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HiLabs Product Caselet 2023 Questions

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174 views2 pages

HiLabs Product Caselet 2023 Questions

Uploaded by

prayani2003
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Case Overview:

The accuracy of provider data is an ongoing, industry-wide challenge. Inaccurate provider directory data heavily
impacts the member experience and can lead to surprise billing or poor access to care. Poor quality provider data
also costs organizations a staggering $2B+ a year, impacting operational efficiency, profits, quality of care, and
patient outcomes. Many of these costs are borne by the health plan and stem from downstream impacts including
member and provider dissatisfaction, claims impact (under/over-payment) and compliance penalties. We need
to solve the problem of maintaining the quality of Provider directory data of Health Plans. There are different
approaches being used by the industry right now (Discussed in detail below).

Provider Data Flow:


1. Provider Organizations send the data to Health Plans every month or at different cadences in excel
sheets (also known as Rosters).
2. Health Plans process these files and make the changes in their Provider Database.
3. The quality of this Provider Directory data is affected due to multiple reasons.
4. Health Plans need to maintain the quality of this Provider Directory to ensure smooth member
experience and meeting the regulatory compliance requirements.

Current Approaches:
1. Manual Outreach Program: This is one of the widely followed approaches. Health Plans run Outreach
Quality Programs in which Provider Organizations are reached out manually via call or emails to validate
the data. This process is neither scalable nor economically feasible for the millions of records.
2. MCheck Provider – Directory Accuracy: Our team of engineers and data scientists has developed
MCheck™ Provider, a fully automated, scalable solution to vastly improve provider data accuracy and
operations for health plans. We search for providers on the internet and validate the given Provider’s
Address and Phone through robust and automated MCheck R3 solution. The bot replicates human
behavior and searches for the most reliable information from different sources on the Internet.

Problem Statement:
You are a PM at HiLabs and tasked with finding alternative approaches to solve the problem of maintaining
Provider Directory accuracy at scale. You need to design a technology-based solution that will help Health Plans
solve this problem. You can choose to solve the problem mainly for Provider practice locations and contact details
only. The solution can be targeting any part of the flow to fix the problem at the downstream end.

(OR)

The field of pharmaceuticals faces a critical challenge in leveraging real-world evidence for data-driven decision-
making. With vast and diverse sources of data, ranging from clinical records to genomic information, ensuring
data quality, conversion, and curation has become a daunting task. Errors and inconsistencies in these datasets
hinder the timely and accurate analysis of patient outcomes, treatment effectiveness, and disease progression.
You need to design an AI solution that will help solve this problem (or part of the problem). [PREFERRED]

The case study should consist of the following slides (8 slides max) -
• Assumptions
• Target Users & the stakeholders involved.
• 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)
• Pitfalls & Future Enhancements

Appendix:
Provider Data – Provider Data is a hierarchical dataset that contains information about the Providers Profile,
Practice locations, contact details and the participating networks under a given Health Plan. You can assume
provider data as a combination of 5-6 different tables with provider table as the parent table and following tables
are connected to it in the below hierarchical levels:

1. Profile: Information about Providers- NPI, Name, Gender, Specialty, etc.

2. Address: Information about the Practice address - Address Street, City, Zip code & contact details. All
addresses are linked to an NPI/Provider.

3. Network: Networks are associated with the service locations where members can avail the benefits of their
Insurance Plan.

4. Address Network Details: Other details around member eligibility for address-network combination

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

• Provider data management


• CAA 2021
• HIPAA

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