Leveraging Value Chain of Managed Care Based on Data Analysis: A Case Study of Xinxiang Healthcare Innovation Program

摘要

The author configures the value chain of managed care, in which the primary activities are characterized by integrated delivery system, consumer cost sharing, proactive health management, innovative incentives to providers and progressive medical management, and hence add more value to the insurance by improving cost effectiveness and quality of the care, while data analysis is the supporting activity facilitating .all the primary activities. Although managed care elements were introduced into the healthcare reform plan of China, the author found that local social health insurance administrations badly need to implement these managed care elements by enhancing healthcare data analysis. The case of Xinxiang healthcare innovation program shows that data mining can produce rich insight to medical and health management. In order to better leverage the value chain of managed care, China needs more data collected by IT integration, development of EBM and more policy support.