Provider Claims benchmarking analytics
Product Statement
Dynamic Providers Enterprises must manage providers from different locations, market sizes, and lines of business which can be challenging. They need to comprehend and efficiently manage providers and understand their performance level. However, this can be difficult without proper benchmarking use cases that provide a comprehensive perspective of the providers.
Solution
To efficiently manage providers, Dynamic Providers Enterprises can utilize benchmarking use cases that offer insight into provider performance levels. This can help identify underperforming, moderately performing, and well-performing providers. To execute data analysis from the Jupyter notebook of the PD Analytical platform, Dynamic Providers Enterprises need to scale up the cluster as they require multi-month data. To do this, they need to work with the P360 team for the six months claims data to connect with the Provider Ops team for further analysis.
Product Values
- Efficient provider management: The product enables Dynamic Providers Enterprises to efficiently manage providers from different locations, market sizes, and lines of business. This helps to streamline their operations and reduce costs.
- Comprehensive perspective: The use of benchmarking use cases helps Dynamic Providers Enterprises to gain a comprehensive perspective of their providers' performance levels. This helps to identify underperforming, moderately performing, and well-performing providers.
- Informed decision-making: By having access to comprehensive data, Dynamic Providers Enterprises can make informed decisions and improve their provider management strategies. This helps to optimize their operations and improve their bottom line.
Key Metrics
- Provider performance levels: This measures the performance of each provider, helping to identify underperforming, moderately performing, and well-performing providers.
- Provider costs: This metric helps to determine the cost of each provider and the value they bring to the organization.
- Provider network size: This measures the size of the provider network, helping to determine if it is sufficient to meet the needs of the organization.
- Provider satisfaction: This measures the satisfaction level of providers, helping to ensure that they are happy with the arrangement and willing to continue working with the organization.
- Provider utilization: These measures how often providers are being utilized, helping to ensure that they are being used effectively and efficiently.
- Provider compliance: These measures how well providers are following regulations, guidelines, and standards, helping to ensure that the organization is in compliance with industry requirements.
Team
| Niteen K Singh | Pavan Kumar T |
| Product Manager | Sr Manager Data Science |
| niteen_singh@optum.com | pavan.kumar_thatha@optum.com |