Long Term Care

Predictive analytics offers several opportunities to Long Term Care Providers. The most significant are:

  • Predicting claim costs
  • Assistance in managing claims
  • Underwriting and pricing
  • Fraud and abuse detection

Predicting Claim Costs

Long Term Care costs depend on many factors, including the unique characteristics of each claimant, the claim stage and prior claim experience. A predictive model can allow for all these factors to give much increased accuracy in the estimate of future claim costs.

Assistance in Managing Claims

Our Claim Opportunity reports identify claims that would benefit from further investigation. This may result in directly reducing costs or review of the care plan.

Pricing

A predictive model can include more factors in its morbidity calculations than traditional methods can manage. Furthermore, predictive modeling offers advantages in quantifying the inter-relationships between factors. The result is a more accurate measure of risk, leading to a more accurate underwriting assessment and pricing opportunities.

Fraud and Abuse Detection

Provider fraud and abuse is an area many insurers can save a significant amount of money. Our provider fraud models identify fraudulent provider activities that were not known in the past as they are trained to identify service providers with atypical treatment practices. This approach will result in more false positives, however by identifying those providers whose costs and experience differ from their peer group can be very successful at uncovering fraudulent and abusive providers and uncovering unknown and novel schemes.

Claim fraud largely relies on individual investigation. We can simplify this by flagging suspicious claims by using a predictive model trained to identify atypical claim activity.