Decision Services International

Big Data

hbubert — Wed, 02 Nov 2011 16:06:22 +0000

This McKinsey piece shows the cost savings and revenue growth made possible by integrating systems and data across vendors and legacy systems. It’s a typical scenario for DSI. Most companies do not have the IT staff available to design, implement and host these complex and dynamic systems. But nearly every company of scale can benefit from tighter coupling to their supply chain, customers and end consumers.

$295mm in medicare fraud

hbubert — Thu, 08 Sep 2011 12:25:20 +0000

The Medicare Fraud Strikeforce has filed charges against physicians, nurses and data thieves that sold names of beneficiaries to those capable of filing for reimbursement. The sting operation spanned 8 cities. Still, the lack of a cohesive strategy to centralize state resident data leaves the door wide open to continued fraud. Medicaid and Medicare would benefit from studying the anti-virus approach on our workstations. They are all updated at least daily. That’s how quickly these threats shift over time. For more, see http://www.hhs.gov/news/press/2011pres/09/20110907c.html.

$23 Billion Lost to Medicare Fraud: A Solution

hsolomon — Tue, 19 Jul 2011 20:21:15 +0000

This enormous leak in our large and growing Medicare program is a tough problem to solve. Many fraud detection programs have been in place for years and others are being rolled out now. Like the computer anti-virus sofware on your pc (and now Mac), fraud detection systems have to constantly expand and improve in order to keep up with the clever people who dedicate themselves to avoiding detection. All of these systems have the same premise, to reduce the fraud, waste and abuse in Medicare and Medicaid. One conspicuously absent element in the automation of fraud detection has been the Electronic Medical Record (EMR). For obvious privacy reasons, EMR data is not provided with every claim. However, when claims are flagged as potentially incorrect, medical record data is provided to the payer by the hospital or clinic. Usually that data comes as paper. Here is a new pilot program that will change the metaphor to EMR (to 3rd party auditors, not payers) with claims. This single step holds out great promise for reducing the fraud in our federal and hopefully soon, state, healthcare programs.

Detect Drunk Driving Without Breathalyzer

hbubert — Wed, 15 Jun 2011 14:42:53 +0000

Engineers at the University of Iowa used three techniques that rely on common automobile sensors to determine if a driver’s ability had deteriorated as it will when the driver is drunk.

– lane keeping and speed measurements
– they debriefed police officers to understand what cues they used in spotting drunk drivers (sounds like case based reasoning)
– a data classification technique called Support Vector Machnies

In it’s current state, the project needs 8 minutes of driving data to detect blood alcohol levels above .08% with accuracy between 73% and 86% – similar to field alcohol testing results.

Algorithms that are tailored to the individual will perform better but the one size fits all is already showing promise.

Helping Your People

hbubert — Thu, 21 Apr 2011 13:51:56 +0000

The Financial Times has an excellent article showing examples of the use of analytics in personnel issues. The opportunity is to optimize the application of the right people for the project. The cost of a failure to do so is over-staffing or task saturating your best people and causing them to perform under their potential. This data lives in ERP, CRM, HR and other enterprise systems and must be coalesced into one normalized database to keep pace with the changing characteristics of the workforce and demands of the customers.

Collaboration Trumps Fraud

hbubert — Thu, 20 Jan 2011 19:57:51 +0000

Medi-Cal, the state owned medical benefits provider, has a $60 billion annual fraud problem. Medicaid, as it’s called in most states has a similarly huge problem. Dr.’s submit fraudulent claims for procedures that are not performed on patients that do not exist. Medi-Cal pays as do the tax payers of the state.

Nigeria, pharma agents sell supplies to retailers and collect payments. Then they ‘skip’ without paying their pharma wholesalers. The same agent who just ‘skipped’ on one pharma wholesaler, moves on to the next unsuspecting wholesaler and repeats the same fraud.

What do these problems have in common? Both rely on data NOT being shared by entities that can and should collaborate to solve the expensive problem.

In Medi-Cals case, it would be fairly straightforward to use data housed by the state to verify that a physician’s office has the number of employees needed to perform the procedures claimed. In Nigeria, a list of agents should be contributed to a common database by each pharma, using biometrics to uniquely identify each agent. Biometrics work well in cases, like Nigeria, where the country lacks a national-id. Any agent who is about to be shipped, will be screened against the database for owing a wholesaler.

