healthcare IT solutions

Healthcare Analytics

The ‘Big Data’ Revolution in Healthcare: Accelerating Value and Innovation

An era of open information in healthcare is now under way. We have already experienced a decade of progress in digitizing medical records, as pharmaceutical companies and other organizations aggregate years of research and development data in electronic databases. The federal government and other public stakeholders have also accelerated the move toward transparency by making decades of stored data usable, searchable, and actionable. Together, these increases in data liquidity have brought the industry to the tipping point. Healthcare stakeholders now have access to promising new threads of knowledge. Pharmaceutical-industry experts, payers, and providers are now beginning to analyze big data to obtain insights. The Big­-Data Revolution is in its early days, and most of the potential for value creation is still unclaimed. But it has set the industry on a path of rapid change and new discoveries; stakeholders that are committed to innovation will likely be the first to reap the rewards. xtLytics is building and offering applications and analytical tools that help healthcare insurance providers, physicians, and other healthcare stakeholders identify value and opportunities.


The best way for organizations to ensure their long-­term success is by leveraging data

An enhanced data foundation leads to insightful action. Healthcare organizations cannot improve what they cannot measure. The best way for organizations to ensure their long-­-term success is by leveraging data. The big data that healthcare organizations need to collect and analyze may come from hospitals, ambulatory care facilities, wellness centers, referral networks, labs and imaging centers, research and other nontraditional data sources like social media. Market Data Explorer from xtLytics enables organizations to access and analyze social media data in near-real time.

Collecting, integrating and analyzing data can be a complex task because the data resides in many internal and external locations and its level of quality may be unknown. In addition, about 80 percent of medical data is unstructured, which further increases the challenge. Even with all of this complexity, healthcare organizations that implement clinical and advanced analytics capabilities have a lot to gain. Some areas in which enhanced data and analytics from xtLytics can yield the greatest results include:

  • Gain a better understanding of actual costs and outcomes
  • Identify areas where they have the most to gain from improvements
  • Rigorously track performance over time
  • Defining value drivers for members, as well as the member behaviors and choices that drive value for payers
  • Building clear analytical methods to evaluate expected member value and actual performance
  • Building “A/B” testing capabilities to compare efficacy of messaging and explore alternatives to member-­- or provider-­-outreach  campaigns
  • Identifying resource-­-intensive workflows and business processes that could be made more efficient through big data, such as provider  authorization, evaluation of claims accuracy, and auto-­-adjudication of claims

Claims Financial Analytics

Quickly analyze all your claims data and gain new knowledge to solve your most pressing health care issues.

Claims data is the most valuable health data available, and it offers the broadest view of health care services provided to patients both within and outside of an organization. Health care organizations need to be able to access large sets of claims data, share analysis across the organization securely, and use these insights to improve quality of care and bend the cost curve.

Our solution transforms the way organizations use claims data. By creating a consolidated repository of your data sets and applying best-in class data quality and data management practices we will create an analytics-ready environment to access and analyze claims data. xtLytics solutions, created just for healthcare big data, enables organizations to generate complex claims analytics in near-real time.

Revenue Cycle Management

  • Revenue cycle management to get cash sooner
  • Optimize the limits for instant payouts and shorten claims cycle times
  • Identify the right procedure and diagnosis codes

Optimize Performance Based Payment

  • Cost dispersion and performance based payments
  • Measure and oversee the effectiveness of care coordination models and payment models
  • Make more informed policy decisions

Fraud Prevention

  • Identify fraud sooner and more effectively at each stage of the claims cycle

Forecast Revenue / Forecast Staff and Equipment Need

  • Forecast cost for treating diseases by region and provider
  • Forecast loss reserve  accurately by comparing a loss with similar claims
  • Forecast the cost of health care services overtime to set premium rates or plan out-year budgets

Operations Efficiency

  • Prioritize and assign claims to the most appropriate adjuster
  • Identify high-performing providers and communities that provide cost-effective care
  • Enable targeted population health initiatives and interventions based on granular assessment of health care disparities across geographies
  • Create custom reports and layouts


Health Insurance providers can see underlying and measurable trends driving likelihood of purchase of related products in local markets

More than 140 million Americans currently have discretion over health insurance purchases, representing a total of $785 billion in premiums or premium equivalents. As consumers revisit their current insurance status it is critical for Healthcare Insurance providers to understand the underlying, measurable trends driving likelihood of purchase of healthcare insurance and Specialty products at local level (e.g. Health Insurance, Income Protection, Supplemental Coverage, “Wellness” (fitness/eating/stress/etc), Eldercare, and others).

