DHA and SAS combat health insurance fraud
Cloud-based analytics solution will monitor DHA and Dubai health insurer's claims for possible fraud
Dubai Health Authority (DHA) and analytics provider SAS have developed a new solution to detect fraud, waste and abuse in the Emirate's health insurance market.
The DHA's Health Funding Department, along with SAS and health systems specialist Dimensions Healthcare have completed a pilot for the E-claimlink Healthcare Fraud Analytics Service, which will be offered to health insurance companies in Dubai to help them prevent fraud.
With the recent introduction of Dubai's Mandatory Health Insurance law, the DHA wanted to ensure that the healthcare ecosystem would be transparent. The new E-claimlink solution provides advanced monitoring and analysis of claims data by both the DHA and the Emirate's health insurance providers to drive market efficiency and restrain wasteful practices.
The software performs advanced predictive analytics through hybrid detection methods that allow for improved identification of fraud, waste and abuse factors and significantly reduces false positives. Health insurance payers will be availing the service with a zero technology footprint requirement as a cloud deployment, with data being analyzed with DHA's E-claimlink DHPO (Data Health Post Office).
Dr. Haidar Al Yousuf, director of Health Funding at DHA, said: "The insight that is generated using SAS' analytics enables us to take vital steps towards our vision of providing a world-class regulated health system, renowned for its excellence in health information management and service. The more use we make of the data at hand, the better we will be at creating solutions that improve the health ecosystem of Dubai. With this new technology on board, DHA would be tracking cross carrier level issues to drive policy modifications, while insurers would have a powerful tool for cost containment."
"By using our unique hybrid detection method which combines anomaly detection methods, predictive models and complex rules, our analytical models go beyond linear claim views and analyzes related activities and relationships to detect anomalies for the health insurers. Dimensions Healthcare, DHA and SAS share a common vision for the critical role that analytics will play in the future of health care in Dubai. With this engagement we hope to not only showcase the power of SAS, but also establish a new benchmark for healthcare regulator driven innovation with a focus on improving patient health outcomes and controlling costs" said Amir Sohrabi, SAS general manager for Gulf and Emerging Markets.
SAS in-memory, high-performance analytics along with the SAS Healthcare Fraud Framework enables the development of sophisticated insights incorporated into E-claimlink workflows. The software runs in-memory analytics against the growing system wide, secure Hadoop store of structured and unstructured big data, which is rapidly building at Eclaimlink. Additionally, the ability to provide secure access to an ever-increasing library of analytic offerings in the cloud through Dubai's E-claimlink over time will allow even the smallest Healthcare Payers to benefit from the advanced analytics and associated best practices developed as a result of this collaboration.
Dr Omar Ghoshesh, CEO of Dimensions Healthcare said: "We are excited about the possibilities of the partnership with SAS and Dimensions Healthcare in extracting data driven insight for providers, payers and the regulator from E-claimlink."