I recently participated in the TriZetto 2015 Healthcare Conference, which took place on May 17-20 in Orlando, FL. Among the attendees were benefit administrators, representatives of health plans and provider markets, as well as professionals from data, analytics, and technology companies.
Experts from the healthcare industry, along with data and analytics experts, discussed some principal challenges that this ever-evolving, competitive industry is facing, and how to tackle these challenges.
The broad range of topics included:
- Improving benefits management and claims processing.
- Reducing operating costs.
- Creating value with healthcare data.
- Incorporating digital strategies to provide a competitive market advantage.
Making better healthcare happen with better analytics
The theme for the conference was “Making better healthcare happen.” With that goal in mind, Microsoft and Pyramid Analytics teamed up to demonstrate the tremendous possibilities for healthcare improvement through better analytics. (For more information, see Microsoft and Pyramid Analytics Help Make Better Healthcare Happen at the TriZetto 2015 Healthcare Conference.)
Better analytics is the sum of a business intelligence (BI) solution being user-ready, yet governed. Enterprise-wide innovation in both providers and health plans requires user-ready analytic capabilities combined with a centralized and governed data model. Only then can information workers and clinicians share insights and BI across the organization to drive better health for their members and patients.
For instance, enhanced analytic capabilities in healthcare enable healthcare payers to:
- Put the focus on the customer; improve and personalize the customer experience.
- Target the most relevant areas of improvement in health plans and financial performance.
- Compete and succeed in the fast-paced marketplace with timely insights and decisions.
- Reduce member attrition.
The list goes on.
Using Pyramid Analytics’ BI Office for health plan analytics
In a talk called “Health Plan Analytics: Uncover Insights, Reveal Trends and Take Action,” I demonstrated how Pyramid Analytics’ BI Office suite is used in real-world health care scenarios involving health-plan professionals and customers—for instance, gaining insights on large-group financial performance.
BI Office, connects to the Microsoft BI stack to enable CEOs, operational managers, analysts, and end users to spot trends and outliers quickly, to easily create dashboards and analytics reports, and to drill down for more details and root causes. These and other easy-to-use capabilities are combined with a platform that’s centralized, governed, highly scalable, and secure.
Highlights of my demonstration
My demonstration of BI Office focused on the following tasks and capabilities:
1. Performing several types of analytics for business users, with the interactive dashboard
- Financial and demographics
- Per-member, per-month (PMPM) paid and member months by age group
- Key metrics for type of service
- Actual and trended costs vs. incurred but not reported (IBNR) by month
- Group analysis
- Medical episodes groups for chronic disease categories
- Drill-down and cross-drilling on allowed amounts, MEG (Medical Episode Grouper) episodes, and risk expected allowed amounts
- Comparison of individual employer’s performance with total group performance
- Clinical analysis
- Top 10 ICD-9 (International Classification of Diseases-9) categories by cost and claimant
- Top 10 CPT14 (Current Procedural Terminology® ) categories by cost and service
- Period-by-period product by risk band
- Paid amount, member months, claimant count by risk band
2. Developing analytics reports and dashboards from scratch in just minutes
3. Automating employer reporting
- Publisher module in BI Office, featuring content from analytics reports
- Featured dynamic text driven by data from analytics reports. As the data is updated, the story dynamically changes
- Automated scheduling to distribute by organization breakdown structure, data type, and user security profile
- There is definitely pent-up demand for health plan analytics.
- There is a need for Pyramid Analytics, TriZetto, Cognizant, and others to provide leadership in providing data models by subject area for the health plans, especially the smaller plans.
- We will be working on providing this data model leadership, so that these companies can take advantage of the value delivered by BI Office.