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.

The IBM Health Plan Data Model is the strategic blueprint necessary to deliver comprehensive health analytics and business insights required to transform, innovate and improve the cost, quality and experience of healthcare:

• 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.

• Provides a foundation for the Health Insurance Portability and Accountability Act (HIPAA) 5010 specification

• Supports 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

• Leverages InfoSphere Data Architect capabilities for deployment on a wide variety of warehouse platforms including IBM Data Netezza Warehouse Appliances and non-IBM platforms

• Business Solution Templates offer comprehensive functional coverage to meet the requirements of large and small hospitals, chains, service providers and ACOs and provide a logical basis for business intelligence tools, such as IBM Cognos Business Intelligence

• Integrates with InfoSphere Business Glossary to provide a gateway between business language and technical data elements used to deliver your data warehousing vision