Data Analytics

The need for quality analysis of health care data has increased exponentially since the launch of the Affordable Care Act (ACA). Since much of health care reform implementation was left up to the states, they need to gather and analyze data on current and new methodologies in order to make evidence-based decisions regarding health care policies that increase quality while controlling costs. Additionally, the federal government must examine enrollees’ experience in the new health care system, and adjust the ACA accordingly, under the transparency requirements of the law.

Payers are looking for effective and timely methods to reduce spend on specialty drugs. Some strategies that have proven successful are channel management (coverage of a medication under the medical or pharmacy benefit), site of care optimization (shifting administration away from hospital outpatient clinics when possible), and clinical and formulary management. A challenge for payers in developing these strategies is the availability of data about medications from medical claims.

All of these considerations require government agencies, health plans, and providers to obtain accurate data, and to hire analysts capable of interpreting the data relative to the health care field.  

We partner with state agencies and health care organizations seeking to transform data into actionable intelligence for health care provision. Our data analysts collect, clean, and synthesize data from providers and patients. We are also experienced in analyzing data from existing large databases such as all-payer claims datasets and state Medicaid databases. Learn about our TrendFinder data analytics platform.

Our data analytics work includes:

  • Examination of every aspect of data, including pharmacy, medical, and laboratory claims.
  • Analysis of data relative to current evidence-based medicine.
  • Translation of information into actions that advance clinical outcomes and contain costs.
  • Review of utilization trends, discrepancies in data, and identification of outliers.
  • Payment method modeling to evaluate how reimbursement and purchasing reforms affect system financing and service delivery.
  • Data warehousing and customized data management solutions, including cleansing, profiling, integration, reporting, and data governance.
  • Evaluation of medication spend under both the pharmacy and medical benefit, including site of care.
  • Identification of fraud, waste, and abuse.
  • Designing mortality review processes and analyzing mortality and incident data.