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Optimization Dramatic changes in the economics of the health care industry were putting the mission of Houston-based Texas Children's Hospital at risk. Private insurers
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Submitted by tammyjg on July 5, 2008
Category: Miscellaneous
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Dramatic changes in the economics of the health care industry were putting the mission of Houston-based Texas Children's Hospital at risk. Private insurers and public health care financing programs such as Medicaid, squeezed the country’s largest pediatric health care facility between rising costs of medical services and equipment, and resistance to absorbing those higher costs. In addition, new reimbursement contract structures, including “diagnosis-related group” (DRG) and fixed-fee-per-patient arrangements, were shifting huge financial risks to Texas Children's, demanding a far more sophisticated approach to contract negotiation.
With a mission of saving lives and training physicians, Texas Children's Hospital (TCH) focus was not on profit maximization unlike an airline, hotel or car rental company. Similar to those struggling companies in those industries, TCH took advantage of PROS revenue management analytical support, tailored to its unique financial circumstances. A large proportion of the hospital's revenue is base on contracts not individual payments, the cost and revenue implications of complex contracts intimate knowledge is required prior to acceptance. Organizational research based optimization models can identify globally optimal solutions that satisfy pre-set goals over multiple forms of contracts, they can provide an advantage to the user of the optimization models that may not be clearly visible to the party on the other side of the negotiation.
TCH and PROS collaborated in the development of a customized solution, known as the Hospital Optimization System (HOS), to monitor contract performance and support contract negotiations. HOS, relying on Bayesian forecasting and nonlinear optimization models, uses data from prior patient encounters, including charges and resource usage, and hospital capacity information, to propose optimized contract terms for use in negotiations. The system also forecasts demand for hospital...
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