Solution Brief
Value-Based Cost Analytics
Succeed in value-based models to decrease costs and improve outcomes with a faster, more productive data and AI platform
The issue
Around the world, the shift from volume-based to value-based care is transforming the health care industry. Organizations are asked to deliver high-quality care that improves health outcomes while reducing costs. While there is agreement on the objective of value-based care, the current debate is centered around how to effectively achieve the goals. In large part, success in value-based programs and payment models is dependent on the ability to integrate data and apply advanced analytics. Organizations that fail to utilize analytics and AI increase the risk of higher industrywide costs and compromise health outcomes, hindering the shift to value-based care.
In the US, the shift from volume to value is evident in the reimbursement trends. As they adjust processes, providers are working hard to overcome data silos, analytical limitations and budgetary constraints so that they can identify unnecessary costs, pinpoint operational efficiencies and understand comprehensive patient health statuses to effectively tailor care and predict future needs.
Providers need to go beyond data insights with action-oriented solutions that deliver continuous innovation and automation to keep pace with the market.
The challenge
Data silos
Data is not freely shared among stakeholders and is often locked in separate systems and formats, making it difficult to integrate data from multiple sources.
Analytical limitations
Providers want to trust their data for informed decisions, but they often lack the analytic capabilities to derive insights to effectively tailor care programs to population needs.
Lack of technical expertise
The majority of a provider’s workforce are clinical professionals whose expertise is in care delivery, not the architecture, deployment and maintenance of analytical solutions.
Budgetary constraints
Current fee-for-service reimbursement models have left providers operating under thin margins, providing little capital for investment in analytics.
Program complexity
Complex models often have competing incentives, leaving some providers wary of participation, potentially missing out on revenue growth opportunities. The ability to identify, measure impact and report on which programs drive ROI versus those that don’t is a mandatory ingredient for success.
(Enable an equitable data exchange; Derive analytical insights; Enhance financial and operational efficiencies; Effectively tailor care services; Improve health quality measures )
Our approach
A fully integrated data and AI platform can be a game changer for health care organizations that want to transition from volume-based to value-based care. Such a platform can power a decision support layer that is applicable across the entire organization and the patient’s entire care continuum.
We approach this by providing software and services to help you:
Improve access to insights
Data insights can be explored visually and shared across teams using easy-to-build, no-code/low-code visualizations. Now clinicians, managers and partners can all have access to insights in a form they can understand and use.
Improve financial and operational efficiency
Identify areas of avoidable utilization faster to mitigate spending and develop clinical models that control the cost of care delivery. Pinpoint inefficiencies in the operational processes of the business faster, such as gaps in the quality of comparative treatments, staffing models or scheduling practices.
Classify patient populations into cohorts
Build population-based or index-based patient cohorts based on demographics to effectively tailor care services to improve health outcomes.
Improve program development and ROI
Identify the most effective program for a particular patient population. Understand which programs have the best ROI.
Faster medical record reviews
Use AI and generative AI for accurate medical coding and faster, cost-efficient medical record reviews for prior authorization, saving staff valuable time.
SAS difference
As the market leader in AI and advanced analytics, SAS can help by providing:
SAS Health on SAS® Viya®
- SAS Health on SAS Viya to integrate health and non-health data from multiple sources into one platform in a low-code/no-code environment.
SAS Viya
- SAS Viya to create custom views that help quantify cost factors to optimize utilization, impact and ROI of value-based care programs.
SAS Health
- SAS Health to unlock the true health status of populations by grouping patients by risk factors and disease state and predict future needs and costs.
Evernorth Health Services
- Evernorth Health Services integrates and analyzes historic claims, demographic and other external data to build a personalized care path that optimizes a patient’s health, overall costs and resource burden on the health care system.
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SAS Health on SAS Viya to integrate health and non-health data from multiple sources into one platform in a low-code/no-code environment.
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SAS Viya to create custom views that help quantify cost factors to optimize utilization, impact and ROI of value-based care programs.
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SAS Health to unlock the true health status of populations by grouping patients by risk factors and disease state and to predict future needs and costs.
SAS facts
>60
>60 countries with SAS health care customers
100%
100% of Fortune Global 50 health care and life sciences are SAS customers
>1,700
>1,700 health and social services customers worldwide