Beth Schultz

Dental Insurer Bites Into BI

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SethBreedlove
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Re: Like the title and...
SethBreedlove   10/12/2011 10:52:59 PM
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@ Sean, I agree. Analytics isn't not cold numbers but rather being able to see life in tiny detail. 

It seems Delta has ingrained into it's workers on how accessable this data is and how it is such an important tool.  I've seen in some companies were personel did have access, however didn't make the connection on how it could improve their jobs or make life easier. 

I love this part of the article: " Delta has spawned a culture of knowledge workers, thanks to the analytics, dashboard, and reporting capabilities it's employed. People don't just scan and then pass along reports anymore -- they actually read them."

When I'm reading and analzing reports and  sometimes go back to an employee and see their shock that "Yes, I actually do read them." 

 

P.S. Beware to health care providers because many insurers are implementing this type of fraud detection software. 

Maryam@Impact
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Dental
Maryam@Impact   10/12/2011 12:38:19 PM
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Beth this is awesome is so refreshing to see analytics being used to not only analyze the past but to drive the future!

BethSchultz
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Re: Like the title and...
BethSchultz   10/7/2011 12:51:45 PM
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Unfortunately, so much of what we do in this country is about bilking the system. Government contractors are another group that has long exploited inefficiencies and "look the other way" attitudes. But that's starting to change too, as government agencies, under pressure themselves, are beginning to demand evidence-based analysis of their contractors, as Shyam Desigan notes in his AllAnalytics.com post today.

Ariella
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Re: Like the title and...
Ariella   10/7/2011 7:17:38 AM
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Yes, Shawn, and it's good that Delta wants to get a clear picture on this. Years ago I complained to Oxford insurance about a certain doctor's practice that tried to augment the flat rate paid for prenatal care by delaying the pregnancy diagnosis and billing for each of the early visits and the ultra-sound as separate items. They didn't seem to care to know about it. It was rather like a teacher who knows that students are cheating but prefers looking the other way rather than confronting them on it.

Shawn Hessinger
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Re: Like the title and...
Shawn Hessinger   10/6/2011 11:01:11 PM
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Ariella,

At the very least, you would expect that it can allow everyone to see the magnitude of the problem a bit better, like creating an effective model for your monthly household budget. It helps you see better where your money is going and, if you don't like what you see, can be the first step in correcting things.

Shawn Hessinger
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Re: Like the title and...
Shawn Hessinger   10/6/2011 10:55:54 PM
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Cordell,

Not  sure where we get the notion that numbers somehow abstract the real world or that they make things somehow detached and unreal. The fact is, as we see here, they can also help us see the world in new ways.

BethSchultz
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Fraud/risk management
BethSchultz   10/6/2011 6:03:33 PM
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Arielle, agreed. I think that is a valuable use of the BI capabilities. For the future, Delta would like to get even more aggressive on monitoring and stopping fraud. The tool it uses today is great at providing a lot of analytic capabilities, but Sheffield says it'll continue to enhance that with more algorithms that enable provider relations to discover abhorrent behavior even more quickly. He says it'll have to mine across a few more metrics to see if the provider is truly worth investigating, and build in more automation so it can look at larger sample sizes, get more accurate results, and probably integrate back to the transaction system to place providers on hold, as necessary. 

 

 


Ariella
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Re: Like the title and...
Ariella   10/6/2011 5:47:10 PM
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I like the idea of monitoring providers to reduce fraud. There is so much fraud in insurance, which raises costs for all the honest folks.

Cordell
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Re: Like the title and...
Cordell   10/6/2011 3:40:27 PM
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I have to agree here too Shawn.  If generating data and metrics is the goal of the exercise then you've missed the point.  You want to unleash your employees creativity in the real world, not one they imagine to be true.  Data just describes what the world is. Hopefully employees will look at it and go "Really? I didn't know that? What can we do to make it better?" or "That's what I thought. I wasn't just imagining things. We need to fix this problem." 

BethSchultz
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Re: Like the title and...
BethSchultz   10/6/2011 1:57:30 PM
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Agreed!

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