In this article, Jim Hoffman, COO of BESLER Consulting, discusses current uses of predictive analytics in healthcare. It was featured in the September 2014 edition of Managing Health Today, a publication of the Hudson Valley Chapter of HFMA.
This document outlines an analysis of health insurance rate data from Healthcare.gov to identify key factors that influence individual rates. The analysis included downloading nationwide data from Healthcare.gov, selecting Delaware data, cleaning the data, and performing various analyses including decision trees, partial least squares, and neural networks. The analysis found that age, insurance plan version number (whether a plan was marked up or down), and insurance issuer were the most significant factors in determining individual health insurance rates in Delaware.
This document discusses knowledge management in healthcare through data mining patient encounter databases. It explains that knowledge management improves organizational performance by transforming data files into insights across departments. Building a single database that combines patient demographic, clinical, and financial information from different software applications allows mining the data for root cause analysis, performance indicators, and patterns. Understanding relationships in the data provides leadership with empirically-based solutions by benchmarking against the healthcare industry's knowledge base. When data mining healthcare databases, it is important to include essential patient and clinical information as well as linking to external sources to facilitate meaningful measurements and insights.
While Healthcare 1.0 was broadly defined by a focus on defensive medicine, billing, and fee-for-service, culminating in the mass adoption of EMRs, Healthcare 2.0 is a new wave focused on improving clinical efficiency, quality of care, affordability, and fee-for-value; culminating in a new age of healthcare analytics. This new age of analytics will require a new set of organizational skills and a foundational set of analytic information systems that many executives have not anticipated.
Join Dale Sanders, a 20-year healthcare CIO veteran and the industry's leading analytics expert, as he discusses his lessons learned, best practices in analytics, and what the C-level suite needs to know about this topic, now. Listen to Dale discuss 1) A step-by-step curriculum for analytic adoption and maturity in healthcare organizations, 2) the basic approach to a late-binding data warehouse, 3) pros and cons of early versus late binding, 4) the volatility in vocabulary and business rules in healthcare, 5) how to engineer your data to accommodate volatility in the future
Seattle code camp 2016 - Role of Data Science in HealthcareGaurav Garg
Everyone loves to shake a stick at the healthcare industry for being backward. Fact is there is no lack of technology or data in healthcare.
Biggest challenge for healthcare providers is to identify what questions to ask the data. My team has implemented over 75 enterprise data warehouse projects in US healthcare industry. At the annual Seattle Code Camp, we discussed some of the examples of how data is used in the healthcare industry for compliance reporting (BI) and predictive analytics.
These slides are from Seattle Code Camp 2016, shares technologies, concepts and ideas for data science in the US healthcare industry.
How To Avoid The 3 Most Common Healthcare Analytics Pitfalls And Related Inef...Health Catalyst
The document discusses three common pitfalls in healthcare analytics: 1) using point solutions that focus on single goals and data slices, 2) relying solely on electronic health record systems, and 3) having independent data marts in different databases. It recommends using an enterprise data warehouse to aggregate data from multiple sources into a single system of truth. The document also describes two common sources of inefficiency: the report factory approach and flavor-of-the-month approach, and recommends a robust deployment system to address these.
Application of data science in healthcareShreyaPai7
Data Science is a field that is widely applied in most other domains on a regular basis. The huge amount of data generated regularly calls for sophisticated methods of analysis so that the best interpretatiosn can be drawn from them. Healthcare is one such field in which data science is being used extensively.
Big data in healthcare refers to large, diverse, and complex datasets that are difficult to analyze using traditional methods. The healthcare industry generates huge amounts of data from sources like electronic health records, medical imaging, and fitness trackers. Analyzing this big data can help improve patient outcomes, reduce costs, and advance personalized medicine. However, healthcare also faces challenges like data silos, privacy concerns, and resistance to change. Opportunities include disease prediction and prevention, reducing readmissions and fraud, and optimizing care through remote monitoring. Some organizations are starting to see benefits from big data initiatives focused on areas like evidence-based treatment and integrated health records.
This document outlines an analysis of health insurance rate data from Healthcare.gov to identify key factors that influence individual rates. The analysis included downloading nationwide data from Healthcare.gov, selecting Delaware data, cleaning the data, and performing various analyses including decision trees, partial least squares, and neural networks. The analysis found that age, insurance plan version number (whether a plan was marked up or down), and insurance issuer were the most significant factors in determining individual health insurance rates in Delaware.
This document discusses knowledge management in healthcare through data mining patient encounter databases. It explains that knowledge management improves organizational performance by transforming data files into insights across departments. Building a single database that combines patient demographic, clinical, and financial information from different software applications allows mining the data for root cause analysis, performance indicators, and patterns. Understanding relationships in the data provides leadership with empirically-based solutions by benchmarking against the healthcare industry's knowledge base. When data mining healthcare databases, it is important to include essential patient and clinical information as well as linking to external sources to facilitate meaningful measurements and insights.
While Healthcare 1.0 was broadly defined by a focus on defensive medicine, billing, and fee-for-service, culminating in the mass adoption of EMRs, Healthcare 2.0 is a new wave focused on improving clinical efficiency, quality of care, affordability, and fee-for-value; culminating in a new age of healthcare analytics. This new age of analytics will require a new set of organizational skills and a foundational set of analytic information systems that many executives have not anticipated.
Join Dale Sanders, a 20-year healthcare CIO veteran and the industry's leading analytics expert, as he discusses his lessons learned, best practices in analytics, and what the C-level suite needs to know about this topic, now. Listen to Dale discuss 1) A step-by-step curriculum for analytic adoption and maturity in healthcare organizations, 2) the basic approach to a late-binding data warehouse, 3) pros and cons of early versus late binding, 4) the volatility in vocabulary and business rules in healthcare, 5) how to engineer your data to accommodate volatility in the future
Seattle code camp 2016 - Role of Data Science in HealthcareGaurav Garg
Everyone loves to shake a stick at the healthcare industry for being backward. Fact is there is no lack of technology or data in healthcare.
