ALYDATA HEALTHCARE CASE STUDY - BIG DATA ANALYTICS

REGIONAL CARDIOLOGY AND INTERNAL MEDICINE FIRM DEFENDS ITSELF FROM FRAUD ALLEGATIONS BY BENCHMARKING ITSELF AGAINST OTHERS

AlyData was selected to provide Advisory and Information Management expertise to Institute of Cardiology Excellence (ICE). ICE operates outpatient surgical centers and satellite offices where it offers care to the sick. PluralSoft’s Healthcare Analytics platform CareQuotient was used to develop benchmarking statistics and mine the EMR data obtained from third parties. The project was delivered on time and on budget in a record 12 weeks by a core team of 10.

The Challenges:

(1) Client was sued for healthcare fraud by the Department of Justice (DOJ) based on historical claims data from 2012 and 2013.

(2) ICE had the option to pay a $10 million penalty to the DOJ to settle the case or litigate it in court. ICE management decided to litigate because they felt that they hadn’t committed fraud.

(3) ICE had a very short 12-week window to provide its legal team the necessary data and benchmarking data to bolster its case.

(4) Client didn’t have technical expertise in Data Science or in-house Information Management capabilities.

How AlyData and Plural Soft Helped the Client

(1) Acquired Medicare and Medicaid claims data for Florida hospitals, National Cardiology practices and ICE’s EMR systems.

(2) Normalized and cleansed the data and ran custom statistical analysis and data mining techniques to benchmark ICE against its peers nationwide and in Florida.

(3) Engaged ICE’s legal team in Washington DC to provide benchmark data and key insights gleaned from the claims data.

(4) PluralSoft is deployed in the Cloud. Eliminated IT infrastructure and support costs for hosting the solution. Freed up IT staff to focus on value-added services.

(5) Engaged with ICE’s healthcare experts and staff to evaluate various data sets for completeness and accuracy, before using them in models.

(6) Automated the data acquisition, cleansing and normalizing process so that it can be run repeatedly against various data sets.

(7) Documented the EMR claims process and provided recommendations for improvement of governance and compliance.

Results, Return on Investment and Future Plans

(1) AlyData and PluralSoft were able to acquire, cleanse and analyze claims data using proprietary methodology and tools and deliver high quality benchmarks to the client against a highly aggressive timeline.

(2) The benchmarking data, process improvements and documentation provided to the client, potentially saved them over $1.5 million in operational and compliance related savings and bolstered their legal case.

(3) Helps standardize processes, manage claims better and implement best practices for claims processing and billing.