Suite of Operational Care Management Dashboards

Triverus led the deployment of multiple Utilization and Care Management dashboards to monitor caseload life-cycle, volume, productivity and audit compliance for the largest non-profit health care organization in the state.

Challenges

Much of the client’s data required to provide analytics for the full claim life-cycle resides in multiple, disparate systems. Understanding the complete data and business requirements and transformation of data to a reportable, consumable format were key to this project’s overwhelming success. Further, a large portion of the end users were field medical associates with limited technical experience. The dashboards needed to be easy to understand and utilize while still providing robust analytical capabilities.

Results

Triverus produced a 360⁰ view of claim authorizations from intake to approval or denial. This dashboard provided the Chief Operating Officer and Chief Medical Officer with essential information to support allocating future capacity as well as providing a valuable tool for the Audit Team. Triverus helped the client overcome many limitations in their current view of the claims life-cycle by integrating the additional analytics and data insights needed to complete the full analysis. The solution also exposed audit liabilities where the client previously had no prior visibility.

How We Helped

Triverus worked closely with business stakeholders to understand the system interactions required for each business process in question. We then analyzed the available data sources to identify the key information required to support the analytics and supported the client's data teams to expose these data sources for analysis. Triverus designed and implemented the dashboards and supporting analytics incorporating business feedback along the way.

Technologies

Power BI, SQL Server, SharePoint