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Situation

The client, a large medical group focused on value-based care, faced significant challenges in improving clinical care quality, optimizing patient experience, reducing healthcare costs, and driving business growth. The lack of a unified data platform and standardized Key Performance Indicators (KPIs) across critical business domains hindered informed decision-making to enhance care delivery, operational efficiency, and financial performance.

Objective

To design and implement a robust data platform that aggregates and harmonizes data across multiple systems, enabling the development of enterprise-wide KPIs in the following domains: Revenue Cycle Management (RCM) Analytics, Operations Analytics, Patient Access Analytics, Clinical Analytics, HR Analytics.

Value addition

Reliable and standardized Enterprise KPIs across these domains was critical for driving improvements in healthcare outcomes, financial sustainability, operational excellence, and strategic growth. The following steps were undertaken:

Assessment and documentation
  1. Comprehensive Evaluation:
    Assessed the existing business processes, systems, and data landscape, which included: multiple Electronic Medical Record (EMR) systems, payors data feeds, HR system, financial system, others.
  2. Process Mapping:
    Developed data flow and sequence diagrams to capture the integration points for patient, financial, operational, and workforce data.
  3. KPI Documentation:
    Identified and standardized KPIs aligned with value-based care objectives, business efficiency, and growth strategy.
Technical architecture
  1. Future State Architecture:
    Designed and implemented an Azure Databricks Data Lake with the Medallion Architecture:
    • Bronze Zone: Raw ingestion of clinical, payer, HR, financial, and operational data.
    • Silver Zone: Cleansed, conformed, and enriched data, ensuring consistency and quality.
    • Gold Zone: Curated datasets optimized for analytics and reporting.
  2. Scalable and Secure Infrastructure:
    Leveraged Azure’s built-in security and compliance features, ensuring HIPAA-compliant handling of PHI (Protected Health Information).
Enterprise KPIs Dashboards & Reports (Power BI)
  1. Unified Data Models:
    Built domain-specific data models to support the creation of KPIs for RCM, clinical, operational, patient access, marketing, HR, talent pipeline, and cost analytics.
  2. Power BI Dashboards & Reports:
    Designed interactive Power BI dashboards tailored to each functional domain, enabling business leaders to:
    • Improve financial outcomes through RCM analytics.
    • Monitor clinical quality and cost performance for value-based care.
    • Optimize patient access and referral management.
    • Analyze clinician productivity and staffing efficiency.

Impact

  1. Optimized Financial Outcomes:
    Comprehensive RCM analytics reduced Days in AR and improved collection efficiency, positively impacting cash flow and profitability.
  2. Improved Clinical Care Quality:
    Enhanced tracking and closure of care gaps drove better compliance with value-based care quality measures.
  3. Enhanced Patient Access and Experience:
    Insights from Patient Access Analytics enabled targeted strategies to reduce no-shows and improve appointment availability.
  4. Operational excellence:
    Operations Analytics highlighted inefficiencies, leading to better resource allocation and cost management.
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