Seeking to help healthcare providers improve cash flow and reduce claims denials, GE Healthcare and Accenture are combining on an effort to apply Big Data to medical claims management. Specifically, Accenture will bundle services with GE Healthcare’s DenialsIQ analytics engine.
The companies announced their collaboration Thursday in Phoenix at GE Healthcare’s annual software users’ conference. It is the first healthcare manifestation of a strategic alliance in Big Data that Accenture entered into with General Electric at the corporate level in 2013.
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According to Jon Zimmerman, vice president and general manager of GE Healthcare’s IT Clinical Business Solutions division, DenialsIQ serves three purposes:
- It combs claims history, looking for patterns of denial. “Denial codes from the payers are not always informative. They’re difficult to understand and interpret,” Zimmerman said.
- It explains the patterns in plan English. Zimmerman said one customer told him, “We would spend 90 percent of the time discovering the cause and 10 percent fixing it.” Now, the percentages are reversed.
- It identifies what to do next. Zimmerman said he believes GE Healthcare is on a path to create a “self-healing revenue cycle.” It’s not a reality yet, but it’s coming.
After seeing DenialsIQ, Accenture said, ‘Wow, a lot of places could use this capability,'” Zimmerman according to Zimmerman, and a collaboration was born. Accenture brings its big customer base to the partnership, as well as expertise in what Zimmerman called ways to “productize” a service.”
Accenture has said that it costs about $25 to reprocess each denied claim, and denials account for one in five of every medical claim submitted to a payer in the U.S. GE Healthcare estimated that the combination of DenialsIQ technology and Accenture consulting services could help providers cut those reprocessing costs by 25-50 percent.
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“We see the challenges providers face with the medical claims process. We are pivoting to the new by combining our capabilities to bolster the use of analytics in driving financial performance and provide health systems with actionable insights to reduce claims denials,” Matthew Collier, managing director for health in Accenture’s strategy division, said in joint press release.
In creating DenialsIQ, GE Healthcare borrowed an algorithm from sister company GE Aviation. “Then we wrapped more information technology around it to make it more understandable,” Zimmerman said.
GE launched the product at the 2015 HIMSS conference. Then, we listed DenialsIQ among our “half-baked ideas at HIMSS 2015 that could become future healthcare game-changers.” Clearly, GE believes that product’s time is now.
As MedCity News founder Chris Seper wrote then:
GE Healthcare IT President and CEO Jan de Witte gushed over DenialsIQ in an interview with me. He praised it well above all other GE Healthcare products debuted at HIMSS and on multiple occasions called it a “beautiful application.”
de Witte is clearly proud of DenialsIQ. It was the best use of data to dig into the “unsexy” parts of medicine – back end and financial processes – that I saw at HIMSS.
DenialsIQ takes the data used to review denied claims to finds patterns and determins why they’re denied in order to fix that problem. It goes beyond that, though, and with a touch of Minority Report it can begin to pinpoint when an insurance claim is on a path to being denied and stop it before it happens.
Photo: Chris Seper
