Analytical Solutions to Common Healthcare Problems

Solving the Business Problems

In this module, you will explain why comparing healthcare providers with respect to quality can be beneficial, and what types of metrics and reporting mechanisms can drive quality improvement. You'll recognize the importance of making quality comparisons fairer with risk adjustment and be able to defend this methodology to healthcare providers by stating the importance of clinical and non-clinical adjustment variables, and the importance of high-quality data. You will distinguish the important conceptual steps of performing risk-adjustment; and be able to express the serious nature of medical errors within the US healthcare system, and communicate to stakeholders that reliable performance measures and associated interventions are available to help solve this tremendous problem. You will distinguish the traits that help categorize people into the small group of super-utilizers and summarize how this population can be identified and evaluated. You'll inform healthcare managers how healthcare fraud differs from other types of fraud by illustrating various schemes that fraudsters use to expropriate resources. You will discuss analytical methods that can be applied to healthcare data systems to identify potential fraud schemes.