Health Insurance Buisness Intelligence and Claims Analytics

Speaker: Uma Srinivasan

Affiliation: Capital Markets Cooperative Research Centre (CMCRC); University of Western Sydney

Time: Monday 25/07/2011 from 14:00 to 15:00

Venue: Access Grid UWS. Presented from Parramatta (EB.1.32), accessible from Campbelltown (26.1.50) and Penrith (Y239).

Abstract: The Australian Healthcare system is very complex resulting in fragments of clinical and business data lying scattered across the whole healthcare system. While a large amount of data from the public health system is analysed and reported, the private health care data is often left alone. In this context, information contained in private health insurance claims provide a rich and unique source of both business data (e.g. cost of services) and clinical data (in the form of diagnosis and procedure codes). Combining business data and clinical data available in health insurance claims gives us a unique capability to identify metrics and indicators to study several aspects of health economics as well as clinical outcomes ranging from claims leakage / arbitrage to measuring clinical performance indicators in the national priority areas.

This Talk will present some potential applications and research opportunities in Health Insurance Claims Analytics and the work being done at CMCRC in the Health Insurance Business Intelligence (HIBIS) project, which uses advanced analytical, diagnostic, surveillance and predictive techniques targeted to detect health-related claims leakage in the private and public Health Insurance sectors, as well as the Work Cover and Third-party Personal Accident sectors.

Biography:

Dr Uma Srinivasan has been providing research and consultancy services and information solutions to the Health sector in Australia, and India for over twenty-five years. Her clients include federal and state government health departments, health management organisations and large hospitals and IT companies.

Uma currently works as Health Informatics Specialist for Capital Markets CRC, advising research and product development in the area of health information business intelligence services. Formerly she worked as Principal Research Scientist at CSIRO, Australia leading a team of IT professionals, scientists and engineers in two specialist areas: Health Data Integration and Multimedia Delivery Technologies. Her previous position also includes working as a Project Director at Prince of Wales Hospital Group, South Eastern Sydney Area Health Service, where she was responsible for designing managing implementations of large inter-hospital systems. She has several international publications in the areas of multi-database and multimedia systems and holds a PhD in Computer Science from University of New South Wales. Dr Srinivasan is an Adjunct Associate Professor at University of Western Sydney, Australia.