Big Pharma Uses Analytics to Improve Health CareBy Peter High
Gary Wimberly is the CIO and a senior vice president at Express Scripts, a $94 billion pharmacy benefit management company. CIO Insight contributor Peter High recently had the opportunity to tour Express Scripts Technology and Innovation Center in St. Louis with the company’s CIO. In this CIO Insight Q&A, Wimberly explains how data is captured and analyzed, how technology can detect when a potential prescription conflict arises and how to reconcile risk taking with security practices.
Peter High: Gary, we have just done a quick tour of the Technology and Innovation Center and I wonder if you can take a moment to describe the center, but then also peel back the onion a little bit to describe IT’s role in all this?
Gary Wimberly: Here at Express Scripts we have a Technology and Innovation Center and it is really focused around data analytics. We bring resources from teams across all disciplines within IT, so not only IT for the technology we utilize, but our economists, our clinicians, our physicians that really are focused on analyzing all of the data that we capture at Express Scripts—and we have an enormous amount of data. I think we are close to up to 20 petabytes at this point. We utilize that data to identify opportunities to improve health outcomes and eliminate waste in the healthcare space.
High: Can you talk a little bit about the variety of disciplines that are brought together in this effort?
Wimberly: We have IT people, obviously. We have a lot of technology in here: not only from an infrastructure perspective with all the servers, but the amount of software, the tools that we use to do this analytics, to ensure that those are operating and that we are developing the right solutions. A lot of them are self-serve kinds of applications, so our responsibility on those is to make sure that they are available and that they are performing to what the user experience should be.
We have clinicians that are analyzing this data and looking for trends and looking to see how medications are conflicting with others. On our tour, we showed you some of our applications that you can scan the barcode of a medication and it will look at your entire prescription history and determine are there any side effects that could occur from it. So the clinicians are defining those parameters in our drug realization reviews. We have economists that are looking at what are those savings opportunities and looking at geographical areas and analyzing that. We have people that are a part of our supply chain and are looking at where pharmacies are compared to where our patients are and ensuring that we are optimizing the network so that every patient is able to conveniently get their medication. While we ship close to 120 million prescriptions out of the Express Scripts pharmacies, we actually fill over 1.3 billion prescriptions a year utilizing a retail network across the entire United States. We have resources from all those disciplines that are very focused on looking at all this data and making sure we optimize the experience for our patients.
High: What are the metrics that you hold dearly in an operation like this? I am hearing you talk about elimination of waste, so there must be some sort of cost savings associated with this, ultimately. I am sure patient outcomes and patient health is somehow also monitored and tracked as well. What are some of the things that are on your - or the team’s - dashboard, broadly speaking?
Wimberly: The perfect one is the most staggering number to me: we have over $330 billion of wasted spent a year in health care due to patients being non-adherent on their medication across the United States. We know that if we can help our patients be adherent in their medication, we can drive that cost out of the healthcare system. You can imagine there are a lot of tools and techniques for managing that overall metric, whether it is generic fill rate, whether it is drugs being filled within certain therapies. We have a Therapeutic Resource Center here, but we have these therapeutic research centers that focus on very specific diseases for our patients whether it is MS, whether it is oncology, hemophilia, etc. and we staff them with experts to ensure that those patients get the optimal care. So we have the metrics associated with individual patients and their adherence, to the type of care that they need to have, and the support that we are able to provide them.
High: I wonder if you could talk a little bit about your IT team more generally speaking. You obviously do some of the more traditional aspects of IT under your team as well. How do you think about the division of the different parts of your IT team? How is it divided up?
Wimberly: I think of my IT organization in three spaces. The first is what I call my technology space. It is really my infrastructure and architecture. They are there to ensure that the infrastructure is optimized and it is next generation, that we are architecting the appropriate solutions, and it is the engineers there. They are very much built in a plan-build-run kind of methodology.
The second group I have in IT is in a shared services organization, and there are two primary groups in there. One is information risk management, so it is the things that you would expect from business continuity, planning, disaster recovery. But it is also my information protection, so my Chief Information Security Officer runs that area. I also have a team in that shared services space that is really more around the processes and methodologies that we execute here at Express Scripts, including all of our program managers, project managers, etc. We do that in a shared service organization that loans them out either into architecture, application, infrastructure, etc.
And then my third space within IT is my applications, and that is subdivided into four groups. And those four groups are aligned to the strategic growth pillars of all of Express Scripts: PVM space, home delivery, specialty, and our data and subsidiaries. Those are our four growth areas. My organization is aligned like that to ensure that we meet the needs of our partners, as well as our clients and patients.
High: Can you talk about - I can even start to hear the answer to the question a bit in the way you have thought about those divisions - but, in the initial part of our conversation, we were talking about IT’s contribution to innovation, which is about risk taking. But I know that security is a big part of what you lead and what you think about, which is about risk mitigation. How do you think about the interplay between all that is done here - the very creative thinking that is being done about the “new”, about pursuing new solutions that will ultimately aid patients - and doing so in a secure fashion? How is that balance achieved?
