Data Analytics Helps Manage Medical Insurance Data
By Aditi Bhat
The Centres for Medicare & Medicaid Services, CMS is a well-known US government affiliated organization. It is also a part of the Department of Health and Human Services (HHS). It covers and serves more than 100 million Americans through Medicaid, Medicare and its Health Insurance Programs. For more than a decade, Teradata Corporation has been helping CMS achieve a high-quality and cost-effective health care system by offering data analytics solutions. The number of operations run by CMS generate a huge amount of data on a routine basis. Managing this data is certainly not an easy task.
CMS faced the challenge of managing an overwhelming amount of data generated by its various operations and programs. This data is based on coverage, beneficiaries, claims, eligibility, providers, encounters and more. In the absence of a dedicated tool to fully understand and process this staggering amounts of data, CMS faced the risk of fraud, abuse and waste. This created a requirement for a new and efficient kind of data analytics and a related reporting capability. CMS faced the challenge of dealing with 4.5 million claims and $1.3 Billion paid out daily to settle the claims. Further, CMS needed a competent data warehouse solution to create a reliable, consistent and secure claims-view system to effectively deliver quality healthcare. This solution would also identify fraud, waste and abuse.
Teradata provided the Integrated Data Repository (IDR) that now allows CMS to view, analyze, aggregate and report massive volumes of data at transactional and granular levels. IDE now provides very clear visibility into the complex claims lifecycle. Further, IDR enables wide-ranging investigation, business analytic reporting and data analysis capabilities that helps CMS and the research community. It works as an enterprise resource to provide a unified view of all CMS data for managing the Medicaid and Medicare programs.
- Consistent Analytics based on timely data now support all programs at CMS.
- CMS now has improved ability of tracking various trends in current programs and identifying the fraud schemes.
- There is an integrated data-platform for Medicaid and Medicare that offers increased security for healthcare data.
To read more about the Teradata’s IDR solution, please visit the following link http://bit.ly/2j2wRq3