IBM Health Plan Data Model

Comprehensive data models containing data warehouse design models, business terminology model and analysis templates that accelerate the development of business applications.

Enables the consolidation of trusted information across multiple viewpoints:

• Delivers competitive advantage by enabling the consolidation of clean, meaningful plan data across multiple providers and members.
• Covers Claims handling, adjudication and recovery, disbursements analysis, member service and retention, provider performance and quality, disease management, utilization management, pharmacy benefits, underwriting, profitability visibility and more.
• Enables business users to more effectively control and reduce the time taken to scoping their requirements, subsequent customization and any extension of the data warehouse.
• Provides a solid basis for measuring the cost and effectiveness of health care outcomes, based on the latest regulations via financial reporting and performance management decision support, real-time analytics and predictive modeling.
• Offers a foundation for the Health Insurance Portability and Accountability Act (HIPAA) 5010 specification
• Assistance with regulatory reporting of Medical Loss Ratios, and International Classification of Diseases ICD -9 and ICD-10, and NCQA Healthcare Effectiveness and Data Information Set (HEDIS) standard
• Helps minimize development costs. Reduces the risk of failure by facilitating an incremental approach to delivering integrated reporting repository
• Find out what’s new in the latest version of the IBM Industry Models
• Operating systems supported: Windows family

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• Industry Model Requirements