Databricks for HealthCare – Payers (P1), Providers (P2), Pharma-LS-Med Devices (P3)
A Data & AI driven blueprint leveraging the Databricks Lakehouse Platformto transform Healthcare Payers, Providers, and Pharma-LS-Med Devices organizations. Presenting industry research, real-world use cases, and accelerators to showcase how Databricks enables secure, scalable, and compliant analytics, AI, and Gen AI across the HealthCare ecosystem.
Healthcare Payers operate in one of the most data-intensive environments, balancing cost, quality, compliance, and member experience.
Use Cases
• Claims Analytics & Claims Repair (FHIR, HL7, X12)
• Risk Adjustment (HCC, RAF optimization)
• Utilization Management & Care Management analytics
• Fraud, Waste & Abuse (FWA) detection using ML
• Provider Lifecycle Management (PLM)
• Appeals & Grievances (A&G) sentiment analytics
Data Sources
• Core Claims Systems (NTT – Xcelys, Trizetto - QNXT & Facets, HealthEdge, Plexis)
• EHR/EMR integrations
• CMS, HEDIS, Stars, Social Determinants of Health (SDOH)
Value Delivered
• Single Source of Truth via Lakehouse
• 30–40% faster analytics onboarding
• AI-driven compliance and audit readiness
Providers and Health Systems must unify clinical, operational, and financial data while reducing clinician burnout.
Use Cases
• Clinical Outcomes & Population Health Analytics
• Revenue Cycle Management (RCM)
• Patient Flow & Capacity Optimization
• Readmission Prediction Models
• Clinical NLP on unstructured physician notes
Data Sources
• Epic, Oracle-Cerner, MEDITECH
• Imaging, Lab, and IoT Medical Devices
• Scheduling, Billing, and Supply Chain systems
Value Delivered
• Real-time clinical insights
• Improved patient outcomes
• Reduced operational inefficiencies
Pharma and MedTech organizations rely on data-driven innovation across R&D, clinical trials, manufacturing, and commercialization.
Use Cases
• Clinical Trial Data Management & Real World Evidence (RWE)
• Drug Discovery using GenAI & ML
• Pharmacovigilance & Safety Signal Detection
• Manufacturing Quality & IoT Analytics
• Sales & Market Access Analytics
Data Sources
• Clinical Trial Management Systems (CTMS)
• Genomics & Omics data
• SAP, LIMS, ERP platforms
Value Delivered
• Faster time-to-market
• Regulatory-grade data governance
• AI-powered innovation pipelines
The Databricks Lakehouse architecture enables Healthcare organizations to unify structured, semi-structured, and unstructured data while maintaining governance, security, and scalability. Architecture Highlights:
• Data Sources: EHR/EMR, Claims, SAP, IoT, Imaging, CTMS, Genomics
• Ingestion: Batch & Streaming using Delta Live Tables
• Storage: Delta Lake with Medallion Architecture (Bronze, Silver, Gold)
• Governance: Unity Catalog, Lineage, Fine-grained Access Controls
• Analytics: Databricks SQL, BI tools
• AI & GenAI: Mosaic AI, MLflow, Vector Databases, RAG
• Secure Data Sharing: Delta Sharing
Databricks enables enterprise-grade Generative AI and Agentic AI workflows tailored for regulated healthcare environments.
Payers (P1)
• Automated Claims Explanation (EOB) generation
• Appeals & Grievances summarization
• Risk Adjustment documentation gap analysis
Providers (P2)
• Clinical note summarization & ambient documentation
• Patient discharge instructions personalization
• Capacity planning assistants
Pharma / Med Devices (P3)
• Clinical trial protocol summarization
• Safety signal detection via NLP
• Intelligent regulatory submissions
Reach out to Monika at Monika@GHIT.digital
