Implementing a BI analytical framework for a HealthCare
provider
Client
Client is a health maintenance organization (HMO) for one of the California counties.
Objective
- Provide an Ad-hoc environment for strategic, tactical and operational analysis of enrolment and claims.
- Self-Serve Environment
- Single version of Truth across all departments like finance, medical services and claims processing.
- Provide certified reports for regulatory compliance
Benefits
- Robust Analytics: An analytical framework with all the enrollment and claims metrics pre-calculated to be analyzed by various factors like PCP, geography, health-plans etc.
- Single-source of Truth: An integrated Data mart that does away with information silos and standardizes definitions across the board.
- User Empowerment: User-friendly semantic layer allows business users to generate ad-hoc reports. This will reduce the dependency on others for data
- Metadata Standardization: Consolidation of business definitions and naming conventions enabling common understanding, visibility and collaborative analysis.
- Scalability: A component driven approach enables adding each business component into the solution thus making it highly scalable.
Solution
Alameda Alliance for Health (AAH) evaluated and selected Business Objects XI R2 product and chose InfoSTEP Inc. as implementation partners. InfoSTEP Inc. conducted several interviews with business users to understand their reporting requirements InfoSTEP Inc. conducted a two-week requirements gathering exercise in order to understand business requirements and helped client define business rules for the enrollment (phase 1) and claims (phase 2).
- Developed a Universe that has all metrics to measure each component of the enrolment process.
- Implemented a data mart that hosted business rules for various kinds of doctor-patient encounters, different grounds for member termination, eligibility and enrolments
- Developed a flex-fields universe that hosts volatile on-demand data and links with the membership and claims universe, which increased reporting flexibility.
- Trained the users to derive maximum benefot out of a self-serve environment.
Solution
- Multiple exceptions in dealing with metrics for claims
- Strong Dependence of business on information silos built on excel and access
- Multiple definitions of a metric.
- Near-Real Time changes to membership.
- Data Quality due to frequent cha
