Insurance Providers and Healthcare Maintenance Organizations (HMOs) are sophisticated and complex enterprises that face some unique challenges specific to their industries. Subject to many government laws and regulations, companies in these industries generate massive amounts of data that is both quantitative and categorical. Additionally, continuous changes in market conditions, competition, and government regulations related to the Affordable Healthcare Act, Health Insurance Portability and Accountability Act (HIPAA), and Electronic Protected Health Information (ePHI) laws make it difficult for insurance providers and healthcare maintenance organizations (HMOs) to produce the information they need to operate efficiently, while also maintaining security and adhering to regulatory requirements. Enterprises that wish to compete must react rapidly to change and find new ways to attract customers, avoid heavy fines from failures to comply with regulations, and adapt processes and methodologies to better service customers and reduce the overall cost of healthcare.
In order to provide up-to-date relevant information and make accurate decisions, companies in these industries require an integrated view of data extracted from multiple disparate systems. At the same time, security and customer privacy are paramount for these enterprises as they work to protect confidential information and private healthcare data.
Business users must closely monitor claims information and leverage data to its fullest value to reduce risk, investigate healthcare and insurance fraud, increase quality of service and patients care, and capitalize on market opportunities. Business users, underwriters, and practitioners all require the ability to view and analyze data quickly and efficiently in order to ensure smooth business operations, properly manage risk and profit margins, provide quality coverage, and improve patient outcomes and quality of life.
To achieve success in this environment, enterprise organizations must create and monitor key performance indicators (KPIs) and important metrics that are meaningful to the business and support the improvement of day-to-day operations. Establishing true business intelligence (BI) and creating a single source of the truth that enables business users to perform powerful information analytics using dynamic dashboards and decision support systems that predict and forecast future trends and business patterns.
Aculytics’ business intelligence (BI) solutions help insurance providers and healthcare maintenance organizations analyze data collected from all across the enterprise to make fact based decisions that support corporate goals and initiatives. Business users perform analysis and sift through the data, exploring the data in real-time slicing, dicing, searching, and filtering the data to gain the viewpoints and perspectives needed to make informed decisions that best fit the business. Using simple easy-to-use dashboard user interfaces, Aculytics help our manufacturing clients deliver clear and concise information to their business users that is consolidated into a single readily accessible portal, enabling them to optimize investments in corporate performance management (CPM) and gain insights into market trends. With Aculytics help, your users can gather and associate data from multiple disparate back-end systems including: enterprise resource planning (ERP) solutions, enterprise asset management (EAM) solutions, supply chain management systems, electronic medical record (EMR) systems, electronic health record (EHR) systems, purchasing systems, and business process management systems. Creating new and powerful analysis enables business users to understand and resolve issues, forecast and predict supply and demand, as well as plan more effective business strategies.
Business intelligence (BI) has the ability to have a positive impact on all areas of operation within businesses in the insurance industry.
Aculytics experience by area of operation or business functions:
Aculytics builds flexible enterprise architectures that are scalable and support growth in number of users, increases in data volume, and the addition of more locations and complex business rules. Aculytics integrates multiple source systems into a single solution set, extracts the needed data into one common data format, and transforms the data into easily consumable information.
Aculytics then organizes the information into associative data models that are reusable across many dashboards and reports throughout the enterprise. Using powerful desktop and browser-based tools, business users can then perform self-service reporting and create ad-hoc dashboards and analysis solutions without on-going involvement from the IT and data-warehouse groups. Analysis capabilities include the abilities to dynamically convert volume data from one unit of measure (UOM) to another, as well as perform currency conversions on global data to enable the rollup of financial measures across the globe in desired countries currency.
Facilitate and enhance budgeting, profitability, and financial optimization processes by providing the CFO, corporate accountants, and controllers with dashboard solutions that enable them to monitor performance goals and track important metrics like accounts receivable (AR), accounts payable (AP), and cash on hand. Management can gain increased visibility and easily identify problem areas using financial dashboards that allow them to drill through multiple legal entities and levels of detail down to transactional level general ledger (GL) postings, or rollup Cash Flow and Balance Sheet reports across multiple subsidiaries to produce one high-level view of the entire business.
Quickly ascertain which agents have the best customer retention rates and monitor results against agent performance plans, to identify opportunities for cost savings and increased yields.
Analyze claims data and monitor trends and alerts to identify trends and patterns associated to healthcare and insurance fraud or risk. Establish automated reports that notify and highlight specific issues so business users and managers can perform root cause analysis and take action to resolve problems.
Support decision-making and help mitigate risk by performing actuarial and risk management analysis using robust business intelligence tools, balanced score cards, and automated reporting systems that enable business users to do their jobs both efficiently and effectively.