Download - Survey says organizations rely on narrow swatch of data to combat fraud, waste & abuse

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LEVEL OF SOPHISTICATED USE OF ANALYTICS/DATA

TYPES OF ANALYTIC RESOURCES USED

Survey reveals organizations rely on narrow swatch of data, thus creating a big hurdle in effectively predicting and preventing claim FWA with advanced profiling & analytics.

SURVEY RESULTS

BIG DATA CHALLENGES

SOURCES OF DATA USED TO IDENTIFY POTENTIAL FWA PATTERNS1

2

3

CLAIMS DATA PROVIDER DEMOGRAPHICS

MEMBER DEMOGRAPHICS

BEHAVIORAL/ATTITUDINAL DATA

OTHERS

98% 68% 51% 31% 31%

ADVANCEDOUTCOMES REALIZED FROM MULTI SOURCE

DATA

IN PROGRESSIMPLEMENTING A VARIETY OF MULTI

SOURCE DATA

EARLY ONCONSIDERING USE OF

NON TRADITIONAL ANALYTICS / DATA

NOT SURE

35% 34% 17% 14%

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INTERNAL TEAM + EXTERNAL VENDOR TOOL

INTERNAL TEAM NOT SURE EXTERNAL VENDOR TOOL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

?

51% 34%

8% 7%

Source: SCIO-led webinar titled ‘Predicting and Preventing Claim Fraud, Waste and Abuse with Advanced Profiling & Analytics’.

Even though FWA is a growing challenge, nearly all of the respondents rely on claims data (98%) to identify potential FWA patterns while far fewer leverage other types of information.

Organizations are still not optimally using a full range of data – as only 35% of poll participants cited realizing FWA outcomes from multi-source data.

About half of all respondents use a combination of internal teams and external vendor tools in the FWA efforts, which means that about half either are not sure of what their organizations use or don’t use either. This hampers the efficient use of available data.