Health insurance providers seek to control fraud perpetrated by healthcare providers, pharmacists, and patients and manage investigations from detection to prosecution. Payers confront significant data challenges that block them from realizing optimal outcomes. The relevant information is typically locked in data silos and rigid data warehouses that cannot adapt quickly to new data sources.
Analysis is frequently inaccessible to key decision makers within the enterprise. Researchers are often unable to investigate specific procedures, diagnoses, and patient profiles that contribute to macro-trends. Amidst these technical challenges, payers attempt to develop and refine predictive algorithms to eliminate waste, fraud, and abuse. They execute comparative effectiveness analyses and design and back-test plans through regression and strategy modeling. AMSTAT Consulting Insurance Analytics provides a unified solution for these workflows that overcomes technical obstacles and promotes better outcomes.