Biggest challenge for healthcare providers is to identify what questions to ask the data. My team has implemented over 75 enterprise data warehouse projects in US healthcare industry. At the annual Seattle Code Camp, we discussed some of the examples of how data is used in the healthcare industry for compliance reporting (BI) and predictive analytics.
These slides are from Seattle Code Camp 2016, shares technologies, concepts and ideas for data science in the US healthcare industry.
How To Avoid The 3 Most Common Healthcare Analytics Pitfalls And Related Inef...Health Catalyst
The document discusses three common pitfalls in healthcare analytics: 1) using point solutions that focus on single goals and data slices, 2) relying solely on electronic health record systems, and 3) having independent data marts in different databases. It recommends using an enterprise data warehouse to aggregate data from multiple sources into a single system of truth. The document also describes two common sources of inefficiency: the report factory approach and flavor-of-the-month approach, and recommends a robust deployment system to address these.
Application of data science in healthcareShreyaPai7
Data Science is a field that is widely applied in most other domains on a regular basis. The huge amount of data generated regularly calls for sophisticated methods of analysis so that the best interpretatiosn can be drawn from them. Healthcare is one such field in which data science is being used extensively.
Big data in healthcare refers to large, diverse, and complex datasets that are difficult to analyze using traditional methods. The healthcare industry generates huge amounts of data from sources like electronic health records, medical imaging, and fitness trackers. Analyzing this big data can help improve patient outcomes, reduce costs, and advance personalized medicine. However, healthcare also faces challenges like data silos, privacy concerns, and resistance to change. Opportunities include disease prediction and prevention, reducing readmissions and fraud, and optimizing care through remote monitoring. Some organizations are starting to see benefits from big data initiatives focused on areas like evidence-based treatment and integrated health records.
This document discusses using big data and machine learning for policy problems beyond just prediction. It covers using supervised machine learning (SML) to predict patient risk and prioritize high-risk patients for certain procedures. However, SML has limitations and may not fully address resource allocation problems. The document also discusses using SML for health inspections, but notes predictive models don't account for incentives and manipulability, and how entities might reduce safety efforts if they know inspection risks. Overall, the document examines how predictive analytics can inform but not completely solve policy problems, and other factors like incentives are important.
The document is a spreadsheet listing various analytics and healthcare IT vendors. It provides the company name, URL, and brief description for each vendor. Some of the vendors listed include Access, AgileLife, AHI of Indiana, Airstrip Technologies, Alego Health, Amcom Software, and American College of Clinical Engineering. The spreadsheet contains over 50 vendors in total.
Data mining paper survey for Health Care Support System鴻鈞 王
- The document discusses how data mining of electronic health records can help fill knowledge gaps and assist clinical decision making. It provides examples of how different types of health data like administrative data, clinical text, and genetic data can be analyzed. This includes analyzing comorbidities, using machine learning for classification, patient clustering, and cohort querying. Integrating these different data sources and using natural language processing and systems biology approaches can help with genotype-phenotype association studies.
Improving Healthcare Operations Using Process Data Mining Splunk
It’s estimated that 80% of healthcare data is unstructured, which makes it challenging to do any sort of analytics to drive improvements in population health, patient care and operational efficiency. Machine learning techniques can be utilized to predict future events from similar past events, anticipate resource capacity issues and proactively identify bottlenecks and patient outcome risks. This session will provide an overview of how process data mining can be applied to healthcare and provide real-world examples of process data mining in action.
This document discusses machine learning approaches for detecting healthcare fraud, waste, and abuse. It begins by outlining the scope of fraud in the US healthcare system and the large volume of healthcare data available for analysis. It then describes different types of fraud, waste, and abuse and analytical approaches used, including supervised learning models, unsupervised anomaly detection techniques, and generating provider-level features from claims data. Specific challenges in detecting healthcare fraud like imbalanced data and evolving fraud schemes are also discussed.
Business Intelligence & Analytics solutions enable healthcare service providers to build sustainable competitive advantage with the help of insights derived from their existing operations and patient data.
Five Strategies for Easing the Burden of Clinical Quality MeasuresHealth Catalyst
Healthcare systems need to view regulatory measures in a different light. Rather than approaching them as required processes that burden the system, they should be viewed as quality improvement opportunities that lead to best practices. It helps to have a strategy to get there:
Prioritize measures that truly impact patient care
Have a line-of-sight to reimbursement
Understand measure alignment across programs
Involve the right people
Get involved in measure development upstream
The right tools also help, but a plan for success is advised for healthcare system administrators and clinicians who need to ease the reporting burden and take advantage of every measure in a positive way.
Predictive analytics is helping health organizations in improving patient care and outcomes along with aligning with the latest advancements. Read more- https://47billion.com/blog/empowering-healthcare-with-predictive-analytics/
Data Mining - Health Insurance - Jabran NoorJabran Noor
Data mining techniques can help healthcare insurers improve profits, predict trends, and gain competitive advantages by analyzing large volumes of customer data. Traditional actuarial analyses like burning cost analysis and regression models provide useful but limited insights, while data mining techniques like dimensionality reduction, visualization, clustering, classification, and association rule mining can provide deeper insights into relationships within the data. Applying multiple data mining techniques and validating findings with experts can help supplement traditional actuarial methods for a more comprehensive understanding of business dynamics.
This webinar will focus on the technical and practical aspects of creating and deploying predictive analytics. We have seen an emerging need for predictive analytics across clinical, operational, and financial domains. One pitfall we’ve seen with predictive analytics is that while many people with access to free tools can develop predictive models, many organizations fail to provide a sufficient infrastructure in which the models are deployed in a consistent, reliable way and truly embedded into the analytics environment. We will survey techniques that are used to get better predictions at scale. This webinar won’t be an intense mathematical treatment of the latest predictive algorithms, but will rather be a guide for organizations that want to embed predictive analytics into their technical and operational workflows.
