Health Care Solutions

Health Care Finance

Get data-driven insights to navigate financial risk and optimize outcomes.

How SAS Helps Navigate Financial Complexity & Fight Fraud

Control costs, enhance the quality of care and maintain regulatory compliance.

Value-based care & payment models

  • Succeed in value-based care and payment models using advanced analytics to help optimize costs and improve outcomes.
  • Confidently predict and manage financial and clinical risks and rewards associated with contracting for value.

Fraud, waste & abuse (FWA) detection & prevention

  • Identify, prevent and manage health care FWA as early as possible through automation and machine learning.
  • Use powerful analytics and AI to identify new schemes and links between serial fraudsters.

Improved health quality measures

  • Classify patient populations into distinct cohorts so you can tailor care to meet and exceed quality and health outcome measures.
  • Determine the true cost of clinical interventions.
  • Monitor quality measures.

Greater financial stability & regulatory compliance

  • Adopt a cloud-based solution that enables automated updates with no input required for regulatory compliance.
  • Consolidate data sources to reduce capital expenditure.
  • Create customized views to share throughout the organization.

Why choose SAS for health care finance?

Succeed in value-based payment models by combining key data points from disparate sources, enabling data sharing, cost savings and improved health outcomes. Optimize the detection, management and prevention of payment integrity issues from every angle using advanced analytics with embedded AI.

Enable equitable data exchange

  • Seamlessly integrate and visualize health and non-health data from disparate sources into one dashboard.
  • Share dashboards across your organization and with partners.

Uncover suspicious health claims faster

  • Identify links among seemingly unrelated claims.
  • Go beyond individual and account views to analyze all related activities and relationships.
  • Use a comprehensive alert generation process that combines predictive modeling, automated business rules and anomaly detection.

Optimize the cost of care

  • Identify areas of avoidable utilization.
  • Develop clinical models that optimize the costs of care delivery.
  • Reduce money lost in the system to maximize resources for patient care.

Comply with regulatory mandates & quality measures

  • Stay up to date with new fraud approaches.
  • Keep up with regulatory changes to maintain compliance.
  • Track the quality of clinical and operational services to identify areas for improvement.

Customer Success

Fighting FWA in Health Care With SAS

Saving money & lives with AI-powered fraud detection

Pharmacy benefit manager Prime Therapeutics slashes fraud, waste and abuse using artificial intelligence. "We’ve worked so hard over the years to fight fraud, and this new capability with SAS has helped us take it to the next level to safeguard our members and save our clients millions of dollars," says Jo-Ellen Abou Nader, Vice President of Fraud, Waste and Abuse and Supply Chain Optimization at Prime Therapeutics.

On-Demand Webinar

Catch a Fraudster: Finding the Needle in the Haystack With AI

Learn how pharmacy benefit manager Prime Therapeutics – which Fast Company named one of the world's most innovative companies in 2020 – uses SAS AI to fight fraud, waste and abuse.

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