PROCESS MINING IN HEALTHCARE INSURANCE COMPANIES: IDENTIFYING GUIDELINES AND PRACTICES

• Published in: Proceedings of the International Annual Conference of the American Society for Engineering Management p. 1
• Main Authors: Detro, Silvana P, Santos, Eduardo A P, Deschamps, Fernando, Vieira, Agnelo D, Ioshii, Sérgio O
• Format: Conference Proceeding
• Language: English
• Published: Huntsville American Society for Engineering Management (ASEM) 01.01.2014
• Subjects: Breast cancer; Collaboration; Costs; Disease management; Fraud; Health insurance; Information systems; Insurance companies; Knowledge; Medical treatment; Patients

Healthcare has become a major focus of concern and even a political, social and economic issue in modern society. Medical expenditure required to meet public demand for high-quality and high-technology services is substantial. This phenomenon is likely to become more widespread and more intense due to the increasing average lifespan and decreasing birth rates of humans in many societies. People rely on health insurance systems, which are either sponsored by governments or managed by the private sector, to share high healthcare costs. Performing business process analysis in healthcare organizations is particularly difficult due to the highly dynamic, complex, ad-hoc, and multi-disciplinary nature of healthcare processes. Process mining is a promising approach to obtain a better understanding of these processes by analyzing event data recorded in healthcare information systems. The goal of process mining is to use event data to extract process-related information. Taking a set of real process executions (the so-called event logs) as the starting point, this approach can be used to automatically construct a process model reflecting the behavior that has been observed and recorded in the event log. The aim of this present article is to apply a process mining approach to analyze processes of a healthcare insurance company.