Download PDF
Revolutionizing Healthcare Claim Denials: Advent Health Partners' 500% Productivity Lift
Technology Category
- Application Infrastructure & Middleware - Database Management & Storage
- Platform as a Service (PaaS) - Application Development Platforms
Applicable Industries
- Finance & Insurance
- Healthcare & Hospitals
Use Cases
- Time Sensitive Networking
- Usage-Based Insurance
Services
- Cloud Planning, Design & Implementation Services
The Challenge
Advent Health Partners, part of the Powered Health group, was facing a significant challenge due to rapid changes in healthcare regulations in the United States. The re-introduction of the Recovery Audit Contractor (RAC) program and the move to Electronic Medical Records (EMRs) had left many hospitals struggling to keep pace. This resulted in inefficiencies in the healthcare revenue cycle, with billions of dollars tied up in insurance claims denials. The situation was further complicated by the fact that hospital data, both structured and non-structured, was generally stored in siloes, with a lack of communication between different departments. Some processes were still heavily reliant on paper records. With claims-related data scattered across different locations and stored in multiple formats, it was very difficult for analysts to bring together all the information required to review a denied claim and decide whether there was a case for appealing the decision.
About The Customer
Advent Health Partners is part of the Powered Health group and is dedicated to driving maximum financial returns for healthcare providers. The company uses its CAVO technology to provide claims appeal services and coding corrections of denied claims, both as an outsourced service offering and as a standalone product. Advent was established to help healthcare and insurance providers optimize the claims appeal process, reviewing vast volumes of documents to determine the root causes of denials and identifying opportunities for process improvements.
The Solution
To address these challenges, Advent developed CAVO, a technology that integrates multiple sources of data, including paper documents, indexes them and simplifies access to disparate data related to a claim. At the heart of this revolutionary technology is IBM Cloudant, a NoSQL database platform built for unstructured data stored in the cloud. The platform’s impressive scalability makes it easy for Advent to manage growing data volumes. Advent has seamlessly integrated the Cloudant platform with the Apache Lucene indexing and search library, providing an easy-to-use search engine. This allows users to instantly develop a smart search for text for a particular claim, across all of a provider’s claims, or even across an entire health system, significantly accelerating information retrieval. The solution also complies with the Health Insurance Portability and Accountability Act (HIPAA), which sets the standard for protecting patient data.
Operational Impact
Quantitative Benefit
Related Case Studies.
Case Study
Hospital Inventory Management
The hospital supply chain team is responsible for ensuring that the right medical supplies are readily available to clinicians when and where needed, and to do so in the most efficient manner possible. However, many of the systems and processes in use at the cancer center for supply chain management were not best suited to support these goals. Barcoding technology, a commonly used method for inventory management of medical supplies, is labor intensive, time consuming, does not provide real-time visibility into inventory levels and can be prone to error. Consequently, the lack of accurate and real-time visibility into inventory levels across multiple supply rooms in multiple hospital facilities creates additional inefficiency in the system causing over-ordering, hoarding, and wasted supplies. Other sources of waste and cost were also identified as candidates for improvement. Existing systems and processes did not provide adequate security for high-cost inventory within the hospital, which was another driver of cost. A lack of visibility into expiration dates for supplies resulted in supplies being wasted due to past expiry dates. Storage of supplies was also a key consideration given the location of the cancer center’s facilities in a dense urban setting, where space is always at a premium. In order to address the challenges outlined above, the hospital sought a solution that would provide real-time inventory information with high levels of accuracy, reduce the level of manual effort required and enable data driven decision making to ensure that the right supplies were readily available to clinicians in the right location at the right time.
Case Study
Gas Pipeline Monitoring System for Hospitals
This system integrator focuses on providing centralized gas pipeline monitoring systems for hospitals. The service they provide makes it possible for hospitals to reduce both maintenance and labor costs. Since hospitals may not have an existing network suitable for this type of system, GPRS communication provides an easy and ready-to-use solution for remote, distributed monitoring systems System Requirements - GPRS communication - Seamless connection with SCADA software - Simple, front-end control capability - Expandable I/O channels - Combine AI, DI, and DO channels
Case Study
Driving Digital Transformations for Vitro Diagnostic Medical Devices
Diagnostic devices play a vital role in helping to improve healthcare delivery. In fact, an estimated 60 percent of the world’s medical decisions are made with support from in vitrodiagnostics (IVD) solutions, such as those provided by Roche Diagnostics, an industry leader. As the demand for medical diagnostic services grows rapidly in hospitals and clinics across China, so does the market for IVD solutions. In addition, the typically high cost of these diagnostic devices means that comprehensive post-sales services are needed. Wanteed to improve three portions of thr IVD:1. Remotely monitor and manage IVD devices as fixed assets.2. Optimizing device availability with predictive maintenance.3. Recommending the best IVD solution for a customer’s needs.
Case Study
HaemoCloud Global Blood Management System
1) Deliver a connected digital product system to protect and increase the differentiated value of Haemonetics blood and plasma solutions. 2) Improve patient outcomes by increasing the efficiency of blood supply flows. 3) Navigate and satisfy a complex web of global regulatory compliance requirements. 4) Reduce costly and labor-intensive maintenance procedures.
Case Study
Harnessing real-time data to give a holistic picture of patient health
Every day, vast quantities of data are collected about patients as they pass through health service organizations—from operational data such as treatment history and medications to physiological data captured by medical devices. The insights hidden within this treasure trove of data can be used to support more personalized treatments, more accurate diagnosis and more advanced preparative care. But since the information is generated faster than most organizations can consume it, unlocking the power of this big data can be a struggle. This type of predictive approach not only improves patient care—it also helps to reduce costs, because in the healthcare industry, prevention is almost always more cost-effective than treatment. However, collecting, analyzing and presenting these data-streams in a way that clinicians can easily understand can pose a significant technical challenge.