SCIO Health Analytics® Delivers $540M in Annual Client Value Through Elimination of Healthcare Waste View as PDF
Healthcare Organizations Leverage SCIO’s Advanced Analytics to Reduce Waste and Improve Performance
WEST HARTFORD, Conn. – November 14, 2017 – SCIO Health Analytics today announced that it has delivered $540 million in client value year-to-date through the elimination of healthcare waste and improved performance associated with its reimbursement and care optimization solutions. Healthcare waste, which is defined as spending that can be reduced without compromising the quality of care, is a wide-ranging problem in the U.S. healthcare industry driven by the way care is organized, delivered and paid for. Recent estimates indicate that effectively addressing healthcare waste represents a $1 trillion annual opportunity in cost savings.
By delivering deeper market insights that enable payers, providers, health service organizations and life sciences companies to uncover clinical-efficiency improvements that drive behavior change, SCIO Health Analytics’ solutions specialize in reducing healthcare waste in the following four major categories:
- Inaccurate payments: Overspending resulting from overpayment, fraudulent billing, provision of unnecessary or inappropriate services.
- Clinical waste: Spending that could be reduced with better care coordination, elimination of duplicate tests and procedures, early intervention and preventive care.
- Administrative complexity: Spending that could be eliminated with simpler, more standardized processes for billing, collections, credentialing, compliance and oversight.
- Price variation: Overspending resulting from paying high prices charged by inefficient suppliers, which could be reduced by tying prices to efficiency, outcomes and a fair profit.
SCIO’s reimbursement optimization solutions create $300 million of client value annually by reducing the cost of care through clinical and payment audit programs, prepayment and prevention analytics, and pharmacy fraud and abuse analytics. Additionally, SCIO’s care optimization solutions create $240 million of client value annually by improving the quality of care through care-gap identification, clinical outcomes measurement and patient risk and behavioral analytics.
“Healthcare waste is a widespread problem throughout the industry that has reached near-epidemic proportions and is caused by a number of complex and interrelated factors,” said Rose Higgins, president with SCIO Health Analytics. “Through our advanced analytics solutions that enable healthcare organizations to reduce the cost of care while improving care quality, SCIO is dedicated to helping our clients solve the underlying issues that lead to excessive spending and suboptimal outcomes.”
Examples of how SCIO clients have used its advanced analytics solutions to address healthcare waste include:
- A 65,000-member health plan in Texas needed a way to better engage provider groups it worked with to close documentation gaps that were resulting in lower Medicare Advantage reimbursements. SCIO provided analytics, provider education and health assessment tools to improve continuity of care, which drove greater payer-provider collaboration. The result was $24 million in savings and a 38 percent increase in care-gap closure.
- A large global employer identified employees with a high prevalence of invasive, expensive and potentially unnecessary orthopedic surgical procedures. These preference-sensitive conditions often display a bias towards surgery based on the assumption that it provides the highest-quality care, but in many cases the less-invasive treatment provides equal or greater outcomes with fewer complications. SCIO analyzed the outcomes on utilization, cost and reduction of invasive treatments improving overall quality of life for the employee. The result was a 20 percent reduction in invasive treatments, 25 percent reduction in healthcare expenditure and up to 1.5 percent reduction in overall population costs.
- A 2.8-million-member health plan in the Northeastern U.S. was experiencing billing issues with providers, and needed assistance in identifying and recovering overpayments, as well as identifying potential fraud situations. The plan lacked sufficient resources and expertise to conduct the necessary data analysis and in-depth audits, and needed a partner with deep expertise in specialty pharmaceuticals. SCIO’s advanced analytics identified $7 million in overpayments, including $1.5 million in avoided payments to an infusion provider that mischaracterized the drug given to patients and $2 million in overpayments to a provider that was billing vial size incorrectly. Both providers discontinued the inappropriate billing practices once notified.
SCIO Health Analytics Contact:
Michele Norton, M.S., R.N.
Senior Vice President Marketing