Topics will include:
Reducing the time it takes to develop a model
Automating model training and retraining
Feature engineering
Deploying the model in the analytics environment
Deploying the model in the clinical environment
1. Target was able to determine that a teenage girl was pregnant by analyzing her purchase history and comparing it to patterns they had observed in data from thousands of other customers. They noticed she was purchasing items on their list of the top 25 products commonly bought early in pregnancy.
2. Healthcare organizations are generating vast amounts of data from sources like medical records, prescriptions, reports, and monitoring devices. The average hospital will produce over 2 petabytes of patient data per year by 2015.
3. Big data analytics can be used in healthcare for applications like real-time remote patient monitoring, tracking disease spread through epidemiology, and analyzing personal health and activity data from devices.
Building a Data Warehouse at Clover (PDF)Otis Anderson
A brief tour of why we focused on building out a data warehouse early on at Clover, and why we think the Data Science function has room to grow in health insurance.
Delivering the Right Insight to the Right Person: How Workflow Automation Opt...Health Catalyst
While the EHR increases the legibility and comprehensiveness of patient health data and makes vital insights more accessible, digitized records also drive longer workflows and hard-to-manage data volumes. Fortunately, the healthcare digital environment today also makes effective data curation achievable. With an automated EHR workflow, healthcare data and analytics technology mines the data platform, bringing the value of digital documentation directly to team members. Automation of routine, repeatable tasks, paired with curation of the most important information in the chart, allows providers and patients to benefit from the wealth of digitized documentation, as workflows ensure the right person accesses the right insight at the right place and time.
"12 Steps to Better Healthcare" is filled with ideas that you can use right away to improve the efficiency and effectiveness of your healthcare organization. These steps can help you save time, money and lives, as you take part in the rebuilding of our healthcare system from the ground up.
Our Journey to Release a Patient-Centric AI App to Reduce Public Health CostsDatabricks
Health costs are exploding year by year. Thanks to Artificial Intelligence it is possible to address patient needs in a cost-efficient manner.
In the case we will present, we will demonstrate how as part of a telemedicine service we implemented a solution allowing to reduce triage cost of patients by leveraging AI. The app we developed not only allowed to reduce cost but is significantly improving the patient experience.
Disease Surveillance Monitoring and Reacting to Outbreaks (like Ebola) with a...Health Catalyst
The current options for monitoring data to help identify disease outbreaks like Ebola are not great. These are: 1) Monitoring chief complaint/reason for admission data in ADT data streams. Although this is a real-time approach, the data is not codified and would require some degree of NLP. 2) Monitoring coded data collected in EHRs. The most precise option available, but the data is not available until after the patient encounter is closed, which would be too late in most cases. And 3) Monitoring billing data. This approach has the same problems as the two listed above, but it’s better than nothing in the absence of an EMR. All of these weaknesses can be solved with the use of a data warehouse.
This presentation discuss major applications of AI in Healthcare including medical diagnostics, personalized treatments and optimizing US healthcare system. This presentation also discuss some of the challenges of implementing AI in healthcare.
How to Use Text Analytics in Healthcare to Improve Outcomes: Why You Need Mor...Health Catalyst
Given the fact that up to 80 percent of clinical data is stored in unstructured text, healthcare organizations need to harness the power of text analytics. But, surprisingly, less than five percent of health systems use it due to resource limitations and the complexity of text analytics.
But given the industry’s necessity to use text analytics to create precise patient registries, enhance their understanding of high-risk patient populations, and improve outcomes, this executive report explains why systems must start using it—and explains how to get started.
Health systems can start using text analytics to improve outcomes by focusing on four key components:
Optimize text search (display, medical terminologies, and context).
Enhance context and extract values with an NLP pipeline.
Always validate the algorithm.
Focus on interoperability and integration using a Late-Binding approach.
This broad approach with position health systems for clinical and financial success.
Clinical Data-Mining (CDM) involves the conceptualization, extraction, analysis, and interpretation of available clinical data for practice knowledge-building, clinical decision-making and practitioner reflection.
Healthcare IT Services Insights - January 2016Duff & Phelps
The document discusses healthcare information technology M&A activity in the second half of 2015. Some key points:
- 209 HCIT deals were announced in 2015, similar to the 198 announced in 2014. Acquirers sought solutions for electronic health records, meaningful use, and issues affecting revenue cycles.
- Strategic buyers represented 93% of deals, with financial buyers representing the remaining 7%.
- Approximately 25% of M&A activity involved cloud-based solutions for areas like EHRs, imaging storage, and billing due to their lower costs and elasticity.
- The largest deal was the $2.7 billion acquisition of MedAssets by Pamplona Capital Management, expected to close in late January
This document discusses using big data and machine learning for policy problems beyond just prediction. It covers using supervised machine learning (SML) to predict patient risk and prioritize high-risk patients for certain procedures. However, SML has limitations and may not fully address resource allocation problems. The document also discusses using SML for health inspections, but notes predictive models don't account for incentives and manipulability, and how entities might reduce safety efforts if they know inspection risks. Overall, the document examines how predictive analytics can inform but not completely solve policy problems, and other factors like incentives are important.
The document is a spreadsheet listing various analytics and healthcare IT vendors. It provides the company name, URL, and brief description for each vendor. Some of the vendors listed include Access, AgileLife, AHI of Indiana, Airstrip Technologies, Alego Health, Amcom Software, and American College of Clinical Engineering. The spreadsheet contains over 50 vendors in total.
Data mining paper survey for Health Care Support System鴻鈞 王
- The document discusses how data mining of electronic health records can help fill knowledge gaps and assist clinical decision making. It provides examples of how different types of health data like administrative data, clinical text, and genetic data can be analyzed. This includes analyzing comorbidities, using machine learning for classification, patient clustering, and cohort querying. Integrating these different data sources and using natural language processing and systems biology approaches can help with genotype-phenotype association studies.
