Care Gap Analysis

A growing population creates greater demand for healthcare - in particular an increased use of emergency treatment - putting enormous pressures on emergency healthcare providers.  The US spends $650 billion more on healthcare than other developed nations, with an estimated $91 billion of that wasted because of system inefficiencies.

Why does identifying care gaps matter?

With emergency treatment typically costing up to 40 per cent more than non-emergency treatment, and around an estimated fifty per cent of emergency room visits being avoidable, there are strong benefits to both patient and healthcare providers to identify where healthcare ‘gaps’ are occurring and step in before the need for emergency treatment arises.

Our Clients

Fuzzy Logix has worked with two health insurance providers - Anthem and Blue Cross Blue Shield Tennessee (BCBS TN) who both wanted to improve their customer’s access to appropriate healthcare and reduce the cost of unnecessary emergency treatment.

Anthem's Rules Engine

For Anthem Fuzzy Logix used high-performance analytics to create a rules engine that can identify possible care gaps in treating conditions before they reach an advanced stage. Results from the rules engine are used to allow timely outreach and communication with patients, allowing for subsequent non-emergency treatment.

  • Facilitate appropriate & timely care
  • Ensure preventative services are made accessible
  • Avoid complications & hospitalizations
BCBS TN Geospatial Analytics

For BCBS TN we applied a geospatial approach to care by measuring the relative distance and density of doctors and healthcare facilities to each individual member.

Our advanced analytics models allowed them to:

  • Identify healthcare ‘deserts’
  • Identify vulnerabilities to crisis
  • Predict utilization inefficiencies
  • Target outreach that recognizes access problems but only when relevant to a member
Challenges and Results

In both cases the challenge lay in the volume of data and computationally heavy nature of the analytics required. Fuzzy Logix in-database approach to analytics typically achieves 10-100x faster results than conventional methods.

Results for Anthem

For Anthem we were able to deliver new analytic capabilities & performance that were simply not possible on traditional multi-tier analytics platforms, resulting in:

  • A 1000x Performance Jump - Overall execution time for the largest Rule Sets (2300+ rules) reduced from 22 days to 27 hours
  • Reduced IT System Cost for the largest Rule Sets (2300+ rules) reduced from 22 days to 27 hours
  • Reduced IT System Cost –Multi server (hardware/software) SQL server environment replaced by a single IBM Netezza (PureData) Striper database with full data volume
    • Savings & Better Care –Customer was able to substantially reduce cost due to the number of emergency cases. This also meant better care for the patients.
Results for BCBS TN

In the case of BCBS TN we were able to process more than 500,000 records with more than 200 predictors testing in less than 3 minutes. The subsequent time and resource savings resulted in significant cost savings as well as improved patient care.

All of these contributed to a significant bottom-line financial benefit to both our clients.

Improving healthcare with care gap analysis