Healthcare - proSkale

TRANSFORM YOUR HEALTHCARE PRACTICE WITH proSkale’s INNOVATIVE SOLUTIONS

With over two decades of experience in developing and integrating business, clinical, and IT solutions for public and private sector health organizations globally, proSkale helps clients anticipate challenges and achieve real transformation. Our focus is on renewing the user experience, deriving better health outcomes, and providing cost-effective results across the entire healthcare ecosystem. Our expertise covers a wide range of areas, ensuring comprehensive solutions that meet your specific needs.

Healthcare is in a transitional state. Changes in regulation, payment methods, medical research, new technology, and demographics have created uncertainty and turbulence.

One of the most significant challenges to employing analytics is the underlying data. Traditional Data Warehouses, MDM, and Data Governance approaches help but are not sufficient. Applications and data crisscross over multiple functions, creating a confusing network of connections, redundancies, gaps, and dependencies.

Better Outcomes

Increased Revenue

Lower Costs

Reduced Risk

More and more hospitals, doctors, insurance companies, pharmaceutical manufacturers, governments, and others in healthcare are using advanced healthcare analytics to achieve:

We recommend thinking in terms of Data Harmonization. It is a broader, function-focused approach to take data from many systems and align it with the functions of an organization.

Data Harmonization utilizes Data Warehouses, MDM, and Data Governance, but has the supporting function at the center – not which data element has primacy. Harmonized data enables Advanced Analytics and brings many benefits to Healthcare. Below are some examples of how Advanced Analytics can help Physicians, Hospital Systems, Health Insurance, and Government achieve their common goals:

Better Outcomes

Increased Revenue

Reduced Costs

Timely Care

The healthcare industry is undergoing a significant transformation driven by regulatory changes, evolving payment methods, advancements in medical research, new technologies, and shifting demographics. This transition period is marked by uncertainty and turbulence.

One of the major challenges in leveraging advanced analytics is the complexity of the underlying data. While traditional data warehouses, master data management (MDM), and data governance frameworks provide some support, they are often insufficient. Healthcare data spans multiple functions and systems, creating a complex web of connections, redundancies, gaps, and dependencies that complicate effective data analysis.

Healthcare is rapidly evolving with new technologies, patient care methods, and operational efficiencies. Our additional solutions address these needs, ensuring your practice remains innovative and effective.

Overcoming data integration and interoperability challenges is crucial. Traditional systems often operate in silos, hindering efficient information exchange. Our solutions break down these barriers, ensuring seamless data flow and enabling superior patient care and optimized operations.

Ready to revolutionize your healthcare practice? Achieve better outcomes faster with insights from proSkale's experts.

Emergency Room Visits

The limited availability and high cost of maintaining Emergency Room (ER) facilities are under incredible scrutiny by payers, government, providers, and employers. According to the CDC, in 2014 Americans made 136 million ER visits. According to a study published in the American Journal of Managed Care – more than 30% of ER visits were avoidable.

proSkale’s analytics team can help you collect the data from disparate data sources and implement the appropriate predictive model to reduce emergency visits. Analytics can lower costs of care, shorten wait times, and improve outcomes.

Readmission Reductions

There are several environmental factors (social, demographic, economic, behavioral, ethnic, etc.) that contribute to patient admission and/or readmission rates to a hospital. Delivery care (both inside and outside the hospital) has a significant influence on the continuity of care available to a patient, and the multitude of clinical decisions physicians make on an ongoing basis impact the care a patient receives. This interplay of factors influences both the clinical as well as social diagnosis (the environment a patient comes from before admission and goes to after discharge) has to be better understood if continuity of care is to be long-term focused and optimized.

proSkale’s readmission analytics team uses an integrated toolbox of policies, processes, and information to improve decisions related to patient outcomes.

Coordination of Benefits Identification

According to the Census, over 20% of the population has more than one health insurance plan in a year. Processing Coordination of Benefit (COB) claims is often incorrect due to incomplete information. Finding these individuals means reduced administrative work for Providers and potential cost recoveries for Health Plans.

proSkale’s sophisticated data mining techniques and scoring algorithms can identify people that have other healthcare coverages.

Early Chronic Health Detection

Chronic health conditions, such as heart disease, stroke, type 2 diabetes, cancer, and chronic lung diseases, account for 86% of total healthcare costs. Many of these conditions are preventable. Wellness programs are in place to encourage people to stay healthy.

proSkale analytics can enhance Wellness programs by identifying people that are at higher risk of acquiring a chronic health condition before it manifests itself. Intervention before the onset of conditions like diabetes can improve the life of people and contain costs.

Supply Waste Reduction

After staff, the second largest expense for Hospitals are supplies (about 17% of expenditures). Reducing supply chain costs and losses increases the profitability of the Hospital. proSkale can develop predictive models to improve ordering, reduce urgent orders, and cut losses due to expiration.

In addition, Analytics can indicate when a claim may have insufficient supply charges for a procedure and can be flagged for verification to ensure correct reimbursement.

Moneyball for Hospitals

72% of healthcare executives are concerned with staff shortages. A hospital that is short one physician loses about $1M in revenue per year.

proSkale’s analytics can use the history of encounters and current schedules, to better allocate resources, thus reducing gaps. Also by analyzing past encounters and associated workforce data, ideal combinations of teams can be identified that perform procedures more efficiently and with quality outcomes.

Pre-Authorization Automation

Delays in pre-authorizations by Health Plans can cause Member and Provider dissatisfaction. Pre-authorization can be accelerated by partially automating the analysis and decision-making process of a case.

proSkale will develop the models and rules engines to reduce the overall workload per case reviewer. In doing so, the same number of people can process more pre-authorizations and improve satisfaction.

Volume to Value

As commercial and government payers continue to reduce reimbursement rates, and shift to value rather than fee-for-service, Hospitals need to treat a larger volume of patients to break even.

proSkale recommends Hospitals should draw upon consumer engagement and retention analytic strategies that have been used in retail and other industries to attract and retain patients. Our experience will help you segment and attract patients and keep the ones you already have.

Transformative Healthcare Solutions for Your Practice.