Adapting Healthcare Analytics for Fraud, Waste and Abuse
Perhaps more often than not, the topic of “healthcare analytics” focuses on dramatic breakthroughs in data analysis that enables the identification of diagnoses gaps in quality care delivery, or managing acute care populations, even the development of evidence based services, and best practices using predictive analytics to identify health warnings in advance of intervention.
Each of these strategic imperatives and outcomes are noble in themselves, and definitely generate the headlines. But when considering these analytical targets along-side a healthcare claims and payment system that is at best inefficient, and is at worst wasteful and redundant, the impact of analytics may be even more powerful.
The problem is coupling these analytic applications would constitute a healthcare system that would have to shine a light on itself.
The independent Institute of Medicine estimates that $800 billion is wasted in the US healthcare system annually. The breakdown of these costs is alarming:
- $216B in Unnecessary services
- $200B in Administration costs
- $136B in Inefficient care delivery
- $112B in Inflated prices
- $80B in Fraud
- $56B in Prevention failures
Coupling powerful analytics across the business operations of the healthcare system will increasingly improve the transparency of the systemic breakdowns, and enable real savings that can be translated to improved care delivery across the populations. If analytics can be utilized so effectively to identify these problem areas, what don’t they seem to be utilized more widely in correcting these same areas?