The fact that health is an expensive commodity is clearly illustrated by the efforts being invested in reforming the financial systems in the health care system. Health insurance funds need to be fully informed about health costs in relation to the services provided. Informative data material is essential in order to gain the upper hand in what is becoming an increasingly competitive market. The data provides the platform for negotiating with doctors and their associations, with drugstores, hospitals and other service providers and for concluding agreements with these. The Health Care Structure Act 1993 obliges the statutory health insurance funds in Germany to improve the transparency of costs and performance. Social Security Code V requires that billing data is transferred between service providers and health insurance funds in digital format.
Identifying weak points and potential
Anyone wanting to modernize the health care system, must be able to identify weak points and harness synergies. To this end, the data should support a whole variety of analysis options. Transparency is vital for finding answers to questions such as: Where are the main areas of expenditure? Where can savings be made? Which doctors primarily prescribe high price medicines? What services are utilized and where?
The great many specialized issues and the quantity and complexity of data available call for a structured approach and support from a flexible and powerful data warehouse. In the past, only database experts were able to filter the correct information from the existing diversity of systems. Depending on the particular issue in question, the data had to be identified, logically linked, then processed and supplied to the user. This procedure took up considerable time – time that may not necessarily be available since the results were needed quickly for the decision-making process. At the same time, the live systems were placed under extreme strain and staff were tied up.
420 million data records each year
In 1999 the IKK Federal Association opted for SAP Business Information Warehouse (SAP BW), the data warehouse solution making up part of SAP Business Intelligence (SAP BI). A feasibility study revealed that SAP BW satisfied the needs of the guild health insurance funds regarding its openness for non-SAP systems and its ability to process even very large quantities of data.
IKK proCon – IKK’s own data warehouse solution – have been used live since 2001. At the current time, around 420 million data records are loaded annually. The high data volume of around 400 GB per year van be analyzed very efficiently with SAP BW. These services are made possible by multiproviders who are able to interlink various features to meet the user’s needs. The features, for example relating to policyholders or the prescription of medicines and therapies, have been defined in the form of InfoCubes in the BI solution. By way of example, the user defines a number of attributes for a medicine – including the central pharmaceutical number (the designation used for the medicines in Germany), the trading name, active substances, price and packaging size. A legal requirement for operating the data warehouse was to ensure that personal data was adequately protected. The data relating to each individual insured person is pseudonymized. The role-based rights concept used by SAP BI prevents unauthorized persons from accessing protected data.
IKK proCon provides the technical platform for controlling contractual and service programs and is used to support management decisions. Data is currently available for billed medicines, the billing data of panel doctors, and statistics about types of illness. The solution also covers up-to-date analyses of the prescriptions issued in Germany. This information can be used to identify trends and supply KPIs for regional comparisons. Prior to being loaded, the billing data is linked with statistical data and other infrastructure data such as information of policyholders, master register of doctors and pharmacies, registers of fees and diagnoses, et cetera. This opens up a whole range of evaluation options.
The analyses are performed using standard evaluations. These enable the data from the health insurance fund’s own database to be compared with the mean data from the entire IKK system at the push of a button. This information can then be used to derive conclusions that can be employed in strategic and operational management decisions. This is the case, for example, with evaluations relating to medications in scenarios where, for instance, several medicines are prescribed for treating one and the same illness or if main indication areas and diagnosis groups can be identified. In addition, the high granularity of the base data also makes it possible to search for inconsistencies down to the individual data record level or to examine specific issues. This provides a valuable means of highlighting possible relationships between illnesses and sociodemographic characteristics, such as the frequency of diabetes in conurbations.
Benchmarking in the health care sector
As part of online searches, an authorized user can examine the results of the standard analyses in greater detail. He is able, for example, to analyze the prescribing behavior of individual doctors within the framework of a targeted consultancy process. Benchmarking can be used to identify key areas of expenditure. The results can be used in budget negotiations with doctors’ associations and the associations of statutory health insurance physicians. The BI solution helps uncover cost-efficiency reserves, for example: What are the potential savings when expensive original preparations are replaced by cheaper generic solutions? IKK proCon can be used to represent various KPIs over time, analyzed for example based on policyholder groups, medicines and active substances, groups of doctors and specialists, health insurance regions and federal states, pharmacies and pharmacy data centers, age, sex, fee codes and diagnoses.
The analysis results are primarily presented in Excel. The changeover to SAP BW 3.0 in 2004 gives users improved presentation options using Web Reporting. Thanks to IKK proCon and the transparency this generates in contract matters and the provision of services, the IKK system is well equipped for future structural changes in the health care system.