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Business Intelligence Technologies, Tools & Services in Healthcare Industries
Hypatia Research, LLC, Dec 2008, Pages: 34
Healthcare organizations in the U.S. are suffering financial strain. In the case of healthcare providers, such as hospitals, those financial pressures are particularly severe. While the current economic crisis has certainly made things worse for healthcare providers, the problems that beset them have been in the making for several years. Declining admissions, rising costs for medical supplies and services, and less generous reimbursements from the insurance industry. Payer-side health insurance companies, are also feeling the pinch of rising costs and lower employer contributions.
The health care industry has never been as technically advanced nor as financially troubled as it is today. The diagnosis and treatment options available to patients are the most sophisticated in the world. New therapies and life saving pharmaceuticals are coming onto the market every year. But partly because of this advancement, health care costs now consume nearly 16 percent of the U.S. GDP, and hospitals and other healthcare providers suffer the constant financial strain of providing treatments that are often not paid for or paid for only in part. In fact, one-third of the nation's 5,000 hospitals are operating at a loss while another third are just breaking even--Symptomatic of a very ill industry.
The insurance industry likewise has its troubles, albeit not as dire. Payers must grapple with how to fairly compensate providers for high-cost treatments, while weeding out those claims that are inflated or are outright fraudulent. Nearly a quarter of insurance claims are fraudulent, by one estimate, while another puts it at seven percent. Yet insurance companies as a group do not have a consistent policy for dealing with suspected fraud and many insurers bother to prosecute only the most egregious cases.
Business intelligence could help address these serious problems that undermine the financial health of both the provider and payer sides of the healthcare industry—and most large healthcare organizations already recognize this. Major companies, both on the provider [hospitals/clinics/physician] and the payer [insurance] side, have been adopting business intelligence platforms, tools and/or using information management services for several years, starting with data warehouse projects. One of the largest examples of this is Blue Cross Blue Shield Association's Blue Health Intelligence database, started in 2006. Comprised of 80 million 'de-identified3' or blinded patient histories, this data mart will eventually be used to analyze critical clinical practices and their outcomes, costs vs. success, and other healthcare trends that BCBS intends to use to create benchmarks for clinical practices.
In virtually all large healthcare organization today there is one or more data warehouse project either completed or underway. In some instances, the problem is there are multiple data warehouses and these need to be integrated or consolidated for BI purposes. .
Mid-sized and small healthcare organizations are less likely to have large data warehouses, but may have other types of data consolidation and the implementation of simple BI tools for financial planning and reporting.
All of these data warehouses, data marts and databases in healthcare organizations contain a vast store of clinical, operational and insurance data, including patient histories, supply inventories, vendor invoices, admissions data and unstructured information such as patient verbatims, radiology images and scanned documents.
But for many healthcare provider and payer organizations, this store of data has not been transformed into useful information. It has not produced answers to questions about costs, revenues, trends, treatment outcomes, or correlations that would enhance profitability or quantity of patient care.
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