By Jane Clabby
We’ve blogged about how healthcare analytics can help improve patient diagnostics and treatment, but another area where analytics can make a huge impact in the healthcare industry in is anti-fraud. Each year healthcare fraud exceeds $250B, according to the FBI.
On March 20, IBM announced new consulting services and software that uses predictive analytics and “big data” to support decision making for the C-suite in three vital areas: Anti-fraud, Waste & Abuse; Next Best Action; and CFO Performance Insight. These solutions are grouped under the family of IBM Smarter Analytics Signature Solutions, and are based on experiences drawn from over 20,000 analytics engagements.
Anti-Fraud, Waste and Abuse uses IBM’s adaptive systems to learn from the latest data, looking for patterns to help protect against emerging fraud. The solution’s advanced algorithms are able to detect fraud in real-time and recommend the most effective remedy for each case. In some cases, information about an individual might suggest that by just sending a letter requesting payment the issue could be resolved, while in other cases, a more in-depth investigation may be needed. This solution can be used in healthcare as well as other insurance areas and also to detect tax fraud.
Next Best Action Smarter Analytics Signature Solution is designed to help organizations get a comprehensive view of a particular customer by analyzing traditional customer data as well as customer sentiment data gathered from social media websites such as Twitter. In this way, customer behavior can be predicted as well as customer preferences. This insight can be used by customer service representatives for “upsell” opportunities, by predicting the “next best action” that is most likely to prompt a consumer purchase.
CFO Performance Insight Smarter Analytics Signature Solution helps collect and correlate a range of financial data—this data can provide a much more comprehensive view of business operations across product lines, helping companies determine which products are the most profitable over time, and how to handle inventory levels and distribution to maximize profit.