Post on 13-Apr-2017
1
Business Intelligence Solution in the Business Case
of Health Insurance Industry Created by: Tran Thi Bao Thuy
Submitted to: Prof. Dr. Monika Frey-Luxemburger17th Jan. 2017
2
Agenda• Company Profile, Problem Statement and Project
Scope• KPIs• Data Modelling• Excel Prototype• Implementation in SAP BI DW• Implementation in Xtract QV and Qlik View• Project Plan• Lesson Learned• References
3
GRANDSON INSURANCE Ltd.*
Industry: Third Party Administrator for Health and Travel Insurance
Operation in: Philippines, Indonesia, Thailand, Vietnam, Cambodia and Myanmar
Company Size: 450 employees
Gross Premium Revenue: US$ 21,5 mil. in 2014
Profit: US$ 1,3 Mil. in 2014* Company name is changed
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
TPA Services:• Design of Health and Travel insurance products• Pricing, policy wording, benefit schedule, rules
and procedures • Underwriting, Claim adjudication, renewal
assessment, analysis of product performance
4
Problem Statement• CLAIMS are unknown and in some case, unpredictable
• LACK OF INFORMATION sharing among insurance companies
• CLINICS AND HOSPITALS charge different prices for the same work
• Places / location where go for health care VARIES IN PRICE
• Claim Department spends much time at the end of month to create REPORT for Partners - Insurance Companies
SOLUTION PROPOSED:
Implementing a Business Intelligence Tool to improve business performance, easily create reports, share visual information among top managers, partners as well as Claim Department.
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
5
Project ObjectivesBased on the scope of project, three main KIPs will be analyzed and presented as a part of monthly report from Claim department. • Top three hospitals with the highest treatment cost in the specific
month• Top three diagnosis with highest treatment cost in the specific month• Top three treatment cost of the top three diagnosis at hospitals in the
specific month
Project Scope• Limited Project Area: Ho Chi Minh city, Vietnam• Limited Products: Health Insurance, Out-Patient Service
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
6
Key Performance Indicators
KPI 1Part I: Description
Identification Tophosmont
Description Top three hospitals with highest total treatement cost in month
Addressee Claim Dept. and Board Manager
Formula , n – invoice/current month/hospital
Target Value Total treatment cost per hospital in month
Unit USD
Periodicity Monthly
Dimensions Month, Hospital name, Invoice
Aggregations behaviour Sum
Planned values Below $50,000
Tolerance values Over $50,000
Escalation norms Mark in Red
Validity/Periodicity From now till the next updated version
Dependency Invoices of doctor visiting, medicine and Lab
Person in charge Thuy
Example Total Treatment Cost of FV Hospital in Nov. 2016
Part II: Determining the dataData sources Export from HBS System to Excel file
Measuring method Amount of Invoices
Measuring points monthly
Person in charge Thuy
Part III: Data processing
Calculation methods Sum of the invoice of each hospital in the month; Choose top three hospital with largest amount
Data flow Total Invoive = sum invoice of doctor visiting, medicine and Lab tests
Person in charge Thuy
Part IV: Presentation Layout Bar chart
Dimension Month, Hospital name, Invoice
Aggregation steps Roll up
Access Rights Claim Staff and board of manager
Archiving Report in PDF
Person in charge Thuy
1. Top three hospitals with highest total treatment cost in month (Tophosmont)
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
7
8
KPI 2Part I: Description
Identification Topdiagmont
Description Top Diagnosis with highest treatment in month
Addressee Claim Dept. and Board Manager
Formula , n – invoice/current month/diagnosis
Target Value Total treatment cost per diagnosis in month
Unit USD
Periodicity Monthly
Dimensions Month, Diagnosis name, Invoice
Aggregations behaviour Sum
Planned values Below $10,000
Tolerance values Over $10,000
Escalation norms Mark in Red
Validity/Periodicity From now till the next updated version
Dependency Invoices of doctor visiting, medicine and Lab
Person in charge Thuy
Example Treatment Cost of Osteoarthritis in Nov. 2016
Part II: Determining the dataData sources Export from HBS System to Excel file
Measuring method Amount of Invoices
Measuring points monthly
Person in charge Thuy
Part III: Data processing
Calculation methods Sum of the invoice of each diagnosis in the month; Choose top three diagnosis with largest amount
Data flow Total Invoive = sum invoice of doctor visiting, medicine and Lab tests
Person in charge Thuy
Part IV: Presentation Layout Bar chart
Dimension Month, Diagnosis name, Invoice
Aggregation steps Roll up
Access Rights Claim Staff and board of manager
Archiving Report in PDF
Person in charge Thuy
2. Top three diagnosis with highest treatment cost in month (Topdiagmont)
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
9
KPI 3Part I: Description
Identification Toptreatmentcost
Description Top treatment cost per visiting for the top three diagnosis at hospitals in month
Addressee Claim Dept. and Board Manager
Formula , n – invoice/current month/diagnosis/ visiting
Target Value Total cost per visiting for a diagnosis in month
Unit USD
Periodicity Monthly
Dimensions Month, Diagnosis name, Hospital name, Invoice
Aggregations behaviour Sum
Planned values Below $1,000
Tolerance values Over $1,000
Escalation norms Mark in Red
