Doctors talking in hallway

Gain data-driven insights to navigate financial risk and optimize outcomes

Control costs, improve quality of care and maintain regulatory compliance

Succeed in value-based payment models by combining key data points from disparate sources, enabling data sharing, cost savings and improved health outcomes. Optimize the detection, management and prevention of payment integrity issues and maintain regulatory compliance.

Value-based care and payment models

Succeed in value-based care and payment models using advanced analytics to help optimize costs and improve outcomes. Confidently predict and manage financial and clinical risks and rewards associated with contracting for value.

 Fraud, waste and abuse (FWA) detection and prevention

Detect and prevent FWA faster through automation and machine learning – and manage payment integrity issues from every angle. Use powerful analytics and AI to identify new schemes and links between serial fraudsters.

Improved health quality measures

Classify patient populations into distinct cohorts to tailor care to meet measures of quality and health outcomes. Track the quality of clinical and operational services to identify areas for improvement and determine the true cost of clinical interventions.

Financial stability and regulatory compliance

Adopt a cloud-based solution that enables automated updates with no input required for regulatory compliance. Consolidate data sources to reduce capital expenditures and identify areas of avoidable utilization.

How SAS delivers award-winning health care finance solutions

  • Evernorth analyzes historic claims, demographic and financial data to build personalized care pathways to optimize outcomes, reduce costs for individuals and manage the resource burden on the health care system.

  • $10+ billion

    The Centers for Medicare & Medicaid Services have identified more than $10 billion in potential savings by identifying discrepancies in billing, utilization and payments.

  • $6.9 million

    North Carolina Department of Insurance recovered $6.9 million in fraudulent claims in seven months, reducing the average case resolution time from 90 to 57 days.

    SAS Viya: The data and AI platform for your health care business

    Unlock trusted health insights faster to improve health outcomes, control costs, increase operational efficiency and build healthier, more resilient communities.

    Recommended resources for health care finance analytics solutions

    Webinar

    Keeping Fraud Honest

    White Paper

    Generative AI in Health Care: Opportunities and Cautions

    White Paper

    Achieving Program Integrity for Health Care Cost Containment

    Solution brief

    Value-Based Cost Analytics

    SAS is a leader is health care finance analytics

    SAS is a Leader in The Forrester Wave™: Enterprise Fraud Management, Q2 2024.

    SAS is a luminary in Celent Insurance Fraud Detection Solutions: Health Insurance, 2022 Edition.

    SAS ranks best in class in the Matrix: Payment Integrity in Healthcare.

    Featured Products

    Learn more about our best-in-class products for visualizing costs and resources while predicting fraudulent claims behavior.

    SAS Health Solutions

    SAS Health simplifies health data management and accelerates analytic discovery by providing an end-to-end enterprise solution for analytics and data automation.

    • Adopt an enterprise solution for improved interoperability through an end-to-end capability for health data integration, data management, automation and analytics.
    • Easily ingest data from industry standards and map to a FHIR-based common data model in less time.
    • Combine health and non-health data for industry-specific business solutions.
    • Deploy a low-code/no-code environment for data exploration, advanced analytics and model deployment.

    SAS Payment Integrity for Health Care

    Detect, prevent and manage payment integrity issues from every angle and at every stage of the claims process to stop improper payments before claims are paid.

    • Ensure payment integrity with an integrated solution with components for fraud detection, alert management and case handling.
    • Reduce false positives while boosting efficiency.
    • Build social networks and gain a holistic view of fraud risk and discrepancies.
    • Use a health-care-specific FWA data model that consolidates data from various data sources.