Welcome!

News Feed Item

SCIO Health Analytics Delivers $540M in Annual Client Value Through Elimination of Healthcare Waste

Healthcare Organizations Leverage SCIO's Advanced Analytics to Reduce Waste and Improve Performance

WEST HARTFORD, Conn., Nov. 14, 2017 /PRNewswire/ -- SCIO Health Analytics today announced that it has delivered $540 million in client value year-to-date through the elimination of healthcare waste and improved performance associated with its reimbursement and care optimization solutions. Healthcare waste, which is defined as spending that can be reduced without compromising the quality of care, is a wide-ranging problem in the U.S. healthcare industry driven by the way care is organized, delivered and paid for. Recent estimates indicate that effectively addressing healthcare waste represents a $1 trillion annual opportunity in cost savings.

Serving over 80 healthcare organizations including 20 provider groups and 30 health plans representing more than 90 million members, four of the top six PBMs, and clients in 30 countries for eight of the top 15 global pharmaceutical companies. SCIO’s mission is to drive positive change in healthcare by delivering actionable insights to solve complicated problems simply and efficiently.

By delivering deeper market insights that enable payers, providers, health service organizations and life sciences companies to uncover clinical-efficiency improvements that drive behavior change, SCIO Health Analytics' solutions specialize in reducing healthcare waste in the following four major categories:

  • Inaccurate payments: Overspending resulting from overpayment, fraudulent billing, provision of unnecessary or inappropriate services.
  • Clinical waste: Spending that could be reduced with better care coordination, elimination of duplicate tests and procedures, early intervention and preventive care.
  • Administrative complexity: Spending that could be eliminated with simpler, more standardized processes for billing, collections, credentialing, compliance and oversight.
  • Price variation: Overspending resulting from paying high prices charged by inefficient suppliers, which could be reduced by tying prices to efficiency, outcomes and a fair profit.

SCIO's reimbursement optimization solutions create $300 million of client value annually by reducing the cost of care through clinical and payment audit programs, prepayment and prevention analytics, and pharmacy fraud and abuse analytics. Additionally, SCIO's care optimization solutions create $240 million of client value annually by improving the quality of care through care-gap identification, clinical outcomes measurement and patient risk and behavioral analytics.

"Healthcare waste is a widespread problem throughout the industry that has reached near-epidemic proportions and is caused by a number of complex and interrelated factors," said Rose Higgins, president with SCIO Health Analytics. "Through our advanced analytics solutions that enable healthcare organizations to reduce the cost of care while improving care quality, SCIO is dedicated to helping our clients solve the underlying issues that lead to excessive spending and suboptimal outcomes."

Examples of how SCIO clients have used its advanced analytics solutions to address healthcare waste include:

  • A 65,000-member health plan in Texas needed a way to better engage provider groups it worked with to close documentation gaps that were resulting in lower Medicare Advantage reimbursements. SCIO provided analytics, provider education and health assessment tools to improve continuity of care, which drove greater payer-provider collaboration. The result was $24 million in savings and a 38 percent increase in care-gap closure.
  • A large global employer identified employees with a high prevalence of invasive, expensive and potentially unnecessary orthopedic surgical procedures. These preference-sensitive conditions often display a bias towards surgery based on the assumption that it provides the highest-quality care, but in many cases the less-invasive treatment provides equal or greater outcomes with fewer complications. SCIO analyzed the outcomes on utilization, cost and reduction of invasive treatments improving overall quality of life for the employee. The result was a 20 percent reduction in invasive treatments, 25 percent reduction in healthcare expenditure and up to 1.5 percent reduction in overall population costs.
  • A 2.8-million-member health plan in the Northeastern U.S. was experiencing billing issues with providers, and needed assistance in identifying and recovering overpayments, as well as identifying potential fraud situations. The plan lacked sufficient resources and expertise to conduct the necessary data analysis and in-depth audits, and needed a partner with deep expertise in specialty pharmaceuticals. SCIO's advanced analytics identified $7 million in overpayments, including $1.5 million in avoided payments to an infusion provider that mischaracterized the drug given to patients and $2 million in overpayments to a provider that was billing vial size incorrectly. Both providers discontinued the inappropriate billing practices once notified.

About SCIO Health Analytics

Based in West Hartford, Connecticut, SCIO Health Analytics is a leading health analytics solution and services company serving healthcare organizations across the continuum including provider groups, health plans, PBMs, health services and global life sciences companies.

SCIO provides predictive analytic solutions and services that transform data into actionable insights, helping healthcare organizations create the understanding that drives change through care, network and reimbursement optimization as well as commercial effectiveness. SCIO's insights as a service approach supports the shift to value-based care, solving healthcare problems simply and efficiently. Visit SCIO's new website for up to date information on their product and solution offerings: www.sciohealthanalytics.com

Media Contact:

SCIO Contact:

Brandon Glenn

Michele Norton, M.S., R.N.

Amendola Communications

Senior Vice President Marketing

(216) 233-4357

(727) 815-7710 

bglenn@acmarketingpr.com

mnorton@sciohealthanalytics.com

 

View original content with multimedia:http://www.prnewswire.com/news-releases/scio-health-analytics-delivers-540m-in-annual-client-value-through-elimination-of-healthcare-waste-300555236.html

SOURCE SCIO Health Analytics

More Stories By PR Newswire

Copyright © 2007 PR Newswire. All rights reserved. Republication or redistribution of PRNewswire content is expressly prohibited without the prior written consent of PRNewswire. PRNewswire shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

Latest Stories
Mobile device usage has increased exponentially during the past several years, as consumers rely on handhelds for everything from news and weather to banking and purchases. What can we expect in the next few years? The way in which we interact with our devices will fundamentally change, as businesses leverage Artificial Intelligence. We already see this taking shape as businesses leverage AI for cost savings and customer responsiveness. This trend will continue, as AI is used for more sophistica...
Nordstrom is transforming the way that they do business and the cloud is the key to enabling speed and hyper personalized customer experiences. In his session at 21st Cloud Expo, Ken Schow, VP of Engineering at Nordstrom, discussed some of the key learnings and common pitfalls of large enterprises moving to the cloud. This includes strategies around choosing a cloud provider(s), architecture, and lessons learned. In addition, he covered some of the best practices for structured team migration an...
Most technology leaders, contemporary and from the hardware era, are reshaping their businesses to do software. They hope to capture value from emerging technologies such as IoT, SDN, and AI. Ultimately, irrespective of the vertical, it is about deriving value from independent software applications participating in an ecosystem as one comprehensive solution. In his session at @ThingsExpo, Kausik Sridhar, founder and CTO of Pulzze Systems, discussed how given the magnitude of today's application ...
Recently, REAN Cloud built a digital concierge for a North Carolina hospital that had observed that most patient call button questions were repetitive. In addition, the paper-based process used to measure patient health metrics was laborious, not in real-time and sometimes error-prone. In their session at 21st Cloud Expo, Sean Finnerty, Executive Director, Practice Lead, Health Care & Life Science at REAN Cloud, and Dr. S.P.T. Krishnan, Principal Architect at REAN Cloud, discussed how they built...
In his session at 21st Cloud Expo, Raju Shreewastava, founder of Big Data Trunk, provided a fun and simple way to introduce Machine Leaning to anyone and everyone. He solved a machine learning problem and demonstrated an easy way to be able to do machine learning without even coding. Raju Shreewastava is the founder of Big Data Trunk (www.BigDataTrunk.com), a Big Data Training and consulting firm with offices in the United States. He previously led the data warehouse/business intelligence and B...
The “Digital Era” is forcing us to engage with new methods to build, operate and maintain applications. This transformation also implies an evolution to more and more intelligent applications to better engage with the customers, while creating significant market differentiators. In both cases, the cloud has become a key enabler to embrace this digital revolution. So, moving to the cloud is no longer the question; the new questions are HOW and WHEN. To make this equation even more complex, most ...
As you move to the cloud, your network should be efficient, secure, and easy to manage. An enterprise adopting a hybrid or public cloud needs systems and tools that provide: Agility: ability to deliver applications and services faster, even in complex hybrid environments Easier manageability: enable reliable connectivity with complete oversight as the data center network evolves Greater efficiency: eliminate wasted effort while reducing errors and optimize asset utilization Security: imple...
In his Opening Keynote at 21st Cloud Expo, John Considine, General Manager of IBM Cloud Infrastructure, led attendees through the exciting evolution of the cloud. He looked at this major disruption from the perspective of technology, business models, and what this means for enterprises of all sizes. John Considine is General Manager of Cloud Infrastructure Services at IBM. In that role he is responsible for leading IBM’s public cloud infrastructure including strategy, development, and offering m...
With tough new regulations coming to Europe on data privacy in May 2018, Calligo will explain why in reality the effect is global and transforms how you consider critical data. EU GDPR fundamentally rewrites the rules for cloud, Big Data and IoT. In his session at 21st Cloud Expo, Adam Ryan, Vice President and General Manager EMEA at Calligo, examined the regulations and provided insight on how it affects technology, challenges the established rules and will usher in new levels of diligence arou...
The past few years have brought a sea change in the way applications are architected, developed, and consumed—increasing both the complexity of testing and the business impact of software failures. How can software testing professionals keep pace with modern application delivery, given the trends that impact both architectures (cloud, microservices, and APIs) and processes (DevOps, agile, and continuous delivery)? This is where continuous testing comes in. D
Modern software design has fundamentally changed how we manage applications, causing many to turn to containers as the new virtual machine for resource management. As container adoption grows beyond stateless applications to stateful workloads, the need for persistent storage is foundational - something customers routinely cite as a top pain point. In his session at @DevOpsSummit at 21st Cloud Expo, Bill Borsari, Head of Systems Engineering at Datera, explored how organizations can reap the bene...
Digital transformation is about embracing digital technologies into a company's culture to better connect with its customers, automate processes, create better tools, enter new markets, etc. Such a transformation requires continuous orchestration across teams and an environment based on open collaboration and daily experiments. In his session at 21st Cloud Expo, Alex Casalboni, Technical (Cloud) Evangelist at Cloud Academy, explored and discussed the most urgent unsolved challenges to achieve f...
The dynamic nature of the cloud means that change is a constant when it comes to modern cloud-based infrastructure. Delivering modern applications to end users, therefore, is a constantly shifting challenge. Delivery automation helps IT Ops teams ensure that apps are providing an optimal end user experience over hybrid-cloud and multi-cloud environments, no matter what the current state of the infrastructure is. To employ a delivery automation strategy that reflects your business rules, making r...
The 22nd International Cloud Expo | 1st DXWorld Expo has announced that its Call for Papers is open. Cloud Expo | DXWorld Expo, to be held June 5-7, 2018, at the Javits Center in New York, NY, brings together Cloud Computing, Digital Transformation, Big Data, Internet of Things, DevOps, Machine Learning and WebRTC to one location. With cloud computing driving a higher percentage of enterprise IT budgets every year, it becomes increasingly important to plant your flag in this fast-expanding busin...
In a recent survey, Sumo Logic surveyed 1,500 customers who employ cloud services such as Amazon Web Services (AWS), Microsoft Azure, and Google Cloud Platform (GCP). According to the survey, a quarter of the respondents have already deployed Docker containers and nearly as many (23 percent) are employing the AWS Lambda serverless computing framework. It’s clear: serverless is here to stay. The adoption does come with some needed changes, within both application development and operations. Tha...