Go through the Excel tutorial provided on the following link:
Excel Database Creation Tutorial
. Using the information from your readings in the overview “Providers” and create a simple database using the information you learned from the excel tutorial and the CSBI materials. Explain how the rows and columns you created would help you further analyze the information. Submit the database with explanation of how a database is created and how it functions.
Website for excel database creation tutorial
https://www.lifewire.com/create-a-database-in-excel-3123446
Reading OverView
Payers
Payers, including a multitude of commercial health insurers, employers, and governments,
provide the financing for the high cost of health services in the United States. Payers face ep
ic challenges, including the advent of health information exchanges, health insurance excha
nges, new Affordable Care Act (ACA) regulations on coverage, premium reviews, profit mar
gins and mandates, new provider models such as Accountable Care Organizations (ACOs), a
nd a huge new pool of customers who were previously uninsured. Payers also face the dual
demands to 1) change their business model of providing wholesale insurance to employers
to providing retail health and insurance services to individuals while also 2) focusing on th
e health and management of populations.
Payers had gotten into a routine of managing the economics of benefits and coverage, prem
ium pricing, and various insurance products, but were not as actively engaged in managing
health and medical care of members/employees as they were for the brief but noteworthy
managed care era of the 1990s. Now, the tenor has changed and the pendulum has swung b
ack and beyond such that insurers are changing the very nature of their business by blurrin
g the lines between payers and providers to ensure better business results and also by chan
ging their mission to become a health company and/or to become an information company
where insurance is just one product line for these organizations.
The analytics challenges and opportunities are daunting. Payers have relied on claims data
as their intelligence source to understand their business but will need to rely on diverse dat
a to address the above challenges. This diverse data coupled with need to comply with unre
lenting regulations will necessitate the review of legacy systems, the capacity of existing da
ta warehouses, and a heightened need to integrate, process faster, discover insights, and co
ntribute regularly to the bottom line.
There are two chapters in Part IV on payers, including a health insurer—
Chapter 23, “Aetna,” by Kyle Cheek—and an employer—
Chapter 24, “Employee Health and Benefits Management at EMC: An Information Driven M
odel for Engaged and Accountable Care,” by David Dimond and Robert Morison.
Cheek notes that Aetna’s analytic maturity is high (4+) on the DavenportHarris Analytics Maturity Model relative to an industry average of stage 2. He describes the
five primary services for its internal and external constituencies including 1) provider anal
ytics to identify opportunities for outcome and cost improvements among physicians and h
ospitals, 2) plan-
sponsor reporting for employers, 3) program evaluation of the ongoing effectiveness of car
e management programs, 4) custom informatics for “special projects,” and 5) data warehou
sing.
In terms of the factors of analytics success, Cheek says that the most important are identifyi
ng the strategic drivers that offer the most demonstrable value from analytical enhanceme
nt, lodging the data warehouse with the informatics organization, and developing an intern
al analytics competency.
Diamond and Morison describe a different analytics focus, on the employee, and how the co
mpany promotes health for its workforce. The EMC vision is for employers to engage patien
ts and providers, enable health awareness and literacy, influence health and lifestyle behavi
ors, and drive adoption of patientcentric technologies. The analytics to support the employee focus include an employee heal
th portal, a personal health record, health risk assessments and incentives to be healthy, an
d the availability of related health management programs.
CSBI Materials
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