医保大数据平台在医院精细化管理中的应用

Application of healthcare security big data platform in hospital fine management

目的:以医保信息化大数据为切入点,将数据效能转化为治理效能,赋能医院精细化管理。方法:通过对医保大数据的深度挖掘与分析,促进院内多维度的医保费用和行为评价,助力医院医保运营的精细化管理和决策。结果:医保大数据平台应用后,医院医保DRGs结算核心指标得到有效改善,病组费用结构得到优化,智能审核扣减明显降低,医院药占比、耗占比、自理比整体呈下降趋势,医保医师扣分涉及人数下降明显。结论:医保大数据平台精准、多维度的数据对比分析,及时发现医院可能存在的管理风险,助力医院医保精细化运营管理,促进医院高质量发展。

Objective By taking IT application and big data in medical insurance as the starting point,transform data efficiency into governance efficiency,and empower hospital fine management.Methods Through in-depth mining and analysis of medical insurance big data,the multi-dimensional evaluation of medical insurance expenses and behaviors in hospital was promoted to help the fine management and decision-making of medical insurance operation in the hospital.Results After the application of the healthcare security big data platform,the core indicators of hospital medical insurance DRGs settlement was effectively improved,the cost structure of patient groups was optimized,the deduction of intelligent audits was significantly reduced,the drug proportion,consumption proportion and self-care ratio of hospitals showed an overall downward trend.At the same time,the number of medical insurance doctors involved in the deduction decreased significantly.Conclusion The accurate and multi-dimensional comparative data analysis of the healthcare security big data platform can timely detect possible management risks of hospitals in time,facilitate fine operation and management of medical insurance and the high-quality development of hospitals.