Business Intelligence Solution in the Health Insurance Company

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Business Intelligence Solution in the Business Case

of Health Insurance Industry Created by: Tran Thi Bao Thuy

Submitted to: Prof. Dr. Monika Frey-Luxemburger17th Jan. 2017

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Agenda• Company Profile, Problem Statement and Project

Scope• KPIs• Data Modelling• Excel Prototype• Implementation in SAP BI DW• Implementation in Xtract QV and Qlik View• Project Plan• Lesson Learned• References

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GRANDSON INSURANCE Ltd.*

Industry: Third Party Administrator for Health and Travel Insurance

Operation in: Philippines, Indonesia, Thailand, Vietnam, Cambodia and Myanmar

Company Size: 450 employees

Gross Premium Revenue: US$ 21,5 mil. in 2014

Profit: US$ 1,3 Mil. in 2014* Company name is changed

Company Profile… KPIs Data

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PrototypeImplementation in SAP BI DW

Implementation in Xtract QV and Qlik View

Project Plan Lesson Learned References

TPA Services:• Design of Health and Travel insurance products• Pricing, policy wording, benefit schedule, rules

and procedures • Underwriting, Claim adjudication, renewal

assessment, analysis of product performance

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Problem Statement• CLAIMS are unknown and in some case, unpredictable

• LACK OF INFORMATION sharing among insurance companies

• CLINICS AND HOSPITALS charge different prices for the same work

• Places / location where go for health care VARIES IN PRICE

• Claim Department spends much time at the end of month to create REPORT for Partners - Insurance Companies

SOLUTION PROPOSED:

Implementing a Business Intelligence Tool to improve business performance, easily create reports, share visual information among top managers, partners as well as Claim Department.


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Project ObjectivesBased on the scope of project, three main KIPs will be analyzed and presented as a part of monthly report from Claim department. • Top three hospitals with the highest treatment cost in the specific

month• Top three diagnosis with highest treatment cost in the specific month• Top three treatment cost of the top three diagnosis at hospitals in the

specific month

Project Scope• Limited Project Area: Ho Chi Minh city, Vietnam• Limited Products: Health Insurance, Out-Patient Service


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Key Performance Indicators

KPI 1Part I: Description

Identification Tophosmont

Description Top three hospitals with highest total treatement cost in month

Addressee Claim Dept. and Board Manager

Formula , n – invoice/current month/hospital

Target Value Total treatment cost per hospital in month

Unit USD

Periodicity Monthly

Dimensions Month, Hospital name, Invoice

Aggregations behaviour Sum

Planned values Below $50,000

Tolerance values Over $50,000

Escalation norms Mark in Red

Validity/Periodicity From now till the next updated version

Dependency Invoices of doctor visiting, medicine and Lab

Person in charge Thuy

Example Total Treatment Cost of FV Hospital in Nov. 2016

Part II: Determining the dataData sources Export from HBS System to Excel file

Measuring method Amount of Invoices

Measuring points monthly


Part III: Data processing

Calculation methods Sum of the invoice of each hospital in the month; Choose top three hospital with largest amount

Data flow Total Invoive = sum invoice of doctor visiting, medicine and Lab tests


Part IV: Presentation Layout Bar chart

Dimension Month, Hospital name, Invoice

Aggregation steps Roll up

Access Rights Claim Staff and board of manager

Archiving Report in PDF


1. Top three hospitals with highest total treatment cost in month (Tophosmont)


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Identification Topdiagmont

Description Top Diagnosis with highest treatment in month


Formula , n – invoice/current month/diagnosis

Target Value Total treatment cost per diagnosis in month

Unit USD

Periodicity Monthly

Dimensions Month, Diagnosis name, Invoice








Example Treatment Cost of Osteoarthritis in Nov. 2016






Calculation methods Sum of the invoice of each diagnosis in the month; Choose top three diagnosis with largest amount




Dimension Month, Diagnosis name, Invoice

Aggregation steps Roll up




2. Top three diagnosis with highest treatment cost in month (Topdiagmont)


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Identification Toptreatmentcost

Description Top treatment cost per visiting for the top three diagnosis at hospitals in month


