Reducing cost from health network providers through alerting and understanding provider performance（通过告警与供应商绩效分析降低医疗网络成本）¶

Industry Sector: Health Care

Business Function: Operations

Analyzing provider performance for contract negotiation is a very manual process that typically provides limited indication on what factors are driving holistic provider performance. A Foundry application enabled alerts and a drill-down workflow where analysts could investigate providers from the highest to most granular level across multiple dimensions and timescales, surfacing hundreds of millions of dollars in potential opportunities.

Challenge¶

Contracting and Network Development analysts investigate provider inefficiency for the purpose of re-negotiating future provider contracts, and contact providers to address immediate concerns. Prior to Foundry, analysts reviewed provider performance through a completely manual and limiting process. They submitted requests to their data analytics team to retrieve the relevant claims for a given provider, dug into these claims in Excel, and generated metrics manually to identify opportunities.

In addition to not being scalable, this workflow provided one entry point, no aggregated metrics, limited understanding of how providers are performing in their peer group, and no way to automatically surface alerts.

Solution¶

A Foundry operational dashboard provided multiple entry points that can be used to analyze provider utilization data and make decisions around provider network and contracting. It enabled users to analyze their network of providers by various metrics across different dimensions (cost, quality, utilization, etc.) and also allowed them to perform this drill-down exercise from the highest level (state/plan/service type) down to the individual claim lines.

An alerting workflow encoded several drill-down patterns and automatically surfaced opportunities to the users, who can perform their entire analysis within one object view, then delegate, validate, and capture a surfaced revenue opportunity.

Reducing Cost from Health Network Providers Through Alerting and Understanding Provider Performance

Stakeholders and user groups¶

Primarily analysts responsible for contracting and network development
Additional user groups may including anyone looking to analyze provider performance

Impact¶

Surfaced multi-million dollars in projected opportunities.
Significant time savings for operational users.
Aggregate revenue metrics quantifying analysts’ effort.

How it’s made¶

Ontology Structure¶

The ontology was composed of the objects in bullets below, with 70+ aggregated provider utilization metrics computed on the claims and claim lines.

Claim line
Claim
Attending Provider
Attending Professional
Attending Provider Yearly Metric
Opportunities (alerts generated by rules on any of the objects above)

Applications¶

Drill-down object views
Alerting Inbox surfacing opportunities for review, validation, and capture
Dashboard to track opportunities captured and associated cost savings

Implement a similar use case¶

This use case implements the following Pattern. Follow the link below to read more about a particular Pattern and learn how it is implemented within Foundry.

Alerting workflow (used for 7 other use cases)

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中文翻译¶

通过告警与供应商绩效分析降低医疗网络成本¶

行业领域：医疗健康

业务职能：运营

分析供应商绩效以进行合同谈判是一项高度手动化的流程，通常只能提供有限的信息，难以揭示影响供应商整体绩效的关键因素。通过 Palantir Foundry 应用，实现了告警机制与逐层深入的分析工作流，分析师能够从最高层级到最细粒度，跨多个维度和时间尺度对供应商进行调查，从而发现数亿美元的潜在机会。

挑战¶

合同与网络发展分析师负责调查供应商效率低下的问题，以便重新谈判未来的供应商合同，并联系供应商解决紧迫问题。在使用 Foundry 之前，分析师通过完全手动且受限的流程来审查供应商绩效。他们向数据分析团队提交请求，以获取特定供应商的相关理赔数据，然后在 Excel 中深入分析这些数据，并手动生成指标来识别机会。

除了不具备可扩展性外，这种工作流仅提供单一入口点，缺乏聚合指标，对供应商在同业中的表现了解有限，也无法自动触发告警。

解决方案¶

Foundry 运营仪表板提供了多个入口点，可用于分析供应商利用率数据，并围绕供应商网络和合同做出决策。它使用户能够通过不同维度（成本、质量、利用率等）的多种指标分析其供应商网络，并允许他们从最高层级（州/计划/服务类型）逐层深入到单个理赔条目。

告警工作流编码了多种逐层深入的模式，自动向用户展示机会。用户可以在一个对象视图中完成全部分析，然后委派、验证并捕获所发现的收入机会。

通过告警与供应商绩效分析降低医疗网络成本

利益相关者与用户群体¶

主要负责合同与网络发展的分析师
其他用户群体可能包括任何需要分析供应商绩效的人员

影响¶

发现数千万美元的预期机会。
为运营用户节省大量时间。
通过聚合收入指标量化分析师的努力成果。

实现方式¶

本体结构¶

本体由以下对象组成，并在理赔和理赔条目上计算了 70 多个聚合的供应商利用率指标。

理赔条目 (Claim line)
理赔 (Claim)
主治供应商 (Attending Provider)
主治专业人员 (Attending Professional)
主治供应商年度指标 (Attending Provider Yearly Metric)
机会 (Opportunities)（基于上述任一对象的规则生成的告警）

应用¶

逐层深入的对象视图
告警收件箱，用于展示待审查、验证和捕获的机会
仪表板，用于跟踪已捕获的机会及相关的成本节约

实施类似用例¶

本用例实现了以下模式。点击下方链接可了解更多关于特定模式的信息及其在 Foundry 中的实现方式。

告警工作流（另用于 7 个其他用例）

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