Health Care

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Project (1)

Health care : AI Reduce health care cost.

The Challenge

A large healthcare provider wanted to leverage natural language processing (NLP) to mine caregivers’ notes. It wanted to create more complete patient health histories by capturing all these notes in a structured format, identifying and analyzing any details related to social determinants of health (SDH). The organization needed to ascertain which SDH factors, such as economic stability, education, healthcare system and physical environment, significantly impact patients’ health outcomes, and looked to artificial intelligence and machine learning. This healthcare organization turned to our support Healthcare Technology Expertise.+

Our approach

The provider asked to our develop a text mining engine that would efficiently analyze caregivers’ notes to not only extract specific words and relevant information but also identify context and meaningful insights. We implemented an algorithm that analyzed 500,000 records from approximately 200,000 patients to generate these critical insights. Our team created seven NLP models, validated by the healthcare provider’s subject matter experts, to produce results on a regular basis, giving the organization a 360-degree view of each patient with more and better SDH details.

Anonymized records of caregiver notes taken at patient visits or other encounters include all notes related to multiple visits for the same medical issue, such as clinical, pre-and post-operative, and discharge notes for a surgery. Our Artificial intelligence data analysis solution also identifies people in need of care for a particular disease and points them to specific outreach programs in their local area.

Leaf Business Consulting Services

Data analytics improves the quality of care and lowers healthcare costs

By supporting patients with the proper care in their local communities, their overall health and any illnesses or diseases are more closely monitored and controlled. This results in fewer acute medical issues requiring emergency room visits and actually lowers healthcare costs overall.

500,000 patient records analyzed for critical insights, Improved quality of care and health outcomes, Reduced cost of care

Project (2)

Automated Claims Lead to Increased market Share.

The challenge Our client, has worked with its government client for more than 10 years. As its customer faced care access challenges, recognized that its claims system had to be modernized to ensure beneficiaries would have timely access to healthcare. Areas to address included the speed and accuracy of claims processing, reporting methodologies, compliance, security and administrative support. powered by the Facets core administrative platform and hosted in the Microsoft Azure was selected as the optimal solution to address the claims modernization roadmap for government client.

Our approach

commitment to reducing healthcare administrative costs inspired it to create a robust managed services offering. This offering includes modular and scalable business platform. Facets’ data-driven approach streamlines administrative tasks and has eliminated administrative backlogs, eased provider frustrations and reduced other manual challenges often associated with claims administration.

Challenge

Improve claims processing speed and accuracy during growing demand for health services in a manner consistent with the broad data compliance and security requirements of a client serving a government customer.

Leaf Business Consulting Services

Success Highlights

Achieved claims auto-adjudication level of 94% within the initial months post-implementation, an increase of more than 30%

Project (3)

Health Insurance

Healthcare products are software solutions that help organization enhance revenue growth, drive administrative efficiency, improve cost and quality of care, and improve the members and patient experience. A major US health insurer , operating more than 30 Health plans for 30 million members wanted to streamline its ancillary claims administrative functions through automation. Including how the insurer processes approximately 100000 health insurance claims per day. The company also wanted to improve the members experience through quick and accurately claims settlement.

Our Approach

We developed and implementing cloud based intelligent process automation. Effectively augmenting the clients workforce with more than 2000 bots, these bots run 20 hours a day , six days a week, and have self healing properties to ensure minimum downtime without manual intervention.The continuous integration and continuous deployment process boosted the clients claims processing capacity to 3.5 million per month.Besides claims adjudication , our robotic process automation solutions enable payment integrity, benefits coordination and claims reclassification. Our bots make the client more flexible in tackling emerging business needs, like addressing the operational impacts of Covid19. Developed an opioid lock in process that automates the end to end analysis, detection, and prevention of Opioid / Narcotics ( Controlled ) Drug abuse.

Outcomes

Develop the new virtual healthcare solutions utilizes differentiated capabilities, built on the secure and compliant,. Microsoft Cloud that make it easy for people to collect and share health data using their own devices. While ensuring that providers have the data and insights they need to diagnose and treat patients. combining our technologies and collective expertise to deliver additional solutions that offer high quality healthcare and enable patient well - being. The first of several planned offerings that combine remote patient monitoring and virtual health, utilizing products like smart watches, blood pressure monitors and glucose meters to collect and communicate patient health data to providers. Built in analytics allow providers to cross reference historical health information to gain patient insights and potentially identify early warning signs of chronic conditions so preventative measures can be taken.

the solutions remote capabilities enable telehealth visits. Which continue to be a valuable option to mitigate barriers of care for patients with accessibility constraints, as well as implement time sensitive interventions and improve personalized care. With chronic disease expected to account for 70% of global deaths by 2030 , advancements in digital integration are quickly becoming recognized as an optimal approach to preventing, managing and treating disease.