Case Overview:

Healthcare data is notorious for being one of the most unstructured and at the same time one of the most
valuable datasets. The complex nature of healthcare data is not just due to the multitudes of information it
encompasses, but also the various interdependencies that exist in the system as well as the sensitivity of the
information. These factors and prevailing regulatory requirements make it hard to ingest, manage and analyze
healthcare data. The applicant is expected to design a technology-based solution that will enable users to solve
any one aspect of the US healthcare data problem.

You can refer to HiLabs solutions/products to understand some use cases that we are addressing.

The case study should consist of the following slides-

• Problem statement (subset of healthcare data targeted, problems related to the dataset that the
solution is trying to solve)
• Assumptions
• Target Users
• Solution outline (outlining the use of technology and the key value offering)
• Wireframes/Mockups of important screens (HINT: identify user touch points. Use Balsamiq for mockups)
• Pricing of the product/solution: Identify different pricing strategies and choose the best one with logical
reason(s)/evaluation (Please use strategies that are relevant to the industry)

Commonly Used Healthcare Data:

• Claims data (information related to claims processing and submissions)
• Clinical data (information related to hospital visits)
• Provider directory data (information related to various hospital and care center networks that are part
of different insurance plans)

Common Stakeholders for any Healthcare Data Solution:

• Healthcare insurance companies (e.g., Anthem, Aetna)
• Service providers (e.g., hospitals, pharmacy)
• Members (individuals/families who have taken an insurance plan from a healthcare insurance company)
• Government (e.g., CMS) who are jointly involved with healthcare insurance companies for certain
healthcare plans like Medicare Advantage

Relevant content:
To get more context about data issues in the US healthcare, you want to read about the following–

• Provider data management

• Claims adjudication
• Risk Adjustment
• Population health management
• CAA 2021
• HIPAA