Analytics of social media and member’s historical records can uncover combination of factors leading to consumer decisions including:

  • Economic drivers ­- unemployment, out of pocket costs, median income ranges, housing prices, CPI/modified CPI
  • Consumer Bias and relative influence power – political objections, perceived value of insurance and trust
  • Share of wallet in play ­- disposable income for healthcare related products ­- personal economics and trends
  • Sentiment trends, conversation topics ­- keywords trending

xtLytics Big Data Analytics provides a 360-­degree view across all critical trends driving consumer purchase behavior. You will be able to exploit new opportunities to market Healthcare Insurance and Specialty products in local markets to existing customer and new prospects.


Data-driven/Artificial Intelligence for Fraud and Abuse Prevention

Medicare fraud and abuse is a serious problem requiring attention. Although there is no precise measure of  health care fraud and the majority of health care providers are honest and well-­-intentioned, a minority of providers who are intent on abusing the system can cost taxpayers billions of dollars and put beneficiaries’ health and welfare at risk. The impact of these losses and risks is magnified by the growing number of people served by Medicare and the increased strain on Federal and state budgets.

Government audits recently revealed huge uptick in fraud and abuse in Medicare coming from HER mis­-use. Apparently, many HER vendors have built in coding optimization tools, which can be misused to increase reimbursement for various services.

Model simulation with scenario analysis can be used to predict fraudulent behavior. These models can quantify the impact of fraud and abuse on the system based on different policy models and help support policy change decisions. Big­-data Analytics tools from xtLytics can be used to review large healthcare claims and billing information to target the following:

  • Assess payment risk associated with each provider
  • Over-­-utilization of services in very short-­-time windows
  • Patients simultaneously enrolled in multiple states
  • Geographic dispersion of patients and providers
  • Patients traveling large distances for controlled substances
  • Likelihood of certain types of billing errors
  • Billing for “unlikely” services
  • Pre-established code pair violation
  • Up-­coding claims to bill at higher rates


Improve healthcare outcomes and identify trends related to various cost drivers for patient care 

Analytics tools from xtLytics enable organizations to improve healthcare outcomes and identify trends related to various cost drivers for patient care, including those that appear unusual because they deviate from expectations or from levels reported by peer organizations. For instance, payers should identify providers, health conditions, and patient types where costs have been much lower than expected.

Companies can evaluate total costs for the highest performers, including those related to readmission, administrative tasks, and laboratory work. And companies can quantify the metrics that define best-in-class performers, initiate programs to communicate them, and create incentives to meet these standards.

Applications and analytical tools from xtLytics can help organizations to:

Improve Health

  • Performance Measures: Quickly view performance measures and direct your attention to under-performing cost drivers of patient care
  • Feedback: Insights leading to better understanding of what aspect of the patient interaction might be lacking
  • Pre-Screening: Have better patient outreach based on who need preventive health screenings such as mammograms and colorectal screenings
  • Improving outcomes by examining vitals from at­-home health monitors, and then proactively contacting patients when abnormalities are detected
  • Driving consumer empowerment, involvement and responsibility by providing individuals with the information they need to make informed decisions
  • Managing population health by detecting vulnerabilities within patient populations during disease outbreaks or disasters, and then taking preemptive action
  • Identifying the correlation of factors that influence health outcomes

Reduce Cost of Care

  • Predict: Reduce adverse drug effects by preventing Medication Errors
  • Risk & Outlier Analysis: Analyze outliers cost variability and their experience/procedures/lab test to refine payment policies
  • Identifying treatments, programs and processes that are not delivering demonstrable benefits or are costing too much, and then determining how to replace them with more efficient and effective options
  • Building sustainability into a health system by bringing clinical, financial and operational data together to analyze resource utilization, productivity and throughput
  • Building and maintaining innovative health IT systems and mobile technologies that enable collaboration and easy, secure remote access to patient records

Reduce Readmission

  • Care Gap: Opportunity for providers to look at the patient before being seen and take preventative care steps as appropriate while the patient is in the office
  • Behavior change: Look at provider’s patient population risk, drug compliance details, and reduce readmission with improved medication adherence
  • 30 day’s readmission prediction and action plan to reduce re-admission
  • Reducing re-admissions by identifying environmental or lifestyle factors that increase risk or trigger adverse events and adjusting treatment plans accordingly


New opportunities in the consumer direct arena after Healthcare Reform

Healthcare Insurance providers are developing a growth strategy in the new consumer direct arena. Post-­-medical sale of many Specialty products including Dental, Vision, Disability, Life, Telehealth and Wellness presents a new growth opportunity.

A simple means of forecasting the market growth rate is to extrapolate historical data into the future. While this method may provide a first-­-order estimate, it does not predict important turning points. A better method is to study growth drivers such as demographic information and sales growth in complementary products. Such drivers serve as leading indicators that are more accurate than simply historical data. Companies need predictive marketing models to identify what are the best products to up-­-sell to existing customers, when and how to sell them and what would be the most effective messaging and marketing strategy.

xtLytics offers Market Growth Analytics that can determine the attractiveness of a market and help companies to understand its evolving opportunities as they relate to the market size & growth rate, market profitability, distribution channels, market trends and strengths of the Healthcare Insurance providers.


Beyond measurement of share, healthcare Insurance providers can see indicators of share changes (organic, inorganic and local trends)

Market Analytics from xtLytics delivers real-­-time consumer insights that create a whole new playing field for marketing. The potential ways for businesses to understand market trends based on information about customer behaviors and preferences and social media are unprecedented. Figuring out how to manage, filter and analyze that data into actionable insights is truly the challenge — the success of your marketing strategy depends on analytics tools that boost real-­-world business transactions.

xtLytics Marketing Analytics tools can help Healthcare Insurance providers:

  • Establish custom market share data management dashboards to standardize data and provide real-time metrics
  • Identify Healthcare Insurance providers market share down to zip code by product
  • Monitor organic growth – the rising and falling tides (Age-Ins, market expansion and contraction)
  • Create a variety of template-based, standardized or ad-hoc reports to facilitate cross-­functional communication
  • Establish Brand Strength and local trends against competition
  • Identify New Entrants, traditional and non­-traditional correlations and relationships
  • Convert market share data into actionable insights that power strategic decisions and persuasive marketing
  • Identify competitor share down to zip code by product
  • Monitor abnormal high gain and high loss of market share by product


As Healthcare Insurance providers move into consumer oriented markets churn is expected to be higher

Healthcare Insurance providers move into consumer oriented markets where the churn is expected to be higher than in today’s market where healthcare coverage is mainly bought through employers. Big Data Analytics can be leveraged to score the quality of the relationship insurers have with their consumers. Score drive actions can lead to better retention, product up-­-sell, and brand affinity. Insurers can successfully monitoring “Customer Relationship Score” and enable data-­-driven retention marketing programs.

Marketers can work with large amounts of granular data to better understand customer demands, behaviors and preferences – targeting the precise audience with personalized communication streams and the right offers across every customer segments, tactics and channels. Customer Relationship Score empowers marketers to develop, test, manage and constantly improve a customer retention programs. Understanding attrition, every customer leaves for a reason, and understanding retention, learning about the customers who stay will enable insurers to develop models that can help predict customers who are at risk and react quicker with optimized campaigns and tactics.

xtLytics “Customer Relationship Score” helps marketing departments build highly specific segmentation on high volumes of customer data at unparalleled speed.

  • Deliver highly personalized and relevant marketing programs with deep insights into large amounts of marketing­-related data
  • Recognize and react to constantly changing customer behavior and preferences with instant access to real-­time marketing-­related information
  • Create Personalized Communications Streams
  • Accelerate the business impact of marketing with fast analysis and simulations
  • Reduce churn; improve understanding of the kinds of customers that stay
  • Predicting attrition and retention
  • Spend marketing dollars targeting prospects that are likely to stay


Don’t limit your insights to pre–defined aggregates

xtLytics tools enable agile exploration of existing data without burdening IT in the process. xtLytics Big Data Analytics provides a 360­-degree view across all your critical touch points. Using xtLytics, customers can discover new insights across multiple data sets Service Provider Performance Analytics more effectively.

For example, companies can compare the performance of both providers and networks in near real-­time. This information can be used during rate negotiations and when investigating the potential impact of new risk-sharing arrangements with Accountable Care Organization (ACOs). Companies can isolate outliers within the provider network and determine the factors that are driving their performance. If necessary, payers may need to consider changes to their network strategy or member incentives to direct patients to better providers. Companies can share performance data, when possible, with clients and members to encourage greater use of the best-performing providers.

Cost Management

  • Negotiate rates with service providers effectively
  • Analyze cost variability and patients risk distribution to predict future financial expense
  • Cost estimation for the entire continuum of care for high-risk patients by service providers
  • 360-degree view of service provider, physician by specialty, and patients by chronic conditions

Increase Revenue

  • Strategize plan prices using cost trends and population risk
  • Retain customers or market your message based on quality, safety and patient satisfaction

Performance Enhancement

  • Determine factors of performance via analyzing outliers (or excluding outliers) and process change impact on KPI such as LOS (length of stay)
  • Analyze impact on programs such as drug compliance improvement programs on performance
  • Target specific patients to reduce % of non-compliance
  • Reduce readmission rate (shared with Improve cost of care module)
  • Insight into utilization trends to plan future healthcare needs


  • Establish benchmark by geography for chronic conditions
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