Validity/Periodicity From now till the next updated version
Dependency Invoices of doctor visiting, medicine and Lab
Person in charge Thuy
Example Cost of visiting for Osteoarthritis in Nov. 2016
Part II: Determining the dataData sources Export from HBS System to Excel file
Measuring method Amount of Invoices
Measuring points monthly
Person in charge Thuy
Part III: Data processing
Calculation methods Sum of the invoice per visiting of each diagnosis in the month; Choose top three diagnosis with largest amount
Data flow Total Invoive = sum invoice of doctor visiting, medicine and Lab tests
Person in charge Thuy
Part IV: Presentation Layout Bar chart
Dimension Month, Diagnosis name, Invoice
Aggregation steps Dice
Access Rights Claim Staff and board of manager
Archiving Report in PDF
Person in charge Thuy
3. Top treatment cost for the top three diagnosis at hospitals in month (Toptreatmentcost)
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
10
Data Modeling-Star Schema
Member ListMember No. (PK)First NameLast NameDate of BirthProduct TypeEffective Date
Hospital ListHospital ID (PK)Hospital Name
Diagnosis ListDiagnosis ID (PK)Diagnosis Description
Claim TypeClaim Type ID (PK)Claim Name
InvoiceInvoice No. (PK)
Treatment DateDate ID (PK)DateYearMonthDay
Fact TableTreatment Date (FK)Claim No. (FK)Hospital ID (FK)Member No. (FK)Diagnosis ID (FK)Invoice (FK)Claim Type (FK)AmountKPIs
•Top Hospital with highest treatment cost•Top Diagnosis with highest treatment Cost•Top Treatment Cost of Top Diagnosis at hospitals
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
Claim DocumentClaim No. (PK)Claim Date
11
MS Excel Prototype
12
Fact Table in MS Excel
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
13
Dimensions in MS ExcelMember List Dimension
Hospital Dimension Diagnosis Dimension
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
14
Dimensions in MS ExcelClaim DocumentClaim Type
Treatment Date
Invoice
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
15
Report in MS Excel for KPI Tophosmont
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
16
Report in MS Excel for KPI Topdiagmont
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
17
Report in MS Excel for KPI Toptreatmentcost
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
18
Implementation with SAP BI-DW
19
Metadata
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
20
Creating InfoArea
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
21
Creating Dimensions Using InfoObjects
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
22
Register Characteristics as InfoProviders
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
23
InfoCube Creation
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
24
DataSource Creation & Loading Master data into InfoObject
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
25
Loading Transaction DataCreate Application Component, InfoSource, Transformation for InfoSource
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
26
Loading Transaction DataCreate Transformation for InfoCube
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
27
Loading Transaction DataCreate Data Transfer Process and Loading Data to Infocube
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
28
Implementation in Xtract QV
and QlikView
29
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
Creating Queries
30
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
Creating Queries
31
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
Creating formular for Table and Charts
32
Company Profile… KPIs Data
modellingExcel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
Table and Charts
33
Company Profile… KPIs Data model Excel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
Project Phase TaskStart Date
End Date
Progress
1. Preparation Formulating of Business Case 08/11/1615/11/1
6100%
Defining KPIs 15/11/16 29/11/16 100%
2. Modelling and Prototyping
Defining Data Model 29/11/16 13/12/16 100%
Designing Star schema 29/11/16 13/12/16 100%
Creating Excel prototype 29/11/16 13/12/16 100%
3. Implementation on SAP BI DW
Creating Master Data, Transaction Data 29/11/16 06/12/16 100%
Creating InfoObjects and InfoCube 06/12/16 10/01/1
7 100%Upload Master Data &Transaction Data 20/12/16 10/01/1
7 100%4. Implementation on Xtract QV and Qlik View
Implementing on Xtract QV and Qlik View 10/01/16 13/01/1
7 100%
5. Presentation Presenting 17/01/16 17/01/17 100%
Project Plan
34
Lessons Learned• Indentifined and Defined right KPIs for business case• Designed Data Model: Star Schema• Able to use Microsoft Excel to create PivotTables• Able to use SAP BI-DW• Understood Metadata, InfoObjects, InfoCube,
Characteristics, Key Figures, Data Sources, Transformation in SAP BI-DW• Able to use QlikView to create reports and charts
Company Profile… KPIs Data model Excel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
35
References• David Haertzen, “The Analytical Puzzle: Profitable Data Warehousing,
Business Intelligence and Analytics”, Technics Publications, 2012• Oleg Troyansky, Tam Gibson, Charlie Leichtweis, “QlikView Your
Business: An expert guide to Business Discovery with QlikView and Qlik Sence”, Wiley, 2015 • Miguel Garcia, Barry armsen, QlikView 11 for Developers, Packt
Publishing, 2012• Cindi Howson, Successful Business Intelligence, 2014
Company Profile… KPIs Data model Excel
PrototypeImplementation in SAP BI DW
Implementation in Xtract QV and Qlik View
Project Plan Lesson Learned References
36
Thank YouCám Ơn