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Analytics gives HCSC the pulse of provider care

The not-for-profit health insurer is leveraging machine learning and predictive analytics to build provider networks that offer better health outcomes and higher cost efficiency.

Analytics platforms give HCSC the pulse of provider care
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Evaluating the cost efficiency and quality of care is a running challenge for health insurance companies — a challenge that is exacerbated by the myriad physicians, specialists, hospitals, and other providers a patient might visit regarding an issue. Health Care Service Corp. (HCSC), a not-for-profit health insurance company that serves nearly 15 million members in the U.S., is meeting that challenge with a combination of data analytics and machine learning.

"We want to help our providers improve their quality of care and cost of care by giving them access to the right levels of information, so they can compare their outcomes, their treatments, with other providers," explains Marv Richardson, senior vice president of application development at HCSC.

HCSC, with more than 22,000 employees, is the licensee of the Blue Cross and Blue Shield Association for five states: Illinois, Montana, New Mexico, Oklahoma, and Texas. To serve its members, it bundles together sets of providers in a geographic area. A given bundle might include hospital systems, physicians' groups, chiropractic and physical therapy providers, and so on.

"We wanted to be able to understand how well treatments were going in those groups, so we could assemble those networks in the best way for our customers," Richardson says.

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