Health & Life Sciences / Modern BI

U.S. Healthcare Payor Embraces Power BI for Claims Analytics

Health Care Payor - Claims Analytics


A leading U.S. healthcare payor – whose tens of thousands of employees serve millions of members – is transforming business by embracing a nimble, elastic modern data architecture. Through a combination of years of steady growth and ever-improving technology, the decades-old health insurer built up an inventory of nearly 50 data sources and BI tools.

The organization is now looking toward the future, recently launching an initiative to consolidate and modernize its data platform and analytics tools. In order to reap the benefits of a single, enterprise-wide data repository and robust new capabilities, it selected a Microsoft Azure and Power BI foundation.

The insurer partnered with BlueGranite to help launch the transformation for a business process team. Though still in its early phases, our modern business intelligence collaboration is already benefitting stakeholders through rapid access to accurate data.


The Challenge

The health insurer processes millions of claims monthly, some of which require additional review. Claims reprocessing is costly, and inaccuracies in claims handling can be detrimental to patients and providers. The company has a team of analysts and strategists working to identify opportunities to reduce and eliminate claims rework. They review data for trends and patterns – searching for root reprocessing causes, opportunities for process change, and preventative measures.

However, limited legacy reporting tools required data to be aggregated and filtered to reduce size; analysts could only see details on reworked claims and just the summarized numbers on all processed claims. These limitations left analysts manually mashing up whatever detailed data they could find in separate systems. Report users spent most of their time exporting and manipulating data, rather than gleaning insights from well-designed visuals.

The Solution

Our shared goal was to decrease the claims rework rate. Using its Catalyst for Modern BI, BlueGranite's team of experts migrated legacy logic and visuals from QlikView to Power BI. As the complete set of data products is slated to be available in the Azure Data Lake at a later time, a phased approach was appropriate: first BlueGranite would develop reports in Power BI using the existing on-premise data source, and, at the same time create a plan to adjust and expand the data source to Azure Synapse.

BlueGranite sought a variety of perspectives on the legacy solutions and how improvements could be made in this first approach. Working with the technical team offered an important understanding of the dataset and how to build a data model designed for performance. The analysts who work in the detailed data day to day solidified the important use cases, while leadership offered a vision on the future of analytics, as well as the types of questions they hope this dataset can answer.

With a variety of use cases and requirements in mind, BlueGranite replaced existing QlikView functionality in Power BI and created new visuals for more advanced analysis. Some key features include:

  • Bookmarks and buttons in Power BI for easy navigation and optimal user experience.
  • Dynamic measures which group attribute values outside of a “top n” number of values, giving users power to control the level of detail displayed.
  • AI features in Power BI, such as Key Influencers and Decomposition Tree, which can replace manual root cause analysis in Excel.
  • Interactive visuals, drill-through and export functionality.
  • Data refresh triggered by a Power Automate flow to work seamlessly with irregular data source refresh cycle.


The Results

With the new claims reprocessing reporting suite in Power BI:

  • Advanced, modern business intelligence visualizations enable deeper understanding of claims rework.
  • Users spend less time performing manual analysis and more time using insights to establish the important cost-saving process changes that prevent claims reprocessing.
  • Analysts can feel more confident in the accuracy of data without having to visit various systems to find what they need.

The Power BI migration is a big improvement over legacy visuals, but it’s just the beginning. While the business team adjusts to the new reports and visuals in Power BI, the groundwork is being laid for a more detailed and enhanced data source. A modern, scalable solution built using Databricks and Azure Synapse will be better equipped to handle a large volume of data. With this expanded dataset, data scientists can build and train models to identify claims as candidates for rework before it even occurs – allowing for earlier intervention and better outcomes for patients, providers, and the healthcare insurer alike.

To learn how BlueGranite can speed Power BI deployment and adoption for your organization, connect with us today.


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