BI Solutions : SAS® for Disease Management

Business Intelligence BI Software : SAS® for Disease Management

Managed healthcare providers, health insurers and other organizations that pay for healthcare are constantly seeking ways to reduce the burden of healthcare costs. Because the majority of all healthcare costs – a staggering 70 percent – is attributable to patients with chronic illnesses, the best way to decrease these costs (and patient suffering) is to identify those patients who have or are likely to develop a chronic illness, and to take measures to stave off the onset of associated complications.

But how do you identify which patients are at risk? How do you know which interventions make the most medical and financial sense? Will the demand for medical resources match your supply? The answers to these critical questions and more can be found using SAS for Disease Management.

SAS for Disease Management delivers accurate, timely information that enables you to predict risk and optimize interventions, so you can achieve improved outcomes. By leveraging award-winning data warehousing and data mining software for predictive modeling, SAS for Disease Management goes beyond traditional disease management solutions to offer:

• A single view of the patient or member.
• Advanced analytics for predicting risk.
• Optimization of interventions.
• Improved clinical outcomes.

SAS for Disease Management supports the four-step disease management process:

Data Acquisition and Management
Medical and pharmaceutical claims are the core information source for most disease management activities. However, claims records are designed to facilitate billing – not to provide a complete representation of population health characteristics. The SAS solution supplements claims data with data on membership and provider eligibility, pharmaceutical records, in-patient and out-patient billing, dental and vision billing, lab results and medical assessment questionnaires. The result is a more complete picture based on a variety of data sources.

Identification and Severity Classification
The SAS solution uses a variety of methods for identifying patients and assigning a severity classification, including:

• Pre-designated lists (as determined by medical evaluations and diagnoses or hospital discharge data).
• Rules-based algorithms based on diagnosis or procedure codes, pharmacy scripts, lab results and medical assessment questionnaires.
• Advanced analytical methods, such as data mining.

Intervention
The SAS solution supplements the critical business activities associated with the intervention stage by:

• Optimizing the intervention method by using data mining techniques to increase the likelihood of first contact and predict which intervention method may be the most effective.
• Employing advanced reporting capabilities, such as scorecards and Web-based reporting, to facilitate the intervention process.

Outcome Management
The SAS solution supports both utilization and expenditure reporting to track the progress and effect of the disease intervention.

Source: For more information business intelligence BI software, SAS BI solutions, disease management, health insurance, visit sas.com

SAS BI Solutions - Health insurers

Business Intelligence BI Software : SAS BI Solution for Health Insurance

Health insurers are under increased pressure to improve the way they do business. But inefficient business processes, lengthy claims processing and outdated information management strategies are proving to be formidable roadblocks to demonstrating value to those who purchase healthcare benefits. To overcome the roadblocks, health insurers must shift from a reactive to a proactive stance by predicting – and responding to – challenges before they occur.

Such predictive power is available to you from SAS. Our solutions provide a gateway to business intelligence, enabling you to gather data from your existing transactional foundation systems and transform it into critical business knowledge.

SAS solutions for health insurance are comprehensive, offering everything you need to make solid business decisions, align actions with business strategy, improve your operational efficiency and, ultimately, increase your bottom line results:

Customer Intelligence
Identify your most profitable members and employer groups, determine which agents bring in the most members and predict which members will leave your health plan.

Customer Relationship Management. With SAS Customer Relationship Management solutions, you can conduct more effective customer interactions, increase awareness, improve targeted marketing and enhance customer services.
Operational Intelligence
Achieve sustainable operational improvements so you can price services optimally, enable new business strategies, reduce operating costs, improve performance, track progress toward achieving organizational goals and meet service level commitments. With SAS Operational Intelligence solutions for health insurance, you can improve your IT infrastructure management and enhance operational efficiencies.

Health Plan Reporting. Empower your customers with self-service reporting functions that let them answer their own questions about health benefits costs and plan utilization. SAS for Health Plan Reporting relieves your reporting burden by giving employer groups direct access to the information they need in an on-line, self-service format.

Health Plan Intelligence
Make sense of your complex challenges by analyzing and uncovering cost and funding balances; understand the factors that affect premium costs and program rates; align book-of-business and line-of-business profitability; and predict activities related to fraud before they occur. With SAS' powerful analytic capabilities, your organization is better equipped to meet its goals for reducing costs and raising profitability and return on investment.

Health Insurance Fraud. Reduce claims costs and losses due to fraud by making predictive, accurate claims decisions before claims are paid. SAS for Health Insurance Fraud goes beyond traditional rules-based fraud detection solutions to offer advanced analytics and easy integration with your claims payment processes for improved recovery and prosecution efforts.

Health Informatics Intelligence
Effectively manage clinical risk by uncovering early indicators for illness, anticipate future utilization of clinical services, improve reimbursements for contract negotiations, and analyze clinical outcomes and medical expenses to reward provider performance. SAS solutions for health informatics intelligence supply the tools you need to proactively understand which factors are most important for reducing risk and predicting future areas of improvement.
Disease Management. Effectively manage clinical risk and gain control of high-cost diseases by uncovering early indicators for illness. With SAS for Disease Management, you can predict risk and optimize interventions in order to achieve improved outcomes.

Beyond BI™
For health insurers, traditional business intelligence is not enough to meet today's market demands. SAS takes health insurers Beyond BI™, providing you with forecasting, predictive modeling and optimization capabilities so you can evolve from simple historical benchmarking to truly predicting what will happen next and understanding the best that can happen.

Source: For more information on business intelligence BI software, SAS BI solutions for health insurance, visit sas.com