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Background
Team Health is the leading provider of hospital-based physician services in the United States. In 2001 Team Health acquired Integrated Specialists Management Services, Inc. (ISMS), the nation's largest anesthesia management company, now referred to as Team Health Anesthesia Management Services (THAMS). THAMS provides a full complement of administrative and management services through support systems, including contract analysis, income distribution and strategic planning, to large anesthesia groups meeting the needs of some of the nation's highest volume anesthesia providers.
Situation
Poised for additional growth, THAMS kicked off an initiative to deliver a data warehouse that would integrate data from multiple medical billing systems and address the unique reporting and analysis requirements that THAMS needed to deliver to its clients. The goal was to develop a scalable system that would allow for controlled data acquisition while automating THAMS' strict data validation rules.
In the managed care industry, the ability to provide medical groups with monthly revenue, insurance contract, and strategic planning analysis is critical. Although THAMS was already analyzing group revenue, the company was at risk because only one employee had knowledge necessary to perform the complex data migrations necessary to extract data from billing company downloads. Additionally, the legacy system was not HIPPA (Health Insurance Portability and Accountability Act of 1996) compliant and would not accommodate future growth.
Key Goals
- Comply to HIPPA standards.
- Development system that was scalable.
- Perform complex data migration and multiple custom reports.
Solution
SCG worked with Team Health's management and IT staff to design and develop a Data Warehouse architecture that would enable import, validation and loading of data used for analysis of physician charges, payments & adjustments, medical procedures, cases, schedules and utilization. The project name is "Anesstat," alluding to the delivery of statistical information critical to the THAMS client base of anesthesia groups.
The .NET framework and SQL Server were selected as the primary component of the solution due to its scalability and wide variety of components that were utilized to provide analysis, data transformation, and reporting services.
Results
The Anesstat data warehouse enables anesthesia groups to monitor and analyze charges, payments, adjustments on a procedure and case level. They can also analyze insurance contract performance and physician utilization.
Using the Anesstat system gives THAMS data owners the ability to effectively manage data integrity and gain an increased flexibility in adding participating groups. The system also provides the statistical analysis they need.
With solid architecture and accurate design now in place, THAMS is positioned for future growth and accurate reporting.
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| challenges |
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unreliable data |
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changing business rules |
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| technologies |
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SQL Server |
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Data Transformation Services |
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Analysis Services |
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Reporting Services |
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Windows Server |
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| results |
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customized billing processes |
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real-time financial reporting |
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improved business analytics |
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increased data integrity |
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