AAFP, Emdeon fight fraud with analytics

Among the analytics, big data and business intelligence waves at the HIMSS13 conference, the American Academy of Family Physicians (AAFP) is working on an initiative to improve outcomes via benchmarking data, and Emdeon and Atigeo are tapping existing public and private data to reduce readmissions and undertake anti-fraud efforts.

“Just adding a little clinical data made it so we can do a lot more analytics,” said Steven Waldren, MD, adding that the project has already collected administrative data, is in the process of incorporating lab data, and intends to work with EMRs on exchanging Continuity of Care Documents (CCDs) and meaningful use requirements.

The AAFP is working with vendor Emdeon on this project, which ultimately will tie that administrative, lab and medication data together, then run analytics on top of it to delvier reports to participating physicians gauging outcomes across the regional population.

“We have enough data to say we’re headed in the right direction,” Waldren added.

And on Tuesday morning, Emdeon and analytics vendor Atigeo held a breakfast to demonstrate new capabilities for reducing fraud and readmissions via cloud services that tap into Emdeon’s 30 to 40 terabytes of payer data, comprising what Emdeon executive vice president Miriam Paramore described as “roughly two-thirds of US population.”

Atigeo added in public data about fraud so that hospitals can subscribe to the cloud service, log-in to a dashboard and gauge physician billing practices – not just in that particular hospital but across multiple payers to see if a doctor is billing, say, more than 24 hours in one day but doing so with different payers to mask the timing.

The second proof-of-concept is a similar dashboard that presents a patient’s risk of readmission at the time they check-in, also harnessing Emdeon claims data to identity potential problems, and also putting that information into a workflow to essentially prioritize patients by their predicted risk of readmission.

“We have the data, but how do you make it worth something?” asked David Talby, vice president of engineering at Atigeo. “You put it where somebody can use it.”