THE PROBLEM

How can we manage insurance claims in a more personalized way?

Patients are increasingly expecting both highly personalized care and transparency around medicine and costs. As a result, an ,insurance company aims to provide its members with more financial transparency and personalized service, but it's not a straightforward task. Patients' health data is frequently siloed, incompatible or incomplete, and interoperability between systems is often nonexistent or disjointed.

USER GOALS

Management of Insurance Claims

  • View member ,health insurance claims and significant medical events over time by care plan.
  • Correlate claims and acute issues to comorbidities.

Personal Medical Information Hub

  • View basic member profile information.
  • Search for and view details of claim history, medical history and communication history for a specific member.

DATA DISCOVERY

1. Look at the data source.

Member's Medical Records

These include information about demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

Health Insurance Claims Data

Population Health Data

2. Slice data to gain insights.

Dominant Dimensions

Member

Time

Disease

Primary Entities

Health insurance claims

Significant medical events such as acute exacerbation

DATA VISUALIZATION