Case Studies: What we can do for you
A better and more in-depth understanding of our turnkey team's processes, skills, and tools we use for our clients.
Case study 1: A Medicare story
Finding Needles in the Haystack
A state's Medicare Part B contractor needed a way to efficiently review ~60M annual claims, target providers who might be excessively billing, and initiate recovery of potential overpayments.
How we saved $334M per year
- Statistical techniques (Z-scores, 95% confidence intervals) to identify aberrant providers
- Stratified random sample of claims and nurse review
- Extrapolated findings and calculated assessment of Medicare's overpayment to the provider
- Tools deployed: SAP Business Objects and client's proprietary application
20 RN hours/week saved
- Regular 1:1 consultations with client's ICU nurse coordinator
- Automation of patient chart reviews
- Reduced potential errors due to manual data entry
- Formatting of flat file that met national database's standards
Case study 2: An automation story
Streamlining Data Management Processes
A hospital's critical care department was struggling to deliver its weekly ICU data to an important national partner. They asked us to improve their collection and submission workflows without loss of data quality and accuracy.
Tools deployed: SQL, SAP Crystal Reports, SSIS package
Process: Agile methodology
$40M in potential annual savings
- Transition from brand-name to generics
- Focus on specific drug indications
- Encouraged a cost-cutting mindset
- Insights published in monthly newsletter
Case study 3: A Medicaid story
Analyze and highlight drugs leading to significant expenditures
A state's Medicaid program had been granted by the federal government the ability to negotiate pricing directly with pharmaceutical manufacturers. The state engaged us to identify where they could focus their negotiation efforts.
Tools deployed: Client's proprietary BI software, Tableau
Process: Waterfall methodology
$2 to $4 in cost avoidance for every $1 spent
- In-depth literature review
- Incorporated innovative explanatory variables
- Subjected factors to rigorous hypothesis testing
- Presented poster to org's enterprise analytics team
Case study 4: A patient safety story
Predict, Prevent, Protect: A Data-Driven Approach
The Quality department of a state-wide healthcare system recognized a rising trend in inpatient falls. We were brought in to devise a predictive model to proactively identify at-risk patients.
Tools deployed: MIDAS, SQL, and SAS EG
Process: Complete end-to-end execution, given the internal team's limited expertise in statistical modeling