Achieving Program Integrity For Health Care Cost Containment Operations

This whitepaper, “Achieving Program Integrity for Health Care Cost Containment Operations,” by SAS, addresses the critical challenges faced by the healthcare industry in controlling escalating costs, primarily driven by fraud, waste, abuse, and corruption. It is aimed at healthcare payers, government agencies, and organizations responsible for healthcare program integrity, offering a compelling argument for transforming cost containment through advanced analytics. The document highlights the massive financial losses incurred globally due to these integrity breaches and their detrimental impact on quality of care, access, and public trust. Download this insightful whitepaper to discover how a comprehensive

The paper advocates for a platform-based approach to program integrity, emphasizing the need for a comprehensive advanced analytic infrastructure. It details key components such as intelligent data management, advanced analytics (including AI), data investigation and reporting, automation, surveillance, alert creation, action and decision support, and outcome analysis. By showcasing the SAS® Fraud Framework, the whitepaper demonstrates how integrating these capabilities can empower healthcare payers to proactively detect and prevent fraud, minimize waste, and optimize cost-efficiency, ultimately leading to improved health outcomes and financial stability.