New knowledge and analytic merchandise tackle advanced well being care problems with treatment adherence, medical report evaluation, reimbursement fashions, danger administration and value of care
SAS, the chief in knowledge and AI, has introduced a brand new resolution – SAS Well being Price of Care Analytics – focused to well being care payers and suppliers to help efficient resolution making about high quality and value of care.
Obtainable in July 2025, SAS Well being Price of Care Analytics faucets into well being claims knowledge and allows well being care organizations to assemble and analyze claims as episodes of care by stitching collectively codes and patterns all alongside a “care journey” from detection to remedy to care administration. The well being care analytics resolution constructed on the info and AI platform SAS® Viya® can allow extra cost-effective remedy pathways, scale back unwarranted admissions, lower the size of hospital stays and extra.
SAS will introduce SAS Well being Price of Care Analytics and different knowledge and analytic options for well being care payers and the business at AHIP 2025 in Las Vegas.
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Per Gartner®, “Payers more and more want refined knowledge and analytics to attain outcomes equivalent to figuring out rising danger populations, bettering high quality measure efficiency, managing the overall price of care and personalizing experiences.”1
SAS Well being Price of Care Analytics helps the business with distinctive options that embrace:
- Versatile definitions for episodes of care. Customers can analyze claims as episodes of care utilizing clear scientific definitions of their selection and detect associations for a holistic affected person view.
- Worth and care end result measurement. The answer categorizes providers and their care prices as being value-added or probably avoidable. Moreover, anticipated and risk-adjusted prices are robotically calculated and may then be used as high quality/effectivity measures or fee metrics. Different high quality metrics, equivalent to size of keep, are additionally captured.
- Danger-based calculations to check supplier efficiency. Utilizing medical declare knowledge and making use of user-selected guidelines, the answer attributes episodes of care to suppliers, facilitating the measurement of price and high quality of care relative to affected person severity or to set reimbursement targets.
- Analytic insights with simplified knowledge administration. The product helps knowledge validation and simplified knowledge ingestion into the SAS Well being frequent knowledge mannequin to create knowledge repositories.
“As well being care incentives focus in on worth, suppliers and payers should establish the drivers of price, high quality and outcomes to make selections about protocols and supplier contracts,” stated Brett Davis, Senior Supervisor, Well being Care Advisory at SAS. “Going far past conventional claims grouping, SAS Well being Price of Care Analytics generates useful insights to establish variations and alternatives for enchancment when assessing monetary danger, all whereas understanding members in additional element.”
Prepared-made AI fashions for well being care
Additionally new available on the market to help payers and suppliers are ready-made AI fashions. Complementing its well being care options portfolio, SAS’ AI fashions are constructed from many years of experience in making use of scalable and reliable AI to real-world use instances and are designed to sort out enterprise challenges with precision and effectivity.
The newly obtainable fashions embrace:
- SAS Medicine Adherence Danger: Medicine adherence has lengthy been a measure of affected person well being outcomes and a key think about regulatory high quality assessments (e.g., high quality scores for Medicare Benefit, Medicaid and Trade). SAS Medicine Adherence Danger allows managed care organizations to establish the place assets are wanted for well timed and focused intervention, leading to enhanced affected person engagement, higher well being outcomes, improved high quality metrics and decrease well being care prices.
- SAS Doc Evaluation: The SAS Doc Evaluation mannequin is an clever doc processing pipeline targeted on extracting contextual data from scanned doc photographs and producing structured knowledge property. The AI mannequin converts scanned photographs into summarized knowledge for medical reviewers, permitting them to guage information extra successfully and effectively. The SAS Doc Evaluation mannequin’s enhanced evaluation of unstructured claims knowledge has already proven a 400% effectivity achieve over handbook evaluation in one of many largest U.S. well being insurers.
- SAS Fee Integrity for Well being Care Detect and Stop: The fee integrity fashions provide capabilities for addressing points with well being billing errors and declare discrepancies, detecting fraud and stopping improper claims. The fashions are designed to speed up implementation of SAS options that well being care packages inside non-public insurance coverage and government-funded packages use to satisfy regulatory compliance necessities, function transparently, and extra effectively handle and comprise prices related to fraud, waste and abuse.
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