基于商业智能模式下的医院医疗保险综合管理模式探索

Exploration of the Comprehensive Management Model of Hospital Medical Insurance Based on Business Intelligence Mode

基于商业智能模式的特点和结构体系,对其在医疗保险综合管理中的应用进行了探索分析。医院与某智慧医疗平台合作研发了医保数据管理挖掘平台,并从事前、事中、事后三大层次探讨了如何做好医保运行管理工作。利用商业智能工具提取数据,通过数据采集、加工等技术,对医保收入、医保患者费用等指标进行多维度的统计和分析,并建立相应图形或报表,实现了医院数据与医保中心数据的自动化抽取匹配,给予患者优质的医疗服务,明显提高医疗保险管理水平。

Based on the characteristics of business intelligence model and its structure system,we explored die application of business intelligence model in the comprehensive management of medical insurance.My hospital and a wisdom medical platform cooperated and developed medical insurance data management and mining platform,and explored how to complete medical insurance operation and management on three levels：the former,the middle,the later.We extracted datas with business intelligence tools to gather statistics and analyse multi-dimensionally the quotas such as medical insurance income and patient expense with technology of data collection and processing and so on,and established corresponding graphs and report forms.It realizes automated extraction matching of hospital datas and medicare center datas,with superior medicalservice for patients,and improves the management level of medical insurance management.