Formula , n – invoice/current month/diagnosis/ visiting

Target Value Total cost per visiting for a diagnosis in month

Unit USD

Periodicity Monthly

Dimensions Month, Diagnosis name, Hospital name, Invoice








Example Cost of visiting for Osteoarthritis in Nov. 2016






Calculation methods Sum of the invoice per visiting of each diagnosis in the month; Choose top three diagnosis with largest amount




Dimension Month, Diagnosis name, Invoice

Aggregation steps Dice




3. Top treatment cost for the top three diagnosis at hospitals in month (Toptreatmentcost)


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Data Modeling-Star Schema

Member ListMember No. (PK)First NameLast NameDate of BirthProduct TypeEffective Date

Hospital ListHospital ID (PK)Hospital Name

Diagnosis ListDiagnosis ID (PK)Diagnosis Description

Claim TypeClaim Type ID (PK)Claim Name

InvoiceInvoice No. (PK)

Treatment DateDate ID (PK)DateYearMonthDay

Fact TableTreatment Date (FK)Claim No. (FK)Hospital ID (FK)Member No. (FK)Diagnosis ID (FK)Invoice (FK)Claim Type (FK)AmountKPIs

•Top Hospital with highest treatment cost•Top Diagnosis with highest treatment Cost•Top Treatment Cost of Top Diagnosis at hospitals


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Claim DocumentClaim No. (PK)Claim Date

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MS Excel Prototype

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Fact Table in MS Excel


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Dimensions in MS ExcelMember List Dimension

Hospital Dimension Diagnosis Dimension


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Dimensions in MS ExcelClaim DocumentClaim Type

Treatment Date

Invoice


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Report in MS Excel for KPI Tophosmont


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Report in MS Excel for KPI Topdiagmont


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Report in MS Excel for KPI Toptreatmentcost


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Implementation with SAP BI-DW

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Metadata


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Creating InfoArea


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Creating Dimensions Using InfoObjects


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Register Characteristics as InfoProviders


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InfoCube Creation


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DataSource Creation & Loading Master data into InfoObject


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Loading Transaction DataCreate Application Component, InfoSource, Transformation for InfoSource


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Loading Transaction DataCreate Transformation for InfoCube


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Loading Transaction DataCreate Data Transfer Process and Loading Data to Infocube


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Implementation in Xtract QV

and QlikView

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Creating Queries

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Creating Queries

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Creating formular for Table and Charts

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Table and Charts

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Company Profile… KPIs Data model Excel




Project Phase TaskStart Date

End Date

Progress

1. Preparation Formulating of Business Case 08/11/1615/11/1

6100%

Defining KPIs 15/11/16 29/11/16 100%

2. Modelling and Prototyping

Defining Data Model 29/11/16 13/12/16 100%

Designing Star schema 29/11/16 13/12/16 100%

Creating Excel prototype 29/11/16 13/12/16 100%

3. Implementation on SAP BI DW

Creating Master Data, Transaction Data 29/11/16 06/12/16 100%

Creating InfoObjects and InfoCube 06/12/16 10/01/1

7 100%Upload Master Data &Transaction Data 20/12/16 10/01/1

7 100%4. Implementation on Xtract QV and Qlik View

Implementing on Xtract QV and Qlik View 10/01/16 13/01/1

7 100%

5. Presentation Presenting 17/01/16 17/01/17 100%

Project Plan

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Lessons Learned• Indentifined and Defined right KPIs for business case• Designed Data Model: Star Schema• Able to use Microsoft Excel to create PivotTables• Able to use SAP BI-DW• Understood Metadata, InfoObjects, InfoCube,

Characteristics, Key Figures, Data Sources, Transformation in SAP BI-DW• Able to use QlikView to create reports and charts





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References• David Haertzen, “The Analytical Puzzle: Profitable Data Warehousing,

Business Intelligence and Analytics”, Technics Publications, 2012• Oleg Troyansky, Tam Gibson, Charlie Leichtweis, “QlikView Your

Business: An expert guide to Business Discovery with QlikView and Qlik Sence”, Wiley, 2015 • Miguel Garcia, Barry armsen, QlikView 11 for Developers, Packt

Publishing, 2012• Cindi Howson, Successful Business Intelligence, 2014





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Thank YouCám Ơn

Business Intelligence Solution in the Health Insurance Company

Software

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