Improving Healthcare Operations Using Process Data Mining Splunk
It’s estimated that 80% of healthcare data is unstructured, which makes it challenging to do any sort of analytics to drive improvements in population health, patient care and operational efficiency. Machine learning techniques can be utilized to predict future events from similar past events, anticipate resource capacity issues and proactively identify bottlenecks and patient outcome risks. This session will provide an overview of how process data mining can be applied to healthcare and provide real-world examples of process data mining in action.
This document discusses machine learning approaches for detecting healthcare fraud, waste, and abuse. It begins by outlining the scope of fraud in the US healthcare system and the large volume of healthcare data available for analysis. It then describes different types of fraud, waste, and abuse and analytical approaches used, including supervised learning models, unsupervised anomaly detection techniques, and generating provider-level features from claims data. Specific challenges in detecting healthcare fraud like imbalanced data and evolving fraud schemes are also discussed.
Business Intelligence & Analytics solutions enable healthcare service providers to build sustainable competitive advantage with the help of insights derived from their existing operations and patient data.
Five Strategies for Easing the Burden of Clinical Quality MeasuresHealth Catalyst
Healthcare systems need to view regulatory measures in a different light. Rather than approaching them as required processes that burden the system, they should be viewed as quality improvement opportunities that lead to best practices. It helps to have a strategy to get there:
Prioritize measures that truly impact patient care
Have a line-of-sight to reimbursement
Understand measure alignment across programs
Involve the right people
Get involved in measure development upstream
The right tools also help, but a plan for success is advised for healthcare system administrators and clinicians who need to ease the reporting burden and take advantage of every measure in a positive way.
Predictive analytics is helping health organizations in improving patient care and outcomes along with aligning with the latest advancements. Read more- https://47billion.com/blog/empowering-healthcare-with-predictive-analytics/
Data Mining - Health Insurance - Jabran NoorJabran Noor
Data mining techniques can help healthcare insurers improve profits, predict trends, and gain competitive advantages by analyzing large volumes of customer data. Traditional actuarial analyses like burning cost analysis and regression models provide useful but limited insights, while data mining techniques like dimensionality reduction, visualization, clustering, classification, and association rule mining can provide deeper insights into relationships within the data. Applying multiple data mining techniques and validating findings with experts can help supplement traditional actuarial methods for a more comprehensive understanding of business dynamics.
This webinar will focus on the technical and practical aspects of creating and deploying predictive analytics. We have seen an emerging need for predictive analytics across clinical, operational, and financial domains. One pitfall we’ve seen with predictive analytics is that while many people with access to free tools can develop predictive models, many organizations fail to provide a sufficient infrastructure in which the models are deployed in a consistent, reliable way and truly embedded into the analytics environment. We will survey techniques that are used to get better predictions at scale. This webinar won’t be an intense mathematical treatment of the latest predictive algorithms, but will rather be a guide for organizations that want to embed predictive analytics into their technical and operational workflows.
Topics will include:
Reducing the time it takes to develop a model
Automating model training and retraining
Feature engineering
Deploying the model in the analytics environment
Deploying the model in the clinical environment
1. Target was able to determine that a teenage girl was pregnant by analyzing her purchase history and comparing it to patterns they had observed in data from thousands of other customers. They noticed she was purchasing items on their list of the top 25 products commonly bought early in pregnancy.
2. Healthcare organizations are generating vast amounts of data from sources like medical records, prescriptions, reports, and monitoring devices. The average hospital will produce over 2 petabytes of patient data per year by 2015.
3. Big data analytics can be used in healthcare for applications like real-time remote patient monitoring, tracking disease spread through epidemiology, and analyzing personal health and activity data from devices.
Building a Data Warehouse at Clover (PDF)Otis Anderson
A brief tour of why we focused on building out a data warehouse early on at Clover, and why we think the Data Science function has room to grow in health insurance.
Delivering the Right Insight to the Right Person: How Workflow Automation Opt...Health Catalyst
While the EHR increases the legibility and comprehensiveness of patient health data and makes vital insights more accessible, digitized records also drive longer workflows and hard-to-manage data volumes. Fortunately, the healthcare digital environment today also makes effective data curation achievable. With an automated EHR workflow, healthcare data and analytics technology mines the data platform, bringing the value of digital documentation directly to team members. Automation of routine, repeatable tasks, paired with curation of the most important information in the chart, allows providers and patients to benefit from the wealth of digitized documentation, as workflows ensure the right person accesses the right insight at the right place and time.
"12 Steps to Better Healthcare" is filled with ideas that you can use right away to improve the efficiency and effectiveness of your healthcare organization. These steps can help you save time, money and lives, as you take part in the rebuilding of our healthcare system from the ground up.
Our Journey to Release a Patient-Centric AI App to Reduce Public Health CostsDatabricks
Health costs are exploding year by year. Thanks to Artificial Intelligence it is possible to address patient needs in a cost-efficient manner.
In the case we will present, we will demonstrate how as part of a telemedicine service we implemented a solution allowing to reduce triage cost of patients by leveraging AI. The app we developed not only allowed to reduce cost but is significantly improving the patient experience.
Disease Surveillance Monitoring and Reacting to Outbreaks (like Ebola) with a...Health Catalyst
The current options for monitoring data to help identify disease outbreaks like Ebola are not great. These are: 1) Monitoring chief complaint/reason for admission data in ADT data streams. Although this is a real-time approach, the data is not codified and would require some degree of NLP. 2) Monitoring coded data collected in EHRs. The most precise option available, but the data is not available until after the patient encounter is closed, which would be too late in most cases. And 3) Monitoring billing data. This approach has the same problems as the two listed above, but it’s better than nothing in the absence of an EMR. All of these weaknesses can be solved with the use of a data warehouse.
