Gi Ch. 46 Information Management And Mis’S

Front 1

Building a Data Warehouse

Back 1

Integrating data, for reporting and analysis
1. Define needed data.
2. Collect the data
3. Assure integrity of the data (balancing)
4. Put data into context
5. Do “data mining”

Front 2

Information Management Groups (IMG’s)

Back 2

Function-oriented business units

Requirements for the implementation of IMG's:
 Corporate direction
 A data warehouse
 Trained staff
 dealing with the overlap of data
 Standardized terminology
 Centralized IT

Front 3

The Technologies a Company Needs in order to Integrate its MIS’s

Back 3

 A Client-Server System
 Open Architecture – lets data be moved
 the Internet; an intranet
 Document Imaging
 Workflow Management Software
 a Data Warehouse

Front 4

Components of an Insurance Company’s Management Information

Back 4

 Financial Reporting Info
 revenue; profit
 premiums
 expenses
 Event Info
 Frequency, Severity, Causes, and Correlations of claims
 A/E comparisons
 People Info
 Self-Interest and Antiselection;
 effect Utilization and Enrollment

Front 5

CHALLENGES in HEALTH CARE MANAGEMENT INFORMATION

Back 5

 providers’ systems/technologies not compatible
 Quote all the Data Quality Issues
 the Value of the Data (cost-effective to produce?)
 Clearly presenting the data (graphics, numbers, readability, knowing your audience)

Front 6

COMMON TYPES OF REPORTS
(“Applications of Management Information Systems”)

Historical Studies reporting

Back 6

 Financial results (LR, expenses, profits)
 Persistency studies (lapses)
 Mortality studies (by age, sex, industry, location, etc.)
 Disability studies (frequency, severity, recovery rates of disabilities)
 Claim Lag statistics

Front 7

Current reporting

Back 7

 Income Statements by block of business
 Expenses
 Acquisitions, Administrative, Marketing, Commissions, Overhead, Premium Taxes.
 Policyholder Accounting
 Premiums, Claims, Expenses, Loadings, Pooling Charges
 Benefit Analysis Reports
 large claim reports
 breakdown of charges by “source” (type of care)
 Managed Care Reports
 effectiveness of managed care
 discounts, utilization savings, network effectiveness
 Provider and Network Monitoring Reports
 cost vs. quality
 data must be normalized for case/severity mix
 compliance
 credentialing
 # office visits
 # patient complaints
 Sales and Marketing Monitoring Reports
 Sales and marketing affect revenue, customer relations, public image

Monitor:
 sales-in-progress and closing ratios
 agent performance
 key accounts

Front 8

Projecting the Future reporting

Back 8

 Cash Flow and Asset Projections

Front 9

HEDIS reporting

Back 9

 standard format for managed care reporting.
 8 categories of reports:
 Effectiveness of care, Access, Satisfaction, Plan stability, Utilization, Cost of care, Informed choices, and Descriptive information
 widely accepted
 emphasizes quality of care


Done.