Wimberly: I would say most IT organizations, when they think about risk management, I think it is more on a reactive basis, and how to put the security and controls around the perimeter, or almost as an after effect. They will do penetration testing and things like that.
We have really been transforming how we think about risk management and IT, and that is “how do you really build it into the processes?”. So whether I am creating new servers and creating a golden copy of how I am going to roll out additional cloud servers, that the security is built into that, how the patches are being applied through development, QA, production, etc. But especially in my application space, and I will use mobile as an example of that. I have people that specialize - they are IROs, Information Risk Officers, within the application space - who are very focused on when you build something, how do you build it so it is secure right from the start, instead of coming in after the fact and trying to remediate? Of course, we have some areas that we still do some remediation, but we are now very, very focused on how you build it up front, right into the process.
High: How do you think about the engagement - as you think about the ecosystem you have built - what role do external partners play? Obviously, in the three different parts of IT I assume there are probably different answers, depending on who it is you are engaging and in what direction, but what role do you see external partners playing in IT’s success?
Wimberly: Great question. My strategy is actually evolving some, and so I will tell you how I have thought about it and how it is shifting over time. Express Scripts has grown so dramatically. In my eleven years here, we went from 17 billion in revenue to just over 104, 105 billion - great growth. And to support that growth I often use outside partners in a contract, consulting kind of basis. And I have an employee as well.
I continue to have that same kind of strategy. I have employees in key critical roles who are subject matter experts and are there to ensure that we maintain the continuity we need, but I also expect that of my business partners. I expect them to develop subject matter expertise, etc. whether they are global systems integrators, what have you. It really allowed me to scale. I had to scale so dramatically in completing this last integration that allowed us to grow over 100 billion dollars. We wanted to do that in about 18 to 20 months and had huge return for our shareholders. But, I think more importantly, it allowed us to bring systems together that gave a much better experience for our clients and patients. So I utilized those resources of scale.
I am actually going to go through a period of time here where I am starting to in-source a bit more - several hundred resources. And it is because the relationship with our internal business partners, whether it is supply chain or whether it is operations, is changing. We now are building things as a cohesive team and more of an Agile kind of approach. And we are developing these five year strategies that are not just a road map, but they are funding models that have approved dollars. So in the past if I knew I had initiatives that I knew were going to last six to nine months, I would often use an outside resource: get them up to speed quickly, develop the solution and then they would go work for another client. But now that I am getting these long term road maps in our growth pillars, I'm looking to insource more and build true subject matter experts, greater level of leadership so that as we use partners a lot of muscle to help get some of the work done. So we are going to go through that period of time where we are actually infusing a lot of new talent into our organization.
High: That is excellent. You mention that you have been with the company eleven years. You have been the Chief Information Officer for eight, so maybe double the average tenure of a CIO. I can only imagine, in addition to the dramatic growth numbers that you just quoted, just even IT’s contribution to the organization as a whole must be dramatically different today than when you began as CIO, and even more so when you began in the company, more generally speaking. Can you talk a little bit about that transformation from an organization-- and you will confirm this hypothesis or deny it-- from when you joined I can imagine the business did not necessarily see itself as a technology firm to now one that is, in many ways, profoundly one?
Wimberly: I have had a bit of an advantage in that we have a leadership team here at Express Scripts that truly appreciates the value of technology, and always has. But in my first nine years, ten years, let us say, we were an organization that was heavily focused on growth from an M&A perspective. It requires a certain type of skill set to integrate clients and members, patients, if you will, migrate them to new platforms to get the single systems, etc. to one that is now pivoted towards organic growth. We are expected to grow a significant amount per year. Street expects 16 to 19 percent per year growth from Express Scripts. That starts getting a little bit more difficult, but I think we have got great opportunities to do that. But it means we as an organization have to transform ourselves as well.
When I think about our last integration, we migrated our last group of members to this new platform in January of 2014, so for the last 18-20 months we have been transforming who we are. It has to start with me. I have to reengineer myself and how I think and ensure that we are creating an environment that is extremely collaborative and aligned so that people are truly empowered. There are times in an integration when you have a “forced march” you are going through. People can almost get a demeanor of a lack of empowerment. They know exactly what to do; they are not making decisions. I need smart people now who make decisions and help move us to the next level.
