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Software for Healthcare Service Providers

It is of vital importance to healthcare providers´ bottom-line to identify and segment candidates for medical assistance based upon their financial responsibility, using criteria established by Charity Policy. This segmentation procedure is required to provide services with efficiency and sensitivity to the patient´s needs, both medically and financially.

It is extremely difficult to perform the segmentation without specialized medical software able to consider and interrelate different diagnoses, different social groups, different patients´ needs, and many other manifold parameters specified in patients´ questionnaires. This situation worsens as the world faces the financial crisis and old assessment methods used in healthcare sector become inaccurate, as well as it is under the influence of subjective sentiments and stereotypes. All these factors lead to lost revenue.

Of course, for ethical reasons and in accordance with Medicaid eