The client is a hospital that provides comprehensive healthcare services, including inpatient care, emergency services, chronic disease management, and post-discharge support. They use an integrated healthcare application that combines remote patient monitoring, telehealth services, Bluetooth-enabled medical devices, real-time health alerts, patient engagement tools, and care coordination. The Client
The client is a hospital that provides comprehensive healthcare services, including inpatient care, emergency services, chronic disease management, and post-discharge support. They use an integrated healthcare application that combines remote patient monitoring, telehealth services, Bluetooth-enabled medical devices, real-time health alerts, patient engagement tools, and care coordination. Its care management team is available 24/7 to support patients and improve the quality and efficiency of care delivery.
Challenges Faced by the Client
Our customer had been facing the following pain points in the claims utilization of patients, making it further challenging across multiple clients:
- Handling multiple clients’ ROIs across multiple datasets was time-consuming.
- Analysis involving dates, PY claims, and healthcare data comparisons was not feasible consistently between clients.
- Claims based on ICD codes and categories, along with a definitive trend axis and highlightable insights, could not be effectively applied to scattered datasets from different clients.
- Automating clients’ data into a standardized reporting format was challenging.
- Identifying the top claims, along with their causes and reasons, across all other claims based on ICD filters was difficult.
Solutions
- Implemented a file path system to automate client dataset processing with the necessary data transformations and validation.
- Included a filtering scheme to segment data between different clients and identify the top claims occurring within each segment, supported by visualizations.
- Provided bar charts, tables, and interactive slicers to support deeper claims utilization analytics and analysis across the available data.
- Detailed each client’s claims based on ICD codes with descriptions that helped explain the reason for claim occurrence and its timeline trend.
- Captured historical claim amounts with detailed descriptions of profit/loss data for the selected client, including claim events occurring periodically.
- To sum up, the solution’s main features include:
- Automated Report Access: Drop the file into a specified folder and access the reports without manual processing.
- Standardized Data Input: Established a consistent claim data input format for the data flow.
- Interactive Data Visualizations: Enabled users to filter and analyze claims data based on their requirements.
- Organizational Sharing: Made reports shareable within the organization for collaborative analysis.
- Client-Level Summarization: Provided summaries of top and low claims by person and ICD code.
- Timeline-Based Reporting: Enabled report viewing across selected timelines to identify trends in claims data.
