Sreevidya Nair - Presentation
Transcript of Sreevidya Nair - Presentation
-
8/3/2019 Sreevidya Nair - Presentation
1/16
I feel better now I feel better now I feel bettow
Sreevidya NairGroup Lead, Business Systems,Medibank private
Business ProcessManagement Health Insurance
-
8/3/2019 Sreevidya Nair - Presentation
2/16
nowPage2
I feel better now I feel better now I feel better now I feel be
Outline
About Medibank
Health insurance in Australia
Health insurance benefits paid last year
Health industry interaction
Business process, business drivers in health insurance
Case study and findings
Conclusion
-
8/3/2019 Sreevidya Nair - Presentation
3/16
nowPage3
I feel better now I feel better now I feel better now I feel be
About Medibank
Australias largest private health insurer, incorporating the Medibank private and AHMhealth funds providing the largest provider network
Integrated private health insurance and health service group
Across our separate brands almost 3.4 million people are covered
Operates over 100 stores and 50 clinics Australia wide
Provider of occupational and travel health services to Government and corporateAustralia
-
8/3/2019 Sreevidya Nair - Presentation
4/16
nowPage4
I feel better now I feel better now I feel better now I feel be
Health insurance in Australia
Over 11.7 million Australians are covered byprivate health insurance
Over 10 million Australians with Hospital Cover
On 30 June 2010, 44.6% of the population,were covered by hospital treatment cover
The most notable increase in coverage duringthe quarter was for people aged between 30and 34.
Notable decrease in coverage were seen forpeople aged 20 to 24
Source: http://www.phiac.gov.au/resources/file/quarterlystatistics/Qtr%20Stats%20Mar11.pdf
-
8/3/2019 Sreevidya Nair - Presentation
5/16
nowPage5
I feel better now I feel better now I feel better now I feel be
Health Insurance benefits paid last year
The total benefits paid by private health insurance funds for all types of hospital andgeneral treatment services in the year ending June 2011 was $12.997 billion.
Hospital treatment $9.71 billion,
General treatment $3.22 billion
Benefits paid increased across all category types, with hospital treatment benefits
increasing by 8.1% and total benefits increasing by 7.8%.
Source http://www.ahia.org.au/news/stats_and_data/private-health-benefits-paid-by-funds-phiac-june-2011/
-
8/3/2019 Sreevidya Nair - Presentation
6/16
nowPage6
I feel better now I feel better now I feel better now I feel be
Health industry participants
Hospital
Insurance
Medicare
Clinics
Radiology services
Pathology services
Medical staff
-
8/3/2019 Sreevidya Nair - Presentation
7/16
nowPage7
I feel better now I feel better now I feel better now I feel be
Interaction
-
8/3/2019 Sreevidya Nair - Presentation
8/16
nowPage8
I feel better now I feel better now I feel better now I feel be
Business Processwithin Health insurance industry
-
8/3/2019 Sreevidya Nair - Presentation
9/16
nowPage9
I feel better now I feel better now I feel better now I feel be
High level business processes within health insurance
People and
Culture
IT
Claims entry
Manage
Online Services
Sales & Marketing
Preventive health
Legal & compliance
Claims processing
Health care codes
and identifiers
Provider details
Medicare transaction
Membership
Health Insurance
Business process
-
8/3/2019 Sreevidya Nair - Presentation
10/16
nowPage10
I feel better now I feel better now I feel better now I feel be
Business drivers for Health insurance
Accurately assessing and pricing risks of insuring a pool of people
Securing competitive provider contacts and price
Cost effective, technology driven administrative processes
Exercising pricing power over small and mid size employers and individuals
Getting rid of bad health risks whenever feasible
-
8/3/2019 Sreevidya Nair - Presentation
11/16
nowPage11
I feel better now I feel better now I feel better now I feel be
Case Study
How a regulatory change in the US changedthe Health Insurance and business process
-
8/3/2019 Sreevidya Nair - Presentation
12/16
nowPage12
I feel better now I feel better now I feel better now I feel be
HIPAAHIPAAHealth Insurance Portability and Accountability Act of 1996Health Insurance Portability and Accountability Act of 1996
Title II
Preventing Health Care
Fraud and Abuse
Administrative Simplification Medical Liability Reform
Security
Administrative Safeguards
Physical Safeguards
Technical Safeguards
Electronic DataInterchange
Privacy
-
8/3/2019 Sreevidya Nair - Presentation
13/16
nowPage13
I feel better now I feel better now I feel better now I feel be
Case study : HIPAA assessment
The Client: A leading health insurance company in the United States was required to comply with thelegislation of HIPAA standards in healthcare
Scope :
The client had an inorganic growth by acquiring smaller health insurance companyresulting in membership and claims process being unique at each site
More than 50 databases
A number of interfaces and reports
Very little process documentation
Timescale
12 weeks
Deliverables
AS- IS process assessment including maps and transaction flow
Business Impact and technical document
Remediation plan
-
8/3/2019 Sreevidya Nair - Presentation
14/16
nowPage14
I feel better now I feel better now I feel better now I feel be
Summary of the findings and lessons learnt
Unavailability of process documentation lead tomanually documenting each and every AS IS processresulting in more time and effort
Repeatable Process :Encourages cost effectiveness asthe process can be used in future compliance relatedchanges
It is a business issue not an IT project
Successful strategies start with the knowledge ofsystem and impact of each change
-
8/3/2019 Sreevidya Nair - Presentation
15/16
nowPage15
I feel better now I feel better now I feel better now I feel be
Conclusion:Need for better business process in healthcare
HIPAA became the catalyst for evaluation of antiquated businessprocedures as well as a catalyst for an integration strategy
Process mapping allows us to identify productivityopportunities, best practices ,root causes of problems, createworkflow and determine who owns what
Healthcare industry demands reliable and secure transmission ofsensitive data
Healthcare Industry around the world is under tremendous pressure toreform and to improve the quality of care and service therefore thefocus will shift on business process
To conclude, health insurance is a very process intensivebusiness and has to constantly adapt the growing needs
of their customer without impacting the quality of care
-
8/3/2019 Sreevidya Nair - Presentation
16/16
nowPage16
I feel better now I feel better now I feel better now I feel be
Insert Picture Here
Thank you