Claritev believes in the power of data. Our Chief Data Scientist, Benjamin Perryman, PhD, leads a team tasked with the responsibility of harnessing that power. “The goals of data science are to help people make decisions more wisely and spend their time more efficiently,” he said.
The way Claritev’s data scientists accomplish those goals is by making intelligent business solutions that Claritev’s services can leverage. They infuse the company’s systems with models that understand what is occurring and recommend action.
According to Dr. Perryman, the same decision-making process used by humans can be harnessed by machines. That is, the systems collect relevant information, understand the choices available (which may be client-driven or regulatory-driven), make a decision and then act. Once the action is taken, outcomes can be monitored and fed back into the process so that decision-making is always improving.
Data science gives Claritev’s services an advantage
Leveraging data science, Claritev is working to build intelligent processes into each of its cost management and payment and revenue integrity services. Claritev’s Negotiation Services was the first to benefit from a data science project with the implementation of the Negotiation Prioritization Tool. Claritev won the “Healthcare Data Solution of the Year” Designation in the 2022 Data Breakthrough Awards Program for the tool and was named a winner for the CIO 100 Award, which recognizes enterprise excellence and innovation in IT.
Negotiation Prioritization Tool
The Negotiation Prioritization Tool was developed to help Claritev’s team of negotiators manage their work queues. Prior to the tool, each negotiator spent hours each week sorting their queue, using their own method to determine which claims were the most important and which had the highest chance of success.
Using a combination of machine learning and business rules, the Negotiation Prioritization Tool now sets negotiators’ workflow for them. The tool prioritizes claims that have the highest likelihood of reaching a settlement and generating savings for our clients.
Since implementing the Negotiation Prioritization Tool, negotiators have improved their productivity by at least 10%, measured by the average number of claims closed each day. Most important, they have been able to deliver higher savings to our clients. We generated an additional estimated $40 million in incremental savings annually for our clients as a result of this tool.
One of the biggest advantages of building tools and enhancing systems with data science is that the system’s performance isn’t static; rather, it adapts over time with the continual infusion of recent data. The adjustments to our predictive models ensure continued differentiated outcomes for our clients, even with the changes in healthcare caused by COVID-19 and the No Surprises Act.
Claritev’s data scientists are working on several other projects that will enhance other Claritev services. We will provide more detail about these projects in upcoming blog posts.
Learn more about Claritev’s innovation.