Frauds will find ways around fraud detection. The battle is never ‘won’ but is continuously waged with creativity and speed as the primary weapons. In some cases, innovative business models, such as industry associations as fraud system host may be required. In others, a contingency fee based on success.

There are big dollars to be saved and the health of millions depending on a victory. Let’s move quickly to put solutions in place.

Experian Adds RentBureau Rental Data to Credit Report

hsolomon — Tue, 04 Jan 2011 16:38:28 +0000

It’s been nearly 8 months since DSI sold RentBureau to Experian. In that time, Experian has been busy changing the landscape of credit reporting in a way that favors the under banked. As of December, Experian now reports RentBureau’s apartment rental data on all credit reports. This is a watershed event for the 50 mm under banked because 76.6% of under banked population rent according to http://www.fdic.gov/householdsurvey/full_report.pdf.

In all likelihood, an issuer of credit will pull an Experian report since Experian is the largest bureau. That means that a renter, who’s landlord reports to RentBureau, will not have to present paper proof of lease data and is moving closer to achieving interest rate parity with his homeowning equivalent. Of course the FICO and Advantage scores are not going to use this data because not all 3 bureaus have access to it. However, sophisticated lenders are building their own credit models. And manual verification of paper documents is becoming less, rather than more prevalent. Congratulations to Experian for making a big move quickly that benefits underbanked consumer.

See the blog post by one of our directors, Arjun Schutte http://blog.corevc.com/. Here is Experian’s release http://www.experian.com/rentbureau/rental-data.html.

VA Hopitals Outpace Private in Adherence to Care Methods

hbubert — Thu, 11 Nov 2010 20:48:43 +0000

On this veterans day, when we take time to appreciate the sacrifice of our men and woman in uniform, it’s comforting to know they are getting well managed care. In the November Journal Medical Care, a study by the VA, Brown University, the University of California – Los Angeles and the research institution RAND found that the VA outperformed private hospitals in care discipline because of:

* Adoption of electronic health records and other health IT tools;
* Disease management practices;
* Integration of health care settings; and
* Use of performance metrics.

The next step in this research needs to include an investigation regarding the efficiences gained/lost in prescriptions, diagnostics and procedures.

Atlanta, GA is US Financial Services Headquarters

hsolomon — Tue, 09 Nov 2010 16:30:00 +0000

The Technology Association of Georgia spawned FINTECH, a society that gathers the leaders in financial data services, 18 months ago. Their first awards banquet, honoring Jimmy Blanchard, Synovus’ former Chair, was held yesterday. It was obvious from the crowd, speakers and sponsors that Atlanta has a great base of people, companies and customers for our financial services industry. Some of the interesting speakers were Jane Larimer, EVP, ACH Network Administration & General Counsel, Jeff Baker, Chief Development Officer, Global Payments, Jon Ziglar, SVP, Strategic Planning & Enterprise Development, Elavo and Paul Todd, EVP-Mergers, Acquisitions & Strategy, TSYS. Here’s a map of some of the financial information and services companies located here. The color legend identifies their vertical.

Financial Services in Atlanta - source TAG FINTECH

Poverty, Microfinance clash in India

hsolomon — Thu, 04 Nov 2010 15:43:31 +0000

India has clamped down on lending in the microfinance sector in Andhra Pradesh. A host of factors lead to this government intervention in the private sector but the main reason for the strong measures against the MFI’s were the suicides of borrowers. India policy makers have reacted by expressing the importance of ensuring that over-indebtedness must be controlled. The remedy is already under way. Several credit bureaus have operations in India including Cibil (TransUnion/D&B), Equifax, Experian and the newest entrant focused on and partially owned by MFI’s, Highmark. Once these bureaus start collecting positive payment data and lenders start using it to score loan applicants, over-indebtedness will fade as a systemic risk.

This excellent post from Elizabeth Rhyne explains the various issues India’s government and financial market players face in continuing to serve the financial needs of the vast market of the poor. According to the World Bank, 41% of India’s population is living on less than $1.25 per day, making India home to the largest number of impoverished people. There is hope. Micro-finance has attracted investment in India despite continuing bureaucratic hurdles to placing capital in India and repatriating gains. The health of the population, urban development and economic activity are all improving according to the World Bank.