Analytics competency is more important than ever before for the healthcare world. Healthcare payers and providers alike are increasingly investing in advanced analytics to predict risk, prevent fraud and improve medical outcomes.
Adaptive Datamatics focuses on improving healthcare organizations’ ability to identify and engage members for clinical programs and accurately detect fraud.
Healthcare Analytics for Population Management
Using our cutting edge analytics software and predictive analytics techniques and approaches, we can provide answers with a high degree of accuracy to questions such as “who are my high-risk population members?”, “which condition is the costliest to treat?” and “how can we reduce no show rates?”
- Identify and stratify high-risk/high-cost members
- Accurately predict future health plan costs
- Evaluate patient patterns over time
- Measure overall health program performance (ROI Analysis)
- Identify gaps in care for both medical and pharmacy units
- Uncover interventions that are improving patient satisfaction
Fraud Analytics & Assessments
Fraud is a major contributor for loss in the healthcare industry. There is a growing need for companies to proactively detect improper payments and identify fraudulent claims accurately.
At Adaptive Datamatics, we help companies to control costs and prevent losses proactively using the Fraud Analytics & Assessment solution. Our solution utilizes advanced algorithms to combine and analyze a variety of structured data as well as unstructured data such as emails, claim forms, medical reports, etc.
- Early detection of fraud leads to improved loss ratios
- Strengthens regulatory compliance, by identifying suspicious claims
- Create and logically manage business rules, analytic models, alerts and known fraudster lists
- Identify training opportunities and administer online assessments for internal auditors, examiners and investigators