Operational analytics
Gain actionable insights to optimize performance
Claims management
What is claims management?
Claims management is the organization, billing, filing, updating, and processing of medical claims related to patient diagnoses, treatments, and medications.
How can it help your organization?
Claims fraud, waste, and abuse are significant issues worldwide. They encompass a wide spectrum of activities, including deceptive billing for services not rendered, performing unnecessary medical services, and abusing payment rules by coding services at higher levels than performed.
Denied claims represent extraordinary administrative costs to health providers and payors. Claims analytics helps you efficiently predict patterns and detect anomalies to fight fraud and waste.
Connect your health data using HL7 FHIR
Create new opportunities with analytics, machine learning, and actionable intelligence across your health data.
Use insights to deliver value-based care models
Transform health outcomes using data-driven insights to improve clinical decision-making, help reduce process latency, and create proactive care plans to help reduce costs.
Improve staff management and forecast patient throughput
Improve operational efficiency by synchronizing management efforts across clinicians and administrators to reveal actionable insights into cross-institutional operations.
Start with these questions
What percentage of filed claims are being denied or require rework before being paid?
Are you seeing changes in this trend?
What are the top reasons for claims being denied?
Benefits of implementing analytics for claims management
for providers
- Claims management. Improve the identification, management, and collection of patient service revenue.
- Denials and revenue management. Reduce the number of denied claims, a primary contributor to bad debt that represents millions in lost net patient revenue every year.
for payors
- Claims and fraud management. Assess the appropriateness of a claim and predict anomalies within the entire claims data universe to prevent fraudulent activities. For payors, claims management is a critical aspect of determining whether to pay or deny claims and of determining the rate of payment for services a health provider bills to the payor.
- Denial management. Use analytics to track the number of claims filed by providers that a payor denies. For payors, denied claims create large overhead costs.
Connect your health data using HL7 FHIR
Create new opportunities with analytics, machine learning, and actionable intelligence across your health data.
Use insights to deliver value-based care models
Transform health outcomes using data-driven insights to improve clinical decision-making, help reduce process latency, and create proactive care plans to help reduce costs.
Improve staff management and forecast patient throughput
Improve operational efficiency by synchronizing management efforts across clinicians and administrators to reveal actionable insights into cross-institutional operations.
Cost management
What is cost management?
Cost management is a broad category relevant to all aspects of care delivery. It encompasses evaluation of all major provider and payor systems that determine the eventual cost of providing and paying for health and medical services.
How can it help your organization?
Most provider and payor organizations today exist on razor-thin operating margins. In most countries, the cost of providing and paying for care is rising faster than reimbursements are increasing. Health providers and payors are using solutions that improve the management of costs while maintaining the quality of services provided. Cost management solutions use analytics to evaluate and improve the efficiency of major systems used in providing health and medical services.
Connect your health data using HL7 FHIR
Create new opportunities with analytics, machine learning, and actionable intelligence across your health data.
Use insights to deliver value-based care models
Transform health outcomes using data-driven insights to improve clinical decision-making, help reduce process latency, and create proactive care plans to help reduce costs.
Improve staff management and forecast patient throughput
Improve operational efficiency by synchronizing management efforts across clinicians and administrators to reveal actionable insights into cross-institutional operations.
Start with these questions
How do your operating costs compare to reimbursements?
What are your top cost drivers?
Do you have systems in place that help you predict costs so you can better manage them?
Benefits of implementing analytics for cost management
for providers
- Staffing optimization. Match staffing requirements—typically the largest single cost—to the current and future mix of patients.
- Supply cost management. Evaluate which supplies are most cost-effective.
- Throughput management. Optimize the flow of patients through facilities—typically the second-highest cost—including hospitals, emergency departments, operating theaters, and imaging departments.
for payors
- Fraud detection. Spot potentially fraudulent claims, including those miscoded to generate higher payments.
- Shorter patient stays. Predict lengths of stay forcovered services to estimate and minimize costs.
- Claims denial management. Predict which claims will be denied, reducing the number of denials and the cost of managing them.
Connect your health data using HL7 FHIR
Create new opportunities with analytics, machine learning, and actionable intelligence across your health data.
Use insights to deliver value-based care models
Transform health outcomes using data-driven insights to improve clinical decision-making, help reduce process latency, and create proactive care plans to help reduce costs.
Improve staff management and forecast patient throughput
Improve operational efficiency by synchronizing management efforts across clinicians and administrators to reveal actionable insights into cross-institutional operations.
Readmissions management
What is readmissions management?
A hospital readmission occurs when a patient who has been discharged from a hospital is admitted again within a specific time interval. Avoidable readmissions are a strong indicator of a fragmented healthcare system that too often leaves discharged patients confused, consumes resources that are already stretched thin, and produces higher treatment costs.
How can it help your organization?
Analytics solutions can be used to evaluate and predict which patients are at risk for readmission, so hospitals can create a plan to reduce that risk.
Connect your health data using HL7 FHIR
Create new opportunities with analytics, machine learning, and actionable intelligence across your health data.
Use insights to deliver value-based care models
Transform health outcomes using data-driven insights to improve clinical decision-making, help reduce process latency, and create proactive care plans to help reduce costs.
Improve staff management and forecast patient throughput
Improve operational efficiency by synchronizing management efforts across clinicians and administrators to reveal actionable insights into cross-institutional operations.
Start with these questions
What level of inpatient readmissions rates is your organization currently experiencing?
Has your current performance with respect to readmissions affected your level of reimbursement?
Do you have a way to proactively assess which patients have the highest risk of readmission?
Benefits of implementing readmissions management
for providers
- Readmittance risk analysis. “Risk rate” patients before a hospital stay, as they go through treatment and recovery, and as part of the discharge process to assess their likelihood of being readmitted following discharge.
for payors
- Reduced hospital readmissions rate. Use analytics to help with reporting readmission rates and penalizing providers whose rates are high.
- Reduced emergency department bounce-back rate. Reduce bounce-back—an inpatient readmission that occurs when a patient seen in an emergency department returns after discharge because the condition doesn’t improve after the treatment.
Connect your health data using HL7 FHIR
Create new opportunities with analytics, machine learning, and actionable intelligence across your health data.
Use insights to deliver value-based care models
Transform health outcomes using data-driven insights to improve clinical decision-making, help reduce process latency, and create proactive care plans to help reduce costs.
Improve staff management and forecast patient throughput
Improve operational efficiency by synchronizing management efforts across clinicians and administrators to reveal actionable insights into cross-institutional operations.
VIDEXA can help
VIDEXA brings disparate healthcare data sets together
into one consolidated environment.