So we have created this new strategic business framework that thinks about who our customers are that we serve in IT and how that aligns to the overall corporate strategy. What are our objectives and metrics, long term goals and short term objectives? And we create teams that execute on these very specific goals. In fact, we just wrapped up a team. They went on a 90-100 day effort-- our top forty-eight high potential people, eight people to a team-- and we gave them each a significant issue that we needed to transform in the company. It could be anything from culture to succession planning to how you manage data corruption differently, those kinds of things. And these people were so energized with being empowered, and they came forward to me and my vice president of leadership team last week and presented their solutions. Their job was to come up with the recommendations; my job that day was to decide if I was going to fund them. And so we funded these initiatives. Far too often people come forward with great ideas and you never know what is going to happen with that. How do you bring it across the finish line? I committed in 100 days that they would take on this effort and that I would answer their questions within that two day period of time. After they presented, we went off and deliberated, came back and gave them the money to make things happen. That really builds a lot of entrepreneurial spirit. You think about a $100 billion company where you can get people energized in that kind of shark tank mentality - these people left just energized and I feel great that this transformation that we are making here in IT is empowering them and getting them to think differently about how they are to perform IT, not only within Express Scripts, but how they have to reach outside of Express Scripts.
High: Are you at liberty to share any ideas that were produced there?
Wimberly: We did a lot of things there. When I think about culture, for example, that is the hardest thing, I think, for IT people to get their arms around. We are too much engineers, if you will, and want everything-- project plan, every “i” dotted and “t” crossed-- so this was the softer side and they could come up with ideas. So things like “One Simple Thing”, we are calling it, where you can declare this is your one simple thing that helps you, whether it is balance your work and life experience, to how do you want to develop yourself, to how you are going to interact differently. And how you define that Simple Thing? You work with your leader and ensure that is the appropriate thing. One Simple Thing cannot be I am going to work two days a week, but it might be that I am going to take off at 2:00 on Tuesdays to see my child’s soccer game, and you are going to schedule your activities around that. I do not worry about our people being committed.
That is one thing about this organization: they clearly understand why their job matters. This is not about ‘now they are only going to work 38 hours a week.’ This is they are figuring out how to live while they work here at Express Scripts, and it is a very powerful thing and, frankly, something that I have always struggled with. What I think of as work/life balance is very different than every other person that works for me, I am sure. I am at a different place in my life. My children are grown; it is easy for me to get on a conference call or go to a dinner at night, etc. But what is so important for me is to make sure that everybody is getting to think about their career and how they are going to live their life, and managing the two together. I cannot do it for them, but I happen to be able to give them the opportunities and tools to manage it themselves.
High: That is great. You mentioned mergers and acquisitions. Obviously, an organization as large as yours and the mandate you have for growth, which is producing the equivalent of a massive Fortune 250 company every year in essence revenue-wise, what is IT’s role in M&A? Granted, I am sure every acquisition is different, but is there a blueprint you have that you take to each of those when you think about the integration of a new organization?
Wimberly: Yes and no. Obviously, when you are looking at a company for possible acquisition there are some fundamental concepts you are looking at. We are very technology-based here at Express Scripts, whether it is in our core PVM or whether it is in our specialty space, it is about the technology that supports it. There is absolutely a role when we do M&A work on what is the type of technology they have, is it superior to ours, how might we integrate those capabilities- the products and services that they offer - along with that customer base, if you will, into the overall products and services we have at Express Scripts so it can be a win-win for both sides as we bring them together. An M&A team for me is, frankly, often a couple of architects and an engineer - somebody who has a very strong understanding of the capabilities that we have and the challenges that we have effectively to see in an acquisition. Are they going to bring forward some technologies and solutions that we can use to augment all of Express Scripts. They have a real focus on that. And part of their job also is to work with the overall integration team on what it will take to bring them in. We talk about driving waste out of healthcare, which means that I have to drive waste out of anything that I do every day. So when we do an acquisition, we do not keep two general ledger systems running, or two accounts payable, or two HR. Those are immediate quick things that you have to integrate in. But then it gets down to the real products and services that serve the clients and patients and how you are going to bring those together.
High: I was going to ask you a general question about technology trends that you are tracking. What are you looking at if you think two, three, four years out, what are some things you are beginning to investigate that particularly excite you?
Wimberly: I would also like to talk about what I thought back a couple years ago. I was frankly very apprehensive about cloud and getting cloud to a point in the healthcare space where I could guarantee protecting the data of our clients and patients. And cloud in its infancy had a lot to work through for that to happen. So we are very focused now on a private cloud strategy. Levels beyond virtualization as I think about what we have to do to support the growth of this organization, to support how we are really transforming ourselves and organic growth and changing how we deal with patient experience. Our web applications, for example, the constant iterations, the constant evolutions. We are thinking of things no longer as projects, but more like products. It means it is a constantly evolving kind of technology as well.
Frankly, we are implementing some of the more basic things. Waterfall during an integration is a pretty obvious kind of approach. We are far more organization driven around Agile. And it is not just how IT works. It is how the enterprise has to work. So getting business partners working with you and understanding their roles and responsibilities with yourselves and building a product, if you will, that is a bit of transformation that we are making. It is not the latest and the greatest, but it is how we are applying it to be a very different company now.
Peter High is President ofMetis Strategy, author ofImplementing World Class IT Strategy, moderator of the Forum on World Class IT podcast series, and a keynote speaker. Follow him on Twitter @PeterAHigh.