Health Care Analytics

More efficient care delivery with the right staffing and skills enables better patient access. SAS can help you find the path to better patient experience with:

• Health care cost analytics. Improve the operational performance, throughput and capacity of the hospital to deliver higher quality care at a lower cost while improving patient satisfaction.
  
• Performance management. Improve performance by focusing on accountability and creating a culture that supports measurement and transparency.
• Workforce planning. Accurately forecast demand for services and workforce supply, and develop critical workforce plans to mitigate any predicted gaps.
  
• Advanced approaches using AI. Improve population health by integrating environmental data with personal healthcare, genomics and socioeconomic data. 

SAS software provides a powerful array of descriptive and predictive modeling, forecasting, optimization, simulation and project scheduling techniques to help health care providers improve patient flow and resource allocation. As a result, SAS will enable you to:

• Improve patient safety. Understand vulnerabilities for high levels of potentially avoidable complications and implement strategies to reduce risk. 
• Gain productivity with a single, flexible system. Adopt an end-to-end activity-based management solution that combines data management, business modeling, reporting and advanced analytics on one platform. And choose whichever costing and management methodology best fits your needs.
  
• Stay connected with the Internet of Medical Things (IoMT). The unprecedented and realtime access to patient data using sensors, devices and wearables will make the application of streaming and edge IoT analytics an imperative, not an option, with a significant impact on patient outcomes.

SAS provides an episode-based analytics solution that empowers better patient care and addresses emerging provider reimbursement models through:

• A holistic view of patient episodes. Gain a more comprehensive view of patient care across a variety of conditions and procedures so you can identify important episode interdependencies.
• Value-based care and payment models. Fully understand your current performance, and confidently predict and manage the financial and clinical risks and rewards associated with contracting for value.
• Clearer identification of care delivery costs and drivers. Use activity-based management and a profitability calculation engine to determine the true cost of episodes, better manage payment models and improve patient outcomes. 

SAS enables you to view the impact of care delivery and the price of health care services at a level of detail that has never before been possible. Using analytics to stratify patients according to risk is key to driving more targeted patient engagement strategies. With our solution, you can:

• Enable more efficient care delivery. Get a comprehensive view of patient care delivery across a variety of conditions and procedures. Then use sophisticated analytics to identify the best opportunities to reduce care variation – and, therefore, costs – while maintaining quality.
• Gain the knowledge needed for value-based care delivery and payment models. Track potentially avoidable variations in care delivery – and associated financial implications – by analyzing historical patient data. Then identify potentially avoidable costs by category and set financial incentives for care and cost improvements.
  
• Develop more efficient care delivery processes. Perform sophisticated cost modeling and profitability analysis for both direct and indirect activities involving individual patients, services, procedures and departments – all based on the specific care delivery process used.
• Report accurate risk adjustment information. Gain critical insights into the accuracy of submitted information. SAS empowers you to close condition gaps, identify new potential suspects, monitor submissions and highlight conditions that may be the focus of a future audit.
  
  

Fraudulent health care claims may represent as much as 10 percent of total claims costs in the US, which diverts billions away from patient care annually. Faster, more aggressive investigation and detection of fraud and abuse at every stage of the claims process is key to controlling costs and protecting patients. SAS provides a solid foundation of solutions that cover:

• Fraud data management. Consolidate historical data from internal and external sources – such as claims systems, watch lists, third parties, unstructured text.
• Advanced analytics with embedded AI. Uncover suspicious activity sooner with an end-to-end framework that includes modern statistical, machine learning, deep learning and text analytics algorithms. 
• Rule and analytic model management. Create and manage business rules, analytic models, alerts and known bad lists.
• Detection and alert generation. Gain awareness earlier. Alerts are based on a calculated propensity for aberrant billing at first submission, with claims rescored at each processing stage as new data is captured.
• Social network analysis (link analysis). Know connections among entities sooner to expose organized fraud rings or collusive activities.

Improving your ability to detect health care claims fraud pays off quickly. SAS uses advanced analytics with embedded artificial intelligence (AI), combined with components for alert management and case handling, to optimize the detection, management and prevention of payment integrity issues from every angle, giving you:

• A consolidated view of fraud risk. Get one version of the truth. Through standardization, everyone sees the same information, and there are no differences in interpretation. Identify links among seemingly unrelated claims, and go beyond individual and account views to analyze all related activities and relationships.
• Faster, more accurate insights. Spot more payment integrity breaches than ever before with a robust fraud analytics engine that processes all data (not just a sample) in real time or in batch.
• Fewer false positives and greater efficiencies. Put your focus were it matters the most – on fraud alerts that are more crucial to investigate further. Our solution applies risk- and value-based scoring models to accurately prioritize alerts before they go to analysts, clinicians or investigators. Time saved translates to cost savings, less customer inconvenience and greater customer satisfaction.