Case Study: Healthcare
How we do it
With a thriving partnership started in Workers’ Compensation accounts receivable (A/R), the client increasingly called upon Sagility to deliver tasks that positively impacted bottom-line savings and efficiencies. A great example of this work has been meeting the client’s significant challenges with collecting outstanding claims from payers. The client knew of Sagility’s success deploying analytics-as-a-service propensity models to drive end-to-end lifecycle efficiencies, for providers and payers alike. Sagility conducted a deep dive of the client’s challenges to develop a model that presented insights about propensity to pay for claims, targeting a better work process, payer focus, and faster turnaround time.
Sagility’s predictive model estimated and ranked payment collection likelihood by claim and payer, aiming to:
- Improve the rate of collection by guided focus based on claim attributes.
- Save effort and time spent on the overall collection process.
- Increase the amount collected and speed of recovery by prioritizing high-value and high-propensity claims.
Sagility extracted multiple features from various sources/tables to create the predictive model. Model features addressed claims characteristics such as patient demographics and payer detail, service providers within the hospital, payer payment and transaction detail, claim duration, and follow-up duration, and detailed denial information from HIPAA 835 files.
Before Sagility’s deployment of this model, the client was collecting approximately 11-15% of payments on a monthly basis. Sagility now collects 15-20% of funds owed to the provider on a monthly basis as a result of using this model. The additional gain comes from reduction of days sales outstanding (DSO) for those claims with higher collection opportunity. The faster turnaround time and decreased claims loss ratio have resulted in an enhanced 30-day collection rate. Due to increased cash and faster collections, the client views Sagility as a provider of real outcomes.
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The way forward
As a result of faster collections from the Sagility’s propensity-to-pay approach, the client is now rolling this Sagility proprietary model out to two other internal provider systems within the client network. With this analytics-as-a-service showcase model, Sagility has achieved a true trusted partner status.