OPTIMIZING MEDICAL COST CONTAINMENT THROUGH DATA ANALYTICS
Medical Costs are one of the largest expenses faced by the United States. Controlling medical costs is a key area that must be continuously managed. The key is to make sense of available big data and formulate conclusions to make effective decisions and to design and implement effective solutions. To date data related to medical costs are disconnected, fragmented, and are not integrated.
In order to contain medical costs, it is important to manage exposure proactively, predicatively, and critically in all aspects of claims and and fraud management. A fully comprehensive approach using data analytics and predictive forecasting will allow an organization to identify the critical cost drivers of its program. An organization will also be able to benchmark its performance on the average paid, closure rate of files, reserves required, estimated future losses and effectiveness of the current programs.
HCRG has the knowledge and expertise to warehouse, mine or to analyze data in the most effective way to provide the necessary information for payers to make informed decisions. HCRG examines raw claims data with the purpose of drawing conclusions that will assist in the lowering of medical costs. Our data analyst specialists process unstructured and structured data to make better decisions. We specialize in the use of Proprietary Software Data Mining Capability to conduct Data Analytics that predicts the trajectory path of a specific service. HCRG has a proven track record for planning and executing high level defense strategies. We use captured data to verify existing models and to develop our best practice cost containment strategies.
HCRG integrates the following data to conduct analysis:
• Claims Data
• Medical Management Data
• Medical Utilization Data
• Medical Service Payment Data
• Provide Pattern Utilization Data
• Medical Service Demand Data
• Population Co-morbidity Data
We utilize information in the following ways:
• Identify Risks
• Predict Risks
• Conduct Root Cause Analysis
• Capture Complexities of Claims Characteristics
• Capture Complexities of Vendor Performance
• Capture fraud, abuse and wastage
Our goal is to develop value based cost containment solutions. How do you work with us for your Data Analytics needs?
· Select us as a partner and allowing us to access to your data repositories. We will extract the appropriate data and conduct the appropriate analysis.
· Provide us with the data and the questions you want to be answered. We will warehouse and mine the data for analytics purposes.
· Choose us to deliver the specific services to you. In this case we will utilize our own data mining to conduct data analytics.