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© 2017 SCIO Health Analytics®. All rights reserved. 433 South Main St., Suite 203, West Hartford, CT 06110 P: 1.860.676.8808 | F: 1.860.676.8848 E: [email protected] www.sciohealthanalytics.com LEVEL OF SOPHISTICATED USE OF ANALYTICS/DATA TYPES OF ANALYTIC RESOURCES USED Survey reveals organizaons rely on narrow swatch of data, thus creang a big hurdle in effecvely predicng and prevenng claim FWA with advanced profiling & analycs. SURVEY RESULTS BIG DATA CHALLENGES SOURCES OF DATA USED TO IDENTIFY POTENTIAL FWA PATTERNS 1 2 3 CLAIMS DATA PROVIDER DEMOGRAPHICS MEMBER DEMOGRAPHICS BEHAVIORAL/ ATTITUDINAL DATA OTHERS 98% 68% 51% 31% 31% ADVANCED OUTCOMES REALIZED FROM MULTI SOURCE DATA IN PROGRESS IMPLEMENTING A VARIETY OF MULTI SOURCE DATA EARLY ON CONSIDERING USE OF NON TRADITIONAL ANALYTICS / DATA NOT SURE 35% 34% 17% 14% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . INTERNAL TEAM + EXTERNAL VENDOR TOOL INTERNAL TEAM NOT SURE EXTERNAL VENDOR TOOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? 51% 34% 8% 7% Source: SCIO-led webinar tled ‘Predicng and Prevenng Claim Fraud, Waste and Abuse with Advanced Profiling & Analycs’. Even though FWA is a growing challenge, nearly all of the respondents rely on claims data (98%) to idenfy potenal FWA paerns while far fewer leverage other types of informaon. Organizaons are sll not opmally using a full range of data – as only 35% of poll parcipants cited realizing FWA outcomes from mul-source data. About half of all respondents use a combinaon of internal teams and external vendor tools in the FWA efforts, which means that about half either are not sure of what their organizaons use or don’t use either. This hampers the efficient use of available data.
