Calling in an I.T. Cure

WPS’s CIO adopts the latest innovations and technologies to meet the demands of the ever- changing health-care sector

“The key part of I.T. has always been keeping the lights on, but it’s shifting more to how does IT help the business innovate and provide value to our clients” —Guy Ringle
“The key part of I.T. has always been keeping the lights on, but it’s shifting more to how does IT help the business innovate and provide value to our clients” —Guy Ringle

Between political debates, presidential speeches, and televised newscasts, health care in some form or another has become a focal point in American life. Wisconsin Physicians Service Insurance Corporation (WPS), a not-for-profit health insurance company, emphasizes the collaboration between information technology and business objectives to drive innovation.

Guy Ringle, senior vice president and CIO, leads such endeavors, helping WPS remain a major provider of insurance services to the commercial and government health-care markets. “The key part of IT has always been keeping the lights on, but it’s shifting more to how does IT help the business innovate and provide value to our clients,” he says. “Health care is driving investments in technology, to ultimately make access to information about customer care more accessible.”

WPS is focusing on upgrading and replacing every core system, from underwriting to claims processing to medical management to business analytics. Ringle expresses that these investments will help the business meet new compliance requirements while allowing WPS to become more efficient. “I see my role as CIO as collaborating with our business areas to drive end-value to our clients and our corporation,” he says.

Health-care reform and other regulatory changes are significantly driving investments for WPS’s claims platforms. “We’re implementing the TriZetto Facets platform for the core claims functions,” Ringle says. “We’re upgrading our underwriting capabilities with Connecture’s platform, along with a new data warehouse and enhanced business analytics.” The first production phase will deploy in March 2013.

“Predictive analytics” is a key innovation that WPS put in place to identify fraudulent claim activity. In the Medicare world, fraud is a huge challenge, and predictive analytics help to identify suspect claims. “We raise issues sooner in the process before the dollar leaves the building, and that’s a benefit to business and the government,” Ringle says.

Ringle and his department have created a three-year strategy that considers health-care reform, compliance, and customer usability. These new developments will be utilized with services-oriented architecture. With the advancement of technology, security plays a major role in WPS’s overall objectives. In the past two years, the organization has expanded the use of mobile technology to support internal clients’ accessibility. Two vehicles of access, including a platform from Good Technology and a virtualized desktop called Citrix, allow increased mobility and access for WPS employees. “It’s a continuous focus on how to better improve the operational process, leveraging technology to look at automation opportunities and efficiencies,” Ringle says.