, waste and abuse ID tools
Descriptive Analytics
(aka Metrics)
Describes what outcomes have occurred ˗ SaaS-based self-service reporting platform
˗ Real-time dashboards for Operations and
vendor performance
256M Medical Bills, 71M WC Claims
(reflecting all domestic jurisdictions, procedure and diagnostic types)
$
Increasing levels of
value, investment
and complexity

6. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Vanilla – How Everybody Does It
6
Production Environment
 Medical Bills
 Claims
 Admin Settings
 Workflow Rules
 PPO Network Mosaic
ETL
De-Normalization
Client Data
Warehouse
Client
Database
Mirror
Replication
MicroStrategy
Claims Update
Bill In-take
Client or Client
Vendor
Client
Database
“Production”
Client Data
Warehouse

7. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Vanilla – How Everybody Does It
7
Production Environment
 Medical Bills
 Claims
 Admin Settings
 Workflow Rules
 PPO Network Mosaic
ETL
De-Normalization
Client Data
Warehouse
Client
Database
Mirror
Replication
MicroStrategy
Claims Update
Bill In-take
Client or Client
Vendor
Client
Database
“Production”
Client Data
Warehouse

8. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Where the Really Fun Things Happen
8
Production Environment
Client Stewardship & Support
. . . .
Customer Reporting
Network Optimizer
. . .Fraud & Abuse Detection
Network Leakage Detection
Analytics R&D
:
ETL
De-Normalization
Client Data
Warehouse
Client
Database
Mirror
Replication
MicroStrategy
Claims Update
Bill In-take
Client or Client
Vendor
Client
Database
“Production”
Client Data
Warehouse
Enterprise Data
Warehouse
ETL
De-Normalization
ETL
De-Identification
 Medical Bills
 Claims
 Admin Settings
 Workflow Rules
 PPO Network Mosaic

9. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Shades of Analytics Function Xerox Insurance Analytics Assets
Consumable Analytics Automates Making specific outcomes occur ˗ Pilots in progress or product planning
Prescriptive Analytics Makes specific outcomes occur ˗ Network Optimizer (patent US 8,700,426 B2)
˗ CONNECT™
Predictive Analytics Suggests what outcomes will occur ˗ SCORE ™
˗ SCORERX ™
Interpretive Analytics
(aka Diagnostic Analytics)
Insight in to why an outcome occurred ˗ Client stewardship reporting
˗ PPO leakage tools
˗ Fraud, waste and abuse ID tools
Descriptive Analytics
(aka Metrics)
Describes what outcomes have occurred ˗ SaaS-based self-service reporting platform
˗ Real-time dashboards for Operations and
vendor performance
5 Shades of Analytics
9
Scalable private cloud-based Infrastructure, providing secure, compliant
custodianship for sensitive medical information
256M Medical Bills, 71M WC Claims
(reflecting all domestic jurisdictions, procedure and diagnostic types)
$
Increasing levels of
value, investment
and complexity

10. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Score
10
• SCORE™: Workflow management decision support
capability which projects claim progression so that
resources are applied strategically to at-risk WC claims
• SCORE
˗ Leverages neural network/predicative modeling techniques to assesses claim risk on a
predetermined scale
˗ Leverages employer-specific (current and historic) data to develop models, then continuously
scores each claim adjusting the score according per the clinical and medical bill updates
• SCORE’s Value to Clients
˗ Significantly impacting claim outcomes and reductions of care management expenditures
overall.
˗ Senior management’s ability to obtain a snapshot of the total risk exposure of all open claims

11. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Consuming the Score
11
Client
Database
Mirror
Replication
Claims Update
Bill In-take
Client or Client
Vendor
Client
Database
“Production”
Model Deployment and Execution
● Daily updates of identified SCORE parameters are loaded to staging DB
● Updates are applied to the models
● Updated claim “SCORE” made available
Client
Database
Mirror
SCORE
Staging DB
ETL
SCORE Models
11

12. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Consuming the Score
12
Client
Database
Mirror
Replication
Claims Update
Bill In-take
Client or Client
Vendor
Client
Database
“Production”
SCORE
Staging DB
ETL
“Score” made
available via Web API
1.“Score” made available for consumption by Xerox client platforms 3.“Score” delivered via e-mail
Multiple “SCORE” Delivery options: 2. Made available via the financial validation workflow
3. Delivered via e-mail to a specific resource (or resource group)
1. Consumption by client’s Nurse Case Management (NCM) platform
Workflow
Configuration
SCORE Models
Adjuster
Portal
2.“Score” made available to Financial Validation

13. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Shades of Analytics Function Xerox Insurance Analytics Assets
Consumable Analytics Automates Making specific outcomes occur ˗ Pilots in progress or product planning
Prescriptive Analytics Makes specific outcomes occur ˗ Network Optimizer (patent US 8,700,426 B2)
˗ CONNECT™
Predictive Analytics Suggests what outcomes will occur ˗ SCORE ™
˗ SCORERX ™
Interpretive Analytics
(aka Diagnostic Analytics)
Insight in to why an outcome occurred ˗ Client stewardship reporting
˗ PPO leakage tools
˗ Fraud, waste and abuse ID tools
Descriptive Analytics
(aka Metrics)
Describes what outcomes have occurred ˗ SaaS-based self-service reporting platform
˗ Real-time dashboards for Operations and
vendor performance
5 Shades of Analytics
13
Scalable private cloud-based Infrastructure, providing secure, compliant
custodianship for sensitive medical information
256M Medical Bills, 71M WC Claims
(reflecting all domestic jurisdictions, procedure and diagnostic types)
$
Increasing levels of
value, investment
and complexity

14. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Network Optimizer
14
• Xerox has patented (US 8,700,426 B2) an analytical tool (the
Network Optimizer) which allows it’s clients to quickly
evaluate different medical networks used in their workers
compensation programs while delivering significant bottom
line savings
• The Network Optimizer is an interactive, prescriptive
analytics tool that provides an objective comparison of
multiple Preferred Provider Organizations (PPO’s) and
Specialty Network Configurations using a clients historical
bill data
• Utilizing StrataCare’s Book of Business (BOB) to develop metrics by state, PPO network,
provider and specialty class, alternative PPO network mosaics are identified for the client,
optimizing PPO savings state by state
• Use of the Network Optimizer by Xerox clients has resulted in an average of 8-10% of
additional medical savings

15. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Diagnostic
Client
Database
Mirror
Replication
Network Optimizer
. . .Fraud & Abuse Detection
Network Leakage Detection
Analytics R&D
:
:
C
B
Network Optimizer
15
Production Environment
Client Stewardship & Support
. . . .
Customer Reporting
Client
Database
“Production”
Enterprise Data
Warehouse
ETL
De-Identification Network Optimizer
Network
A
ETL
De-Normalization
Client
Database
Mirror
. .
Yesterday: PPO Network Analyst research
descriptive and interpretive analytics to determine
how to achieve outcomes, and updates mosaic
 Medical Bills
 Claims
 Admin Settings
 Workflow Rules
 PPO Network Mosaic
Financial Validation Supply Chain Connectivity

16. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Prescriptive
Client
Database
Mirror
Replication
Network Optimizer
. . .Fraud & Abuse Detection
Network Leakage Detection
Analytics R&D
:
:
C
B
Network Optimizer
16
Production Environment
Client Stewardship & Support
. . . .
Customer Reporting
Client
Database
“Production”
Enterprise Data
Warehouse
ETL
De-Identification Network Optimizer
Network
A
ETL
De-Normalization
Client
Database
Mirror
. .
Today: PPO Configuration Administrator leverages
results of Network Optimizer and updates mosaic
 Medical Bills
 Claims
 Admin Settings
 Workflow Rules
 PPO Network Mosaic
Financial Validation Supply Chain Connectivity

17. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Client
Database
Mirror
Replication
Network Optimizer
. . .Fraud & Abuse Detection
Network Leakage Detection
Analytics R&D
:
:
B
D
Network Optimizer
17
Production Environment
Client Stewardship & Support
. . . .
Customer Reporting
Client
Database
“Production”
Enterprise Data
Warehouse
ETL
De-Identification Network Optimizer
Network
A
ETL
De-Normalization
Client
Database
Mirror
Adaptive Updates
Adaptive
Tomorrow: Mosaic updates are made by the
Network Optimizer, automatically and adaptively
 Medical Bills
 Claims
 Admin Settings
 Workflow Rules
 PPO Network Mosaic
Financial Validation Supply Chain Connectivity

18. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Composable Analytics provides an analytics
platform based on some intuitive data-flow
tools and services
Enterprise Analytics Marketplace
• Platform provides for rapid app authoring and data encapsulation
• Facilitates creation of an enterprise marketplace both data and
analytics for consumptions by users and processes
(1) GE Global Software and Analytics Research, W.A. Ruh, M. Grabb
GE’s Global Research labs are establishing
solutions for the prediction and execution of
required maintenance of physical assets
“Digital Twins”
• Leveraging next generation thermodynamic simulations to create a
“digital twin” of real physical assets
• These models allow for a view of the asset’s future by observing
how its digital twin performs in a wide variety of situations,
including where the asset may break for buckle
Optimization and Continuity: GE is focusing on predictive
and adaptive maintenance to eliminate downtime and optimize
assets to deliver maximum value over their lifetimes
This is News! – Advancing Adaptive Analytics
Composable Analytics2
GE – Predictive Maintenance1
Allows disparate
stakeholders to explore,
discover and leverage
analytical work for
application consumption
(2) Composable Analytics – Data Flow Intelligence, January, 2015
18

19. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Summary – What Are We Doing?
19
Expanding our
adaptive platforms
that can readily
consume intelligence
Optimize Human Assets
Continued investment in
analytical value creation
and harvesting for
consumption

20. © 2015 StrataCare, A Xerox Company
All Rights Reserved.
Laters!
mjosephs@xerox.com