John Bradshaw

I bet many of you have heard of HIPAA, but you may not realize its impact on you and your organization. Personally, if you or a family member has been to see a physician in the last 10 year, you were presented with a HIPAA form to sign. Professionally, if you work in healthcare, you […]

EIM Gumbo 1 portion of Data Governance 1 portion of Data Warehousing A stock of interoperability* Culture, chopped up finely Dash of patience *Measured and added to the extent as needed. Can be made up of a variety of means, manner and mechanisms to facility the move of data to the warehouse and information from […]

What kind of equation is that? I can understand Member Portal, but OBI? BPM? Well, OBI stands for operational business intelligence. OBI is real-time, dynamic use of analytics that enables a service component to decide, based upon the information available, how to proceed in engaging with a stakeholder. BPM, or business process management, refers to […]

Are you making the most of it? Yes, I said Exchange, but will refer to them as Health Insurance Marketplaces (HIM). I know many have been working to get ready for the October 1st open enrollment, but have you been doing everything you can? In the past, sales of individual policies haven’t amounted to more […]

In healthcare, it’s a common occurrence to find your organization having to make an investment, unplanned in many cases, in order to comply with a new regulatory requirement due to Health Reform. When faced with a new compliance need, I have heard many wistfully ponder the question of ROI, yet are already resigned to another […]

I recently read an article in the NY Times talking about an “unexplainable” sharp and persistent slowdown in the growth of healthcare costs. It has been followed by others, such as this one from USA Today, that have begun attempting to shed light on the reasons why. Contrary to the partisanship rhetoric from our lawmakers, […]

I guess I could’ve used “fail” instead of “go on forever,” but I chose to use the latter here for a reason. For smaller initiatives, you occasionally get the former, but as is so often the case with those large enterprise endeavors, it’s the latter. I’ve seen this occur time and time again, a couple […]

There are two areas of focus in the ICD-10 conversion, each of which must be remediated/completed by October 1, 2014. Our initial thoughts, urges and efforts are towards technology or those systems that we must now use to do our jobs. Said another way, we need to update/upgrade the transactional systems, applications, and data repositories […]

If you’re a Health Plan that doesn’t periodically “calculate” and assign risk to members, you’ve put yourself into a tight spot. This is a foundational activity, which drives care management and planning for your member’s future utilization. For capitated or fully insured offerings, this is a critical step in rate setting/premium determination. For self-insured plans, […]

A common need and challenge experienced by many organizations in the delivery of a BI solution is that while the desire for information is great, it is difficult to get those with the desire to articulate what their need really is. This can include what they plan do with the information once they have it, […]

Nothing is more impactful, engaging and notorious for a Health Insurance Payor than the replacement of their Claims platform or consolidation of many into one. For those contemplating such a move or already in the throes of one, here are some thoughts around “Best Practices” to make the effort successful. Data Repository To facilitate the […]

This is a topic I touched on a couple of months ago in my blog “EHRs, Analytics, Utilization and Population Health.” Health Systems have been on a tear over the last several years with the deployment of technology to enable the transactional or tactical execution of business activities and delivery of care. With the diversity […]