Integrated Healthcare Data Warehouse
From Business Intelligence
Contents |
[edit] Project Contact
If you have questions or would like more information, please contact Ted Makowiec (makowiet@umich.edu).
[edit] Project Description
The implementation team worked with a selected vendor to create an integrated healthcare data warehouse that combines U-M benefits eligibility data, paid medical claims, health assessment data, and health and wellness program participation data. The warehouse allows a holistic, independent, employer-based view of the U-M benefits-eligible population, and it will greatly increase our ability to be financial stewards of an approximate $300 million annual healthcare expense. In addition, the data warehouse will be used to support the President’s Michigan Healthy Community (MHealthy) Initiatives, which promote health and well-being and improve the quality of life and productivity for our employed population and the community.
[edit] Business Need
- Reduce the University's current healthcare cost of approximately $300 million dollars annually, which is projected to increase over time.
- Analyze financial and utilization trends to identify root causes of trend and enable potential intervention to ensure quality and reduce the overall cost of healthcare trends.
- Provide the University’s leadership with timely, strategic information for effective management of healthcare spending. Prior to implementing this data warehouse, U-M would request reports from each of our individual health plans, all with their own reporting and counting methodologies.
- Consolidate data across health plans to enable standardized reporting and counting across all health plans and ad-hoc analyses to support decision making.
[edit] Project Purpose, Scope, & Deliverables
The purpose of the warehouse and its related tools was to improve decision-making, asset management, efficiency, communication, and/or performance. The warehouse:
- De-identifies, aggregates and standardizes many healthcare data sources
- Provides data privacy and protection
- Includes preformatted, automatically updated, standard reporting from thousands of standard reports and predefined measures
- Features executive dashboard reports
- Offers robust set of industry norms/benchmarks and the ability to create custom benchmarks
- Enhances staff members' ability to perform timely analysis
- Contains five years of medical, pharmacy, dental, and eligibility data. (data from July 2004 – December 2008 based on most recent update)
- Includes self‐funded and fully insured data from the following vendors:
- Premier Care
- GradCare
- BCBS PPO
- BCBS CMM
- HAP
- Priority/Care Choices
- SXC
- MCARE HMO, PPO, POS, GradCare
- MetLife(dental)
- Delta Dental
- Current year data include ~ 50,000 employees and 99,000 total members
- Includes data on 7.8 million claims
Features and applications for the data warehouse include:
- Integrated claims data that allow Benefits and MHealthy staff to develop the information required by leadership to make strategic decisions related to healthcare. The data warehouse will allow the University to improve decision making related to health and wellness programming and to health benefits and support that could benefit the health of University employees and their families.
- A “cost & utilization report” identifies over- or under-utilized medical services and services where use has increased compared to a prior period. This report:
- Informs discussions with current providers and potential new facilities and helps U-M meet its obligation to provide a high quality, cost effective network of providers for our employees and their families.
- Provides the ability to analyze the impact of a high or low copay or cost sharing amounts on necessary utilization.
- Auditing capability of health care paid claims to potentially find and recover monies for services that are not covered; services for non-eligible employee; fraudulent practice patterns; and claims system payment errors.
- Ability to examine chronic condition prevalence across all of our health plans and use this information to assess health risk characteristics for our entire population that will allow us to focus our resources and implement health and well-being programs designed to reach the greatest number of individuals.
- Ability to monitor the effectiveness of benefit changes.
[edit] Audience/Users
- Benefits Office staff
[edit] Project Sponsors/Partners
- Benefits Office
[edit] Duration/Timeline
Plans for future updates include:
- Health Assessment data feeds from Staywell and inclusion of information about health and well‐being program participation rates
- Executive dashboards to allow leadership to “see at a glance” trends in healthcare costs and utilization as well as health and wellness program participation rates.