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.