The Health Insurance Kaleidoscope
(Note: This post was first published by the author on 31 October 2009 at http://www.healthinsurancecxo.blogspot.com )
Health insurance business involves managing large repositories of data and information. It is critical to understanding the health profile of the country and plan accordingly. To the insurers, it is critical to designing products in such a way that a large percentage of the insured see it as a security, yet the insurers do not lose on account of product characteristics.
To do analysis of the kind suggested in this article, it is assumed that insurers and their TPAs have the appropriate ERP systems to capture the required data and the BI tools to analyze them. The challenge lies, not in doing this kind of analysis once a year, but in being able to do anytime, from anywhere, in near real time! With ease that can be called as ‘child’s play’ – with ‘Drag & Drop’, ‘Filter’, ‘Select / Unselect’ features of typical BI tools.
This post will be built over a period through a series of graphical representation of how data, if captured by the health insurance administrators, can be used meaningfully for strategic and operational management purposes. However, the focus will be more on understanding the Claims, Hospitals and Diseases rather than the enrollment profiles.I will take up some questions randomly and show how graphical representation can give the answers.
Note & Disclaimer: The information shown below is based on “hypothetical scenario” and does not claim to be based on real data. The illustrations are to be used as templates for study and understanding the perspectives of health insurance
1. What is the distribution of Major Expense Heads of hospital bills? (Click on graph for a clear view) | ![]() |
2. How would the above distribution look if we look at only heart related ailments?![]() |
6. How is the distribution of Claims (by Count or Value)based on Length of Stay for major heart diseases such as Chronic IHD (Graph on Left) and Acute Myocardial Infarction (Graph on Right)? | |
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