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Wisconsin Department of Employee Trust Funds
Wisconsin Department of Employee Trust Funds
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Wisconsin Department of Employee Trust Funds

Q&AFrequently Asked Questions
Data Analytics and Insights (DAISI) Data Warehouse and Analytics Tool for Health Claims
and Related Data

Members

Data Warehouse Flowchart - Person to cloud to report

Click on the question below to expand the answer.

DAISI is a data warehouse and analytics tool that ETF uses to analyze data for the Group Health Insurance Program and Wisconsin Public Employers Insurance Program.

In general, the (DAISI) is a data warehouse and analytics tool that is a central place where a variety of data from a range of sources is stored and retrieved in a secure and organized way. Analytics tools help ETF staff make sense of all the data by combining it into meaningful views for both data analysts and program managers.

The Group Insurance Board has contracted with IBM Watson Health to administer a data warehouse and provide analytic tools for health claims and related data.

ETF administers the health benefits provided to all state, University of Wisconsin System and UW Hospital and Clinics' employees and retirees, as well as for many local government employees across the state. These benefits are governed by the Group Insurance Board (GIB). ETF and the GIB work diligently to research and offer high-quality, high-value benefits at a reasonable cost to members and taxpayers. However, as health costs continue to rise -- and as technology and research advances -- it is imperative to have access to and leverage high quality data to inform health insurance policy and benefits-specific decisions.

DAISI securely stores enrollment, claims, and wellness data for all participants of the State Group Health Insurance Program and the Wisconsin Public Employers Group Health Insurance Program.

A claim is generated every time you receive a service covered by the group health insurance program. This ranges from a health care visit to filling a prescription drug. The claim contains standardized codes for each service, and includes such information as the date of the service, and service provider name and location (e.g., physician, facility). This information is like the “Explanation of Benefits” you may receive in the mail after visiting your health care provider. The claims data also provides payment information such as the amount billed by the provider, deductible, copayment or coinsurance amounts, and the amount the insurer paid to the provider for the services rendered.

All entities contracted to provide insurance or administer claims for the group health insurance program submit claims data. We call them “data submitting entities.” This includes all contracted health insurers, the pharmacy benefit manager, the dental benefits administrator, and the wellness plan administrator. For more details, see the data flow graphic.

The data submitting entities set up secure accounts with IBM Watson Health and data is submitted to them through a secure file transfer process.

In addition to your doctor and your other health care providers, your health information is shared with your benefits administrators for medical, pharmacy, dental and wellness. These administrators have always had access to your information, as allowed under HIPAA privacy and security rules, to provide care and to properly process claims. For example, a member’s health plan has access to a covered person’s health information and may contact that member with health care recommendations.

No. Participant data will not be shared with employers.

No. Certain ETF staff will have access to only de-identified data through a secure portal. While very few ETF staff will have access to de-identified medical claims and other health information, ETF staff will never be able to see personally identifiable information about the individual receiving the service.

No. Board members will only review summary reports on health plan performance, spending, utilization, and member health outcomes.

ETF and the Group Insurance Board (GIB) use information from DAISI to better understand members’ health needs and identify opportunities to improve their health and quality of care. For example, ETF will be able to closely monitor health plan and provider performance and compare it to a variety of cost and quality measures. ETF could then develop incentives to improve that performance. This will ensure members receive high quality, valuable and cost-effective care. ETF and the GIB will also gain a better understanding of the prevalence of chronic conditions, such as diabetes or heart disease and can use that understanding to work with the health plans to develop or improve care management and other programs.

To be selected as the group health insurance program’s data warehouse vendor, IBM Watson Health had to demonstrate that it could keep ETF member data secure. This includes meeting appropriate federal standards for data security and participating in multiple independent, third-party reviews of its security standards, testing, processes, and resources.

ETF and the Group Insurance Board hold the data warehouse administrator to strict privacy and security requirements. ETF consulted with data security experts to ensure the requirements met the highest standards. All data submitted to the data warehouse is encrypted, or scrambled in a way that cannot be read by unauthorized parties.

No. All claims paid by health plans participating in the group health insurance program must be submitted to the data warehouse. There is no way for a member enrolled in a health plan to opt out of the data warehouse.

ETF treats privacy breaches very seriously. There are protections in place to prevent a breach. However, if there ever were a breach, ETF and IBM Watson Health have detailed processes in place for handling such a breach, as required under HIPAA privacy and security rules. In the event your data would ever be compromised, you will be notified in writing.