改变生活的分析，抓住掠夺性药店
公司规模
Mid-size Company
地区
- America
国家
- United States
产品
- Alteryx
技术栈
- SQL
- SOAP API
实施规模
- Enterprise-wide Deployment
影响指标
- Cost Savings
- Productivity Improvements
技术
- 分析与建模 - 大数据分析
适用行业
- 医疗保健和医院
适用功能
- 采购
用例
- 欺诈识别
- 质量预测分析
服务
- 数据科学服务
关于客户
SCAN 是一家服务于加利福尼亚州的非营利性 Medicare Advantage 组织。该组织服务于大约 200,000 名会员，主要分布在南加州地区。Medicare 和 Medicaid 中心要求健康计划必须有欺诈、浪费和滥用计划。SCAN 通过特别调查组实现这一目标。该组负责调查可能对会员或计划产生不利财务或合规影响的指控。该团队负责识别和解决可能损害组织或其会员的问题。
挑战
2017 年初，为加州服务的非营利组织 Medicare Advantage 组织 SCAN 开始收到会员的举报，称他们通过邮件收到了不想要的利多卡因软膏。这种骗局在 2015 年开始影响该行业，但尚未对 SCAN 造成重大影响。挑战在于找出这种骗局的来源，并阻止其进一步影响会员和组织的经济状况。SCAN 的特别调查组负责调查这些可能对会员或计划产生不利财务或合规影响的指控。该团队必须弄清楚一名会员在多家药店接受服务的可能性、数十名会员在加州以外去同一家药店的可能性、每位患者获得同样高质量的药的可能性以及多家药店共享同一地址的可能性。
解决方案
SCAN 特别调查组使用数据分析平台 Alteryx 调查这些指控。该团队使用 Alteryx 中的网络分析工具来识别异常行为并确定资源和调查的优先级。该工具帮助他们直观地了解正常行为与异常行为，并确定更多具有类似做法的药房。该团队还使用 Alteryx 每周监控 1,000 名受影响会员的处方，以了解新药房的相同配药模式并根据新方案进行调整。他们还使用 Alteryx 进行空间分析，绘制潜在寻求药物的会员和从外地接受处方或服务的会员的距离和驾驶时间。他们还与第三方数据源集成，从监管机构检索数据。
运营影响
数量效益
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