This presentation discuss major applications of AI in Healthcare including medical diagnostics, personalized treatments and optimizing US healthcare system. This presentation also discuss some of the challenges of implementing AI in healthcare.
How to Use Text Analytics in Healthcare to Improve Outcomes: Why You Need Mor...Health Catalyst
Given the fact that up to 80 percent of clinical data is stored in unstructured text, healthcare organizations need to harness the power of text analytics. But, surprisingly, less than five percent of health systems use it due to resource limitations and the complexity of text analytics.
But given the industry’s necessity to use text analytics to create precise patient registries, enhance their understanding of high-risk patient populations, and improve outcomes, this executive report explains why systems must start using it—and explains how to get started.
Health systems can start using text analytics to improve outcomes by focusing on four key components:
Optimize text search (display, medical terminologies, and context).
Enhance context and extract values with an NLP pipeline.
Always validate the algorithm.
Focus on interoperability and integration using a Late-Binding approach.
This broad approach with position health systems for clinical and financial success.
Clinical Data-Mining (CDM) involves the conceptualization, extraction, analysis, and interpretation of available clinical data for practice knowledge-building, clinical decision-making and practitioner reflection.
Healthcare IT Services Insights - January 2016Duff & Phelps
The document discusses healthcare information technology M&A activity in the second half of 2015. Some key points:
- 209 HCIT deals were announced in 2015, similar to the 198 announced in 2014. Acquirers sought solutions for electronic health records, meaningful use, and issues affecting revenue cycles.
- Strategic buyers represented 93% of deals, with financial buyers representing the remaining 7%.
- Approximately 25% of M&A activity involved cloud-based solutions for areas like EHRs, imaging storage, and billing due to their lower costs and elasticity.
- The largest deal was the $2.7 billion acquisition of MedAssets by Pamplona Capital Management, expected to close in late January
This document discusses the rise of predictive analytics and its value in enterprise decision making. It begins by explaining how predictive analytics has expanded from niche uses to a widely adopted competitive technique, fueled by big data, improved analytics tools, and demonstrated successes. A classic example given is credit scoring, which uses predictive models to assess credit risk. The document then provides examples of other areas where predictive models generate value, such as marketing, customer retention, pricing, and fraud prevention. It discusses how effective predictive models are built by using statistical techniques on data that describes predictive factors and outcomes. The document argues that predictive models provide the most value when applied to processes involving large volumes of similar decisions that have significant financial or other impacts, and where relevant electronic
This document discusses data mining applications in healthcare. It describes how data mining can be used by payers to detect fraud, by physicians to identify effective treatments, and by hospitals to predict patient readmissions. It outlines the standard CRISP-DM process for data mining and discusses challenges like data accuracy and interoperability. Examples of data mining techniques discussed include classification, regression, clustering, and association rule mining. The document recommends using SAS software for its advanced analytics capabilities and applicability to use cases like fraud detection and predicting patient risks and treatment effectiveness.
The document discusses how analytics are being used to drive effectiveness in Medicaid programs and health plans. It notes that Medicaid spending has grown 450% in the past two decades and will cover nearly 100 million Americans by 2020. Without advanced analytics, Medicaid agencies and health plans will be unable to effectively identify, stratify, and manage the high-cost, high-risk patients in the Medicaid population. The document outlines how the most effective organizations are using predictive analytics to measure performance, identify areas for improvement, manage risks, and influence health outcomes and costs.
As per the Market Data Forecast report, the global healthcare prescriptive analytics market is likely to grow at a CAGR of 17.4% from 2022-2027. Organizations use prescriptive analytics to predict outcomes and to identify the logical course of action.
Prescriptive Analytics of user-generated data in the healthcare domain indicates what is likely to occur and suggests the best actions to avoid and mitigate risks. To know more about how healthcare is optimizing its operations with prescriptive analytics
This document discusses how predictive modeling can be integrated into workers' compensation claims handling processes to achieve better outcomes. It explains that early identification of high-risk claims using predictive models is only the first step, and that successful intervention strategies are also required once claims are identified. The document provides an example of how one company has integrated predictive analytics into its claims handling by using models to identify high-risk claims early and developing intervention strategies like drug utilization reviews. It stresses the importance of a feedback loop between claims experts and predictive modeling teams to continuously improve processes.
Data Mining in Healthcare: How Health Systems Can Improve Quality and Reduce...Health Catalyst
This is the complete 4-part series demonstrating real-world examples of the power of data mining in healthcare. Effective data mining requires a three-system approach: the analytics system (including an EDW), the content system (and systematically applying evidence-based best practices to care delivery), and the deployment system (driving change management throughout the organization and implementing a dedicated team structure). Here, we also show organizations with successful data-mining-application in critical areas such as: tracking fee-for-service and value-based payer contracts, population health management initiatives involving primary care reporting, and reducing hospital readmissions. Having the data and tools to use data mining and predict trends is giving these health systems a big advantage.
18 Amazing Benefits of Data Analytics for Healthcare IndustryKavika Roy
https://www.datatobiz.com/blog/data-analytics-for-healthcare-industry/
A Business Intelligence (BI) and monitoring system, like any business, will significantly improve operational efficiency, reduce costs and streamline operations by evaluating and exploiting KPIs to recognize gaps and guide decision-making. Unlocking the usefulness of the data helps everyone from patients and caregivers to payers and vendors.
Let’s look at all the aspects in which a data analytics system will affect the healthcare sector.
This document proposes using big data analytics to improve healthcare fraud management. Traditional methods rely on limited enterprise data and rules-based audits. Big data platforms can efficiently process large volumes of historical claims data, including unstructured social media data. Predictive models built on this extensive data can detect fraud in near real-time, improving over traditional models that rely on limited, outdated data. The document outlines how big data analytics enables more reliable and timely fraud identification compared to conventional approaches.
This podcast discusses how using medical insurance records can help anticipate future medical needs and reduce healthcare costs. Predictive analytics uses data from medical records, treatment outcomes, and more to predict things like responses to medications, hospital readmission rates, and future health conditions. This can help physicians with diagnosis and reduce costs. For example, predictive models are used to assess when patients can safely be discharged from the hospital to meet regulations. Medical insurance records predictive analytics has the potential to improve outcomes and reduce costs through more informed care, treatment that works for individuals, and awareness of health risks.
By using data to make informed decisions and meet business objectives, employers are able to build a culture of intent. Why is this critical? Data analytics identify key patterns, trends and opportunities for improvement, enabling HR leaders to gain insights into which initiatives are working, which are not, and to adjust accordingly
Deliver a First-Class Patient Experience with Five Financial TacticsHealth Catalyst
Healthcare organizations continually strive to improve each patient’s experience to ensure quality care delivery and qualify for financial reimbursements. Health systems try to optimize the patient experience through traditional methods, including better access and appointment reminders. However, organizations can improve the patient journey and deliver a first-class experience by taking a different approach—by targeting the following five aspects of the billings and collections process, providers can proactively inform patients about their financial expectations and avoid surprise bills:
1. Pricing strategy.
2. Charge description master management.
3. Real-time eligibility verification.
4. Patient cost estimation.
5. Propensity to pay.
This document discusses the importance of price transparency in healthcare. It notes that the Affordable Care Act requires hospitals to publicly report their prices. With more consumers enrolled in high-deductible health plans, hospitals need to provide price information to engage cost-conscious consumers and avoid losing business to lower-cost alternatives. The document outlines challenges to price transparency like complex pricing structures and a lack of regulations. It provides recommendations for hospitals to establish price transparency, including forming a task force, building a business case, ensuring organizational readiness, and training staff to discuss prices.
The document discusses how healthcare analytics can be used by hospitals and health systems to reduce costs and improve patient care and outcomes. Specifically, it outlines how analytics can help cut administrative costs, support clinical decision making, reduce fraud and abuse, improve care coordination, promote patient wellness, and manage large volumes of healthcare data. The top 10 healthcare data analytics companies are also listed, including IBM, OptumHealth, Oracle, Verisk Analytics, Medai's Health, MedeAnalytics, McKesson, Truven Health Analytics, Allscripts Healthcare Solutions, and Cerner.
4 Essential Lessons for Adopting Predictive Analytics in HealthcareHealth Catalyst
Predictive analytics is quite a popular current topic. Unfortunately, there are many potential side tracks or pit falls for those that do not approach this carefully. Fortunately for healthcare, there are numerous existing models from other industries that are very efficient at risk stratification in the realm of population management. David Crocket, PhD shares 4 key pitfalls to avoid for those beginning predictive analytics. These include
1) confusing data with insight
2) confusing insight with value
3) overestimating the ability to interpret the data
4) underestimating the challenge of implementation.
How Providers Can Reshape their Operations to Master Value-Based ReimbursementsCognizant
Healthcare providers must make sweeping system, process and operational changes to thrive under the inevitable move to value-based payments. Here are our recommendations on how to get started.
New tools can help hospitals predict insurance claim denials based on past claims data and compare to other hospitals to identify high-risk claims. This allows hospitals to review claims before submitting to potentially avoid denials. Automating this process can help hospitals identify root causes of denials, such as one physician providing insufficient information for a procedure's medical necessity in 70% of knee replacement claims. Hospitals can work to continuously improve documentation quality to avoid static problem areas and reduce future claim denials and requests for more information from insurers. Effective clinical documentation improvement requires physician training to understand what level of detail is needed in documentation to demonstrate medical necessity and avoid denials or patients being financially responsible.
High Flyer Health IT Investments and Health IT Investment TrendsPlatform Houston
This document discusses trends in the healthcare IT industry, focusing on the transition from fee-for-service "volume" models to "value-based" models that emphasize quality and efficiency. It notes that the HITECH and ACA laws have laid the groundwork for this transition. Value-based models like Accountable Care Organizations are now impacting 10% of patients. The document also profiles three high-growth companies in areas like patient engagement, big data analytics, and remote care that are aligned with this transition.
Similar to Predictive Analytics in Healthcare (20)
The 2021 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement. As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2021 IPPS Final Rule to quickly give you insight into the most important changes. BESLER remains your trusted advisor and we look forward to helping you identify areas of revenue opportunity for your facility.
BESLER Easy Work Papers - HFMA Peer Review Key FindingsBESLER
The document discusses the results of a survey conducted as part of Healthcare Financial Management Association’s (HFMA) Peer Review program evaluation process. The survey asked current and prospective clients about various aspects of a healthcare product or service. Across all categories, the product received mean scores ranging from 4.31 to 5, indicating high levels of client satisfaction with recommendations, productivity enhancements, implementation smoothness, data accuracy, ease of installation, sales staff, ease of use, value, and technical support.
The 2020 OPPS Final Rule makes several changes to Medicare reimbursement rates and policies for hospital outpatient departments. Key changes include a 2.6% increase in OPPS payment rates, removal of some procedures from the inpatient only list, changes to device pass-through payments and 340B drug payments, and the adoption of a new quality measure for ambulatory surgical centers. The rule also implements prior authorization for certain frequently furnished clinic visit services to control unnecessary volume increases.
The document summarizes changes to Medicare Severity Diagnosis Related Groups (MS-DRGs) and ICD-10 codes for 2019 and provides an outlook for 2020. In 2019, 15 MS-DRGs were deleted and 19 were added, and there were 435 ICD-10 code changes. For 2020, 28 MS-DRGs were deleted and 28 added, along with 252 new ICD-10 diagnosis codes and 1,660 deleted ICD-10 procedure codes. The biggest changes related to peripheral ECMO and transcatheter mitral valve repair. The areas most impacted by severity shifts were various body systems and factors influencing healthcare status. Two DRGs were removed from the transfer policy list while three new ones did not
2020 Inpatient Prospective Payment System (IPPS) Final Rule Summary - BESLERBESLER
The 2020 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2020 IPPS Final Rule to quickly give you insight into the most important changes.
Research Report - Insights into Revenue Cycle ManagementBESLER
The findings in this report are based on online research conducted in October 2018 among 102 respondents employed in leadership roles within finance, revenue cycle, reimbursement and HIM in U.S. hospitals and acute-care facilities.
With hospitals and acute-care facilities under increasing pressure to optimize the revenue cycle, BESLER and HIMSS Media conducted a new study to identify the biggest industry challenges and potential opportunities for improvement. The study included over 100 respondents employed in leadership roles within finance, revenue cycle, reimbursement, and health information management (HIM) in U.S. hospitals and acute-care facilities.
2019 outpatient prospective payment system final rule key pointsBESLER
- The 2019 OPPS Final Rule updates Medicare payment rates and policies for hospital outpatient departments, with an overall 1.35% increase in payment rates. Key changes include expanding comprehensive APCs to include new ENT and vascular procedures, removing some procedures from the inpatient only list, and modifying device-intensive procedure criteria.
2019 inpatient prospective payment system final rule key pointsBESLER
The 2019 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2019 IPPS Final Rule to quickly give you insight into the most important changes.
BESLER Transfer DRG Revenue Recovery Service HFMA Peer Review key findings - 02BESLER
Healthcare Financial Management Association’s (HFMA) Peer Review designation spotlights healthcare products and services that objectively earn top ratings during a thorough evaluation process. Part of the evaluation process prior to designation is surveying the product’s current clients and prospects on a variety of topics that measure quality and effectiveness.
BESLER Transfer DRG Revenue Recovery Service HFMA Peer Review key findingsBESLER
Healthcare Financial Management Association’s (HFMA) Peer Review designation spotlights healthcare products and services that objectively earn top ratings during a thorough evaluation process. Part of the evaluation process prior to designation is surveying the product’s current clients and prospects on a variety of topics that measure quality and effectiveness.
Creating A New Mindset - Fully Embracing Revenue IntegrityBESLER
Revenue Integrity is an exciting addition to the existing healthcare revenue cycle process. Revenue Integrity brings together a holistic focus on our responsibility to ensure appropriate billing and compliance in all financial aspects of healthcare.
Revenue Integrity has ushered in an elevated level of awareness to healthcare financial organizations along with improved healthcare delivery.
Although, Revenue Integrity is still fairly new, it has proven to be a catalyst for change both in the financial and clinical functions of hospitals and doctors’ offices.
Published January, 2017 - First Illinois Speaks
Author: Maria C. Miranda, FACHE, Director, Emerging Payment Models
Introduction: While the Comprehensive Care for Joint Replacement (CJR) program is positioned as a “test,” given the infrastructure being put in place by the Centers for Medicare and Medicaid Services (CMS) to run the program, CJR is likely just the start of a larger effort by CMS to implement additional mandatory bundled payment programs. Therefore, it’s very important that hospital financial stakeholders become familiar with CJR even if their hospital isn’t currently a participant.
We Turn and Face the Changes - The S-10 Emerges as a Proxy for PaymentBESLER
The Federal Fiscal Year 2017 Hospital Inpatient Prospective Payment System (IPPS) final rule issued a postponement for using data from Worksheet S-10 of the Medicare cost report to determine Medicare Disproportionate Share Uncompensated Care payments.The Centers for Medicare and Medicaid Services originally intended to incorporate WS S-10 in the methodology beginning next October (FFY 2018). However, due to copious and thoughtful observations from commenters, CMS has again put WS S-10 on hold while a number of issues surrounding fairness, consistency and accuracy are deliberated. The hospital community will be engaged in future rulemaking and CMS anticipates WS S-10 will be used for UC payments no later than FFY 2021 (using WS S-10 from cost reports beginning in FFY 2017).So join us as we take a look at the S-10’s key issues and what could have been if the S-10 was employed to determine UC payments sooner rather than later.
Electronic health record (EHR) implementations can be operationally invasive and can have significant financial implications. Organizations may see a reduction in net revenue, an increase in accounts receivable days and a slowdown in cash collections. With several NJ providers in the process of moving to an Epic HIS and EHR environment, preserving net revenue, maintaining consistent cash and ensuring accurate financial reporting should be among the provider’s primary conversion goals. We have worked with several providers throughout the country who have undergone a recent Epic conversion and thought it would be beneficial to share conversion lessons learned from these providers. A consistent phrase in the Epic conversion world is ”Big Bang,” indicating that every module that’s been purchased is implemented at the same time. The conversion timeline is an eighteen month journey and has been described as a conversion like no other. More and more providers are moving towards the “Single Billing Office” (SBO) solution, meaning hospital, physician and potentially other entities such as home health appear on a single statement. This alone is a significant change for hospital providers.
HFMA Colorado chapter newsletter, July 2016. While the Comprehensive Care for Joint Replacement (CJR) program is positioned as a “test,” given the infrastructure being put in place by CMS to run the program, CJR is likely just the start of a larger effort by CMS to implement additional mandatory bundled payment programs. Therefore, it’s very important that hospital financial stakeholders become familiar with CJR even if their hospital isn’t currently a participant.
Healthcare Retrospect Part 3: Achieving The Triple AimBESLER
In part three of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, discusses the effects of the PPACA and the path towards achieving the triple aim.
Healthcare Retrospect Part 2: Skyrocketing Costs and the Emergence of Rate S...BESLER
This document provides a brief history of health care reform efforts in the United States from the 1970s through the 1990s. It describes proposals and actions at both the national and New Jersey state levels, including Nixon's proposals for limited reform and Medicaid expansion, the establishment of hospital rate setting in New Jersey, implementation of diagnosis-related groups (DRGs) for inpatient payments, and Clinton's failed attempt at comprehensive reform in the 1990s. The overarching theme is the rise in health care costs driving attempts to control costs through various payment mechanisms at both the state and national levels over this period.
English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Research, Monitoring and Evaluation, in Public Healthaghedogodday
This is a presentation on the overview of the role of monitoring and evaluation in public health. It describes the various components and how a robust M&E system can possitively impact the results or effectiveness of a public health intervention.
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Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
nursing management of patient with Empyema pptblessyjannu21
prepared by Prof. BLESSY THOMAS, SPN
Empyema is a disease of respiratory system It is defines as the accumulation of thick, purulent fluid within the pleural space, often with fibrin development.
Empyema is also called pyothorax or purulent pleuritis.
It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space.
Pus is a fluid that’s filled with immune cells, dead cells, and bacteria.
Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
Empyema usually develops after pneumonia, which is an infection of the lung tissue. it is mainly caused due in infectious micro-organisms. It can be treated with medications and other measures.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
Fit to Fly PCR Covid Testing at our Clinic Near YouNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.www.nxhealthcare.co.uk
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
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CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
More@: https://tinyurl.com/5n8h3wp8
Solution manual for managerial accounting 18th edition by ray garrison eric n...rightmanforbloodline
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
1. September 2014
Page 1
MANAGING HEALTH TODAY
Serious News & Ideas for Healthcare Executives
September 2014
Volume 19 Issue 2
Westmed Medical Group
Issue highlights:
7 Predictive Analytics in Healthcare
8 Making the Case for Business Intelligence
14-15 SHIN-NY Set to Launch Next Year
pgs. 10-11
featured practice:
The Data
Issue
Don’t miss our
Photo Gallery
of the 2014
Renegades Game!
2. September 2014
Page 7
featured article
Predictive Analytics in Healthcare
Jim Hoffman, COO, Besler Consulting
Predictive analytics has been used for many years in other in-dustries,
but the concept has only recently come into favor in
healthcare.
What does “predictive analytics” mean? At a high level, pre-dictive
analytics involves feeding a software tool a large vol-ume
of historical data to determine patterns of factors that
relate to a particular outcome. The software calculates a set
of rules that can be applied to current data in order to make
a prediction. The outcomes can be anything from “will this
patient be readmitted?” to “will this claim be denied?” to “how
many nurses should I schedule for next Tuesday?”
You interact with predictive analytics every time you visit
a supermarket. The coupons that print out at checkout are
based on analyzing your current order and your past orders
(if you use a membership card), and determining what else
you’re likely to buy. If you buy hot dogs and ketchup, you
might receive a coupon for hot dog buns. This is predictive
analytics at work. On Amazon.com, when you see the section
under an item with the heading “Customers Who Bought This
Item Also Bought,” this list of products is also generated via
predictive analytics.
In healthcare, predictive analytics is being used in a number
of areas:
• Readmissions: Identifying patients likely to be read-mitted
is becoming a popular use of predictive analytics in
healthcare. With increasing Medicare penalties for excess
readmissions, hospitals are incentivized to reduce them. Pre-dictive
analytics can allow limited resources for discharge
planning and post-discharge follow-up to be dedicated to the
patients most likely to be readmitted.
Some payers are using predictive analytics to identify ben-eficiaries
likely to be readmitted. The payer then proactively
communicates with the patient to be sure prescriptions are
filled and primary care appointments are made, in an effort to
reduce expenses related to readmissions.
• Observation: Medical necessity audits by various gov-ernment
and private payers have led hospitals to very care-fully
consider the use of inpatient admission vs. observa-tion.
Overusing observation status can result in reduced
patient revenue, and underutilizing observation status can
lead to medical necessity denials. Efforts are underway to
use predictive analytics to help to determine, in conjunction
with caregiver expertise, the most likely patient classification
based on the demographics, vital signs and medical history
of a patient.
• Denials: By examining thousands of previously billed
claims and their subsequent adjudication, predictive analytics
has been used to identify the claims most likely to be denied
before the bill is dropped. By routing these high risk claims
to a review workflow, denials can be prevented and cash flow
improved.
• Propensity to Pay: Predictive analytics models are also
being used to determine a patient’s ability to pay his or her
out of pocket expenses prior to an elective procedure. Demo-graphics
and credit scores are combined to create a risk score,
and this is used make a decision about whether to extend
credit or to require payment prior to provision of services.
Not every problem is a good candidate for a predictive analytics
solution. If a definitive answer can be derived from the data at
hand, then predictive analytics is a poor fit. For example, one
could use predictive analytics to assign a Medicare DRG to a
claim before it’s billed. Predictive analytics could determine
which DRG the claim “looks like.” However, a DRG grouper
can definitively determine the appropriate DRG, and is what
should be used.
When utilizing predictive analytics, there is often a tradeoff
between ease of implementation and effectiveness. If a pre-dictive
analytics model to determine risk of readmission is
built solely on claims data, which is easily obtainable, then the
model is relatively simple to create and implement - simply
run UB-04 data through the predictive model and generate a
risk score at the time of billing. However, many of the more
accurate readmission predictive models require EMR data and
lab test results, as well as socioeconomic data unrelated to bill-ing.
Interfacing with multiple hospital IT systems and modi-fying
admission processes may be required to gain the benefits
of a more accurate prediction.
Healthcare is beginning to catch up to many other industries
when it comes to the use of predictive analytics. Providers
should monitor the expanding implementation of the tech-nology
to determine when the price point and accuracy can
provide a solid return on investment based on their particular
needs.
Jim Hoffman brings twenty-five years of
technology and operations experience to
his position as COO of BESLER Consulting.
Most recently, he was President and General
Manager of Accuro Revenue Management
for MedAssets. Prior to the acquisition of
Accuro Healthcare by MedAssets, he served as President and
Chief Operating Officer of the Accuro Revenue Management
business unit, and Chief Operating Officer of Innovative Health
Solutions, acquired by Accuro from Besler Consulting in 2005.
Jim is a graduate of the University of Virginia.