Healthcare Cost Assessment for medical supplies
Healthcare Cost Assessment (HCA) is about assessing the healthcare expenditures invoiced by healthcare providers to insurance companies, in hospitalizations. HCA evaluates costs of services and frequencies of services invoiced by healthcare providers, compares charges for consumables to market prices, checks actual quantities compared to expected as defined by physicians and healthcare experts. A comparison of the invoiced prices with the market prices is made and an explanatory report is delivered.
Examples: An insurance company is interested in identifying if there is any financial waste (price or quantity oriented) in invoice level in relation to medical supplies billed by a Healthcare Organization during a hospitalization.
The problem
A major problem faced by insurance companies is abuse and waste in healthcare. Cost estimation for health supplies involves the evaluation of health care costs related to consumables and specialty materials by tracking costs compared to market prices and also tracking quantities compared to the expected amount as defined by physicians and experts in the field of health. A comparison of the invoiced prices with the market prices is made and an explanatory report is delivered.
The purpose
Healthcare Cost Assessment for medical supplies.
The solution
Data analytics, machine learning and artificial intelligence models are great tools to inspect if there is a financial waste (price or quantity oriented) in invoice level in relation to medical supplies billed by a Healthcare Organization during individual hospitalizations.
The benefit
Insurance companies have a negotiating document, in which cases of abuse or waste are identified and proven, on the basis of which they can demand a reduction in charges and put in place permanent policies to deal with such cases.
Mandatory data:
The data required to carry out cost estimation of medical supplies can be extracted from hospital invoices and are the following ones:
- Date
- Description of consumable/special material
- Quantity
- Charge Price
Table 1. Sample table of user input data
|
Date |
Description |
Quantity |
Billing Price |
|
10/10/2022 |
Latex gloves |
19 |
20€ |
|
10/10/2022 |
Cotton tissue |
8 |
40€ |
|
10/10/2022 |
Syringes |
26 |
40€ |
|
10/10/2022 |
High protection Masks |
10 |
40€ |
System Prerequisites:
- Toolbox accepts xlsx or csv files.
- Prerequisite data must be contained in the data file to perform the cost estimate.
- The way to enter the characteristics must be done in the way presented in table 1. Specifically, in the first column you must enter "Date", in the second "Description", in the third "Quantity" and in the fourth "Billing Price".
Output:
After the data has been entered by the user and after a short period of time for its automatic analysis:
- A report of the results and the statistical methods used is extracted from the system.
- An excel is exported with the results of the segmentation.
Note: For any clarification you need regarding the content of the use case or any information related to the collection or validity of your data please contact us.
