IMPACT Model for Healthcare Management
✓ Innovative, ✓ Motivational, ✓ Practical , ✓Applicable , ✓Collaborative ,
✓ sTrategy for Cost-Optimizing and Quality-Orienting in Health Insurance Management
The challenges in healthcare today are numerous. These include aging populations and workforce shortages. They also encompass complex reimbursement systems and strained relationships between insurers and providers. Such challenges highlight the urgent need for innovation.
Health insurance funds that apply modern analytics are a powerful tool. They influence healthcare provision. They also support the effective allocation of financial resources.
Building on prior concerns and over a decade of experience in various healthcare roles, the IMPACT approach emerges. It stands out as a visionary model. It introduces a business model for health insurance funds. This model incorporates advanced reimbursement mechanisms and resource monitoring. It fosters collaboration between insurers, providers, patients, and policymakers.
Its key components—oversight and reimbursement models—are discussed separately and rely on modern data science methods. Achieving optimal results requires high-quality, machine-readable clinical data, crucial for informed funding decisions and efficient health insurance operations.
Published: Biomed J Sci & Tech Res 61(5)-2025.
Will be discussed: Healthcare Summit 2025, Sept 8-9, 2025, Prague
Modern Analytics Enables Tailored Reimbursement in Healthcare
Doctors are not just workers who show up. They are driven by the desire to heal. They want to witness the impact of their treatments. Their focus is on what truly matters to them.
With the IMPACT approach, modern analytics can help shape healthcare reimbursement. Both claim-dependent and independent methods can be tailored to encourage collaboration. They can also recognize meaningful medical outcomes. Furthermore, these methods integrate a diverse range of healthcare and insurance providers. Additionally, it enables effective control of expenditures.
System for Real Time Analysis of Medication Use in the Monetary Value
An insurance company in healthcare has a key responsibility. It must regularly update the list of reimbursable medications. This ensures patients get the most effective and appropriate treatments. Nonetheless, this process is complex. It must carefully balance the interests and needs of all stakeholders. These stakeholders include patients, providers, and insurers.
This approach enables the monitoring and analysis of medication use practices.
It focuses on predefined patient cases and reimbursement rules, ensuring a clear and data-driven approach. This helps balance the complex needs of stakeholders in contract structures while keeping the workload for implementation reasonable.
Steps covered:
- Business system analyses
- Developing data analyses structure
- Database administration, user interface programming, automated analytical reports, data visualization – e.g. a combination of Python, SAP HANA SQL, and MS Power BI’s DAX coding
