Healthcare Insurance

In the US, under the Affordable Care Act, health insurance is a mix of private and public coverage options with mostly private health care options.

Many trends are changing the healthcare insurance industry in significant ways:

• Increased and unpredictable government involvement, rules and regulations
• Competition for the Health Insurance Marketplace
• Soaring costs
• Emphasis on healthcare outcomes via outcomes-based payments
• The impact of chronic diseases from an aging population
• Big data for health records, payer claims, pharma data, test results and related m-health technologies – and that data being increasingly centralized
• Customer-centric focus as customers take more control of services and data

Total US health care expenditures are estimated to be over $3.6 trillion this year representing about 17% of the Gross Domestic Product.

The pace and complexity of legislation and service offerings require comprehensive and flexible IT, applications, reporting and analytic support services across the entire organization.

Systems based on poorly-defined or 'stovepipe' data will have to be redesigned or replaced, which represents significant costs and repeated organizational disruptions.

The Healthcare Insurance industry models consist of integrated Enterprise, Business Area and Data Warehouse data models are developed for organizations in the healthcare insurance industry.

The Healthcare Insurance data models establish a comprehensive data architecture supporting requirements for: