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Making a Big Impact with Big Data: Analytics Applications in Health Care Presented by: Jeremy Clopton, CPA, CFE, ACDA, CIDA Director – Big Data & Analytics, Digital Forensics
Success in Applying Analytics = Becoming an Insight-Driven Organization
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Today’s Topics Building a Foundation Emerging Technologies Applications in Health Care Analytics Framework Closing Thoughts
Building a Foundation
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Definition of Big Data:
Lots of option – pick your favorite.
More important: You have data (lots of it) and need to be using it.
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Definition of Analytics: …analysis methods designed to extract useful information for answering strategic questions...
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But wait, there’s more!
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Data Universe Created in Last 2 Years - 90%
Total Information Awareness
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Data Volumes are Increasing
Source: https://nsa.gov1.info/utah-data-center/udc-photo.html
What are you doing to harness | leverage | capture | use your data?
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Emerging Technologies
Tools
Standard Analysis (Excel, Access) Data Analytics (ACL, IDEA, Arbutus) Data Visualization (Tableau, Analysts’ Notebook) Artificial Intelligence (Machine Learning, Social Media, Sentiment)
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Structured Data Analytics
Visual Analytics
Techniques
Unstructured Data Analytics
Relationship Mapping
New & Developing Technologies • Textual Analytics • Machine learning Supervised Unsupervised
• Advanced analytics Regression Predictive
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Network Relationship Mapping Emotion Detection
Named Entity Extraction
Textual Analytics Social Media Extraction
Predictive Coding Topic Mapping
Machine Learning
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Machine Learning • Supervised Give examples and answers, machine finds more like it.
• Unsupervised Give data, machine finds the patterns, and applies its own rules.
Machine Learning: Clustering
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Advanced Analytics: Outlier Detection
Advanced Analytics: Logistic Regression
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Advanced Analytics: Correlation
How are you applying emerging technologies to everyday problems?
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Applications in Health Care
Application ideas to become insight-driven.
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Profitability Analysis
Business Problem • Hospital guarantees revenue to specialty practice Procedure A = $42 Procedure B = $52 Procedure C = $75
• Over time, percent of guarantee by hospital increases • What is the cause? Option 1: Poor collection efforts/collections Option 2: Change in payor mix
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Payment Percentages by Payor Legend Blue = payor group 1 Red = payor group 2
Payor Mix Trend Legend Blue = payor group 1 Red = payor group 2
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What led to the problem?
Payment Reform
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Success in payment reform requires insights into performance metrics.
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$40,000
160
$35,000
140
$30,000
120
$25,000
100
$20,000
80
$15,000
60
$10,000
40
$5,000
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Patient Volume by Age
Medicare’s Episode Payments
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0
$0 0-60
61-65
66-70
71-75
76-80
81-85
85-90
91-95
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Fraud Risk Management
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The Fraud Triangle Perceived pressure facing individual
Perceived opportunity to commit fraud
Fraud Person’s rationalization or integrity
Emotions: Tone Detection and Sentiment
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Emotions: Tone Detection and Sentiment Anger Frustration Anxiety/Nervous Tension Vague/evasive Conspiratorial Sadness Intimacy
Positive Negative
Fraud Example
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Reputational Risk Management
Reputational Risk Management Objectives: • Identify issues & respond before they become crises • Proactive approach Approach: • Monitor trends & changes in patterns
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Reputational Risk Monitoring - Metrics • Overall sentiment trend
• Nature of activity
• Key emotional drivers
• Location of activity & influencers
• Influencers • Influencer relationships • Proliferation of activity
When
Where
What
Who
Why
Reputation Data
How
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Application Framework
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The Three V’s for Identifying Opportunities 1. Viable The problem is suited to the available tools
2. Valuable Is it worth doing?
3. Vital Technology is key to success
Strategic Question
Procedures
Analyze
Objectives
Data
Manage
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Procedure Development
Ad Hoc Individual Automated Individual Automated Groups Continuous Analytics
Closing Thoughts for the Day
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What’s the Focus? • Not designed as intrusion of privacy • Not reading everyone’s email • Looking for signals • Patterns are key
Challenges to Overcome • Policies around data ownership & use • Legal implications • Ethical considerations
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New Mindset • Communications are used to transact business • Corporates assets are used to transact business • Transacting business = business transaction
THANK YOU! FOR MORE INFORMATION Jeremy Clopton, CPA, CFE, ACDA, CIDA Director | BKD, LLP Practice Leader – Big Data & Analytics, Digital Forensics E: W: T: L:
[email protected] http://bkd.com/bigdata @JeremyClopton http://www.linkedin.com/in/jeremyclopton
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