Healthcare

Healthcare Analytics

Ankura’s healthcare analytics strategy in addressing big, small, disparate, and complex data matters revolves around a proven and innovative industry-specific solution framework. Our analytics capabilities effectively utilize the ever-increasing, robust structured and unstructured data sets available to providers, payers, and life sciences companies. Our deep knowledge of healthcare organizations’ ERP, financial, CRM, EMR, billing, claims, and eligibility systems, coupled with operational experience in how these systems are used throughout an organization, create a unique blend of expertise that is firmly rooted in the real world. Ankura consultants uncover genuine insights used to improve engagement outcomes, create a competitive advantage, improve operational performance, and ultimately, quality of patient care.

Our healthcare analytics team has nearly two decades of experience working with providers, payers, and life sciences companies to analyze and resolve unique challenges they face. Our approach aligns healthcare industry subject-matter expertise with best of breed technology and analysis techniques obtained through our team’s collective and deep engagement experience optimizing data processes and analyzing billions of medical charges, insurance claims, and pharmaceutical supply chain transactions.

Ankura’s experience in successfully handling clinical, financial, and operational analytics matters, in a wide array of situations, demonstrates our proven capabilities in creating innovative data-driven insights and solutions that are key to decision-making and value creation across the healthcare system.

We provide the following solutions to our clients:

  • Strategic, Operational, and Performance Improvement
    • Develop strategies, manage goal setting and monitor performance of analytics-driven initiatives across key service lines and functional areas (e.g., financial decision support, clinical, population health, revenue cycle, supply chain, and labor productivity)
    • Perform cost-benefit analyses and labor analytics, including benchmarking, identifying span of control, analyzing on call, call-back, and overtime utilization as well as staffing to demand, shift schedule optimization, and in-house/outsourcing evaluations
    • Create data analytics to evaluate non-labor spend through automated vendor normalizations, spend categorizations, benchmark comparisons, and GPO/contract optimization
    • Assist clients in evaluating cost and clinical quality of “like-kind” products through a structured Value Analysis (VA) program including onsite “table-top” reviews with clinicians and physicians
    • Assist with design and formation of clinically-integrated physician networks with a focus in coordinating the selection of key drivers, physician quality metrics, and population health initiatives across physicians and specialties
    • Conduct peer group cost per case analysis based on the top diagnosis-related groups (DRGs) to identify “at-risk” population
  • Managed Care Contracting and Value-Based Reimbursement
    • Analyze key terms and conditions in value-based contracts with the greatest potential for revenue improvement, based on volume and contracted rates relative to local Medicare and/or Medicaid rates
    • Assist clients with better management of risk arrangements with payers through the development of claims analytics, financial modeling, and performance reporting
    • Provide managed care contracting negotiation support to provider clients by modeling the financial impact of each set of proposed rates from the payer during the contract negotiation process
    • Develop approaches to addressing performance outliers and physician engagement
  • Due Diligence and IT Systems Review
    • For pre-merger due diligence, conduct managed care “black box” analyses, modeling each organization’s managed care contract rates on historical utilization data to project financial impact (representative clients: large hospital systems, ASCs and Hospitals, large anesthesiology groups)
    • Manage IT due diligence and management analytics matters for private equity clients and their portfolio companies, including in-depth technical reviews and due diligence of IT organization, architecture, infrastructure, and customer relationship management platforms
    • Generate key performance indicator mappings from revenue, cost, and other operational metrics leveraging the company’s existing workflows and databases to determine viability of the healthcare venture
    • Sell side and buy side benchmarking of physician billing patterns to national and regional averages
    • Development of risk focused billing behavior patterns and profiles
  • Advanced Analytics and Business Intelligence
    • Develop financial cost-benefit analysis models and predict return on investment based on a series of variable user inputs for performing provider systems associated with reform incentive payment programs
    • Develop interactive data visualization models for managing labor productivity (e.g., in imaging, laboratory, and emergency room departments)
    • Support the standardization of physician preference items (PPI) through BI/data visualization dashboards at multiple hospitals and health systems. facilitating discussions and process improvement opportunities in minimizing waste and optimizing pricing in specialties such as cardiology, trauma, and orthopedics
    • Design, develop and implement self-service dashboards and visualizations to replace manual daily, weekly, and monthly reporting
  • Government Programs and Contract Compliance
    • Conduct audits and mock-audits of Medicare and Medicaid program compliance in the areas of Medicare Part C and D program measures, data validation audits and/or information systems capabilities assessments on behalf of plan sponsors and pharmacy benefit manager (PBM) clients
    • Creation of risk-scored continuous monitoring analytics and tools (e.g., to monitor health care providers (HCPs) interactions with pharmaceutical manufacturers) that highlight potential Anti-Kickback Statute exposure that improve compliance effectiveness and empower audit teams
    • Review and analyze key accounts to ensure pricing discounts and rebates were applied based on purchasing volume and tiers including the development of data models and programming logic for transactional testing to evaluate compliance against various contract terms and conditions (e.g., generic prescription minimum purchases, brand purchasing volume, formulary and pass-through rebates, admin fees, etc.)
    • Analysis of billing patterns and compliance risks
    • Medical record review focused on coding accuracy and medical necessity of procedures
    • Review of provider compliance policies and processes
    • Medicare Risk Adjustment data analytics including the development and implementation of analyses to assess risk adjustment coding risk including the impact of different chart review methodologies, FFS versus managed care coding, and comparison of coding results across third party vendors with internal sources of data such as claims, encounters, and RAPs data received from providers
    • Development and implementation of risk-scored monitoring analytics and tools based on specific metrics related to risk adjustment provider oversight and provided tools for the visualization and drill down of the results for health plans
  • Investigations and Disputes
    • Determine liability and calculate damages across an array of disputes including provider versus payer, systematic government underpayment, as well as fraud and misconduct matters
    • Support outside counsel through privileged analysis of disparate data sources to identify, quantify, and remediate alleged improper payments in response to government whistleblower investigations
    • Assist counsel analyze physician and hospital performance and reimbursement in litigation or drug pricing disputes associated with best price and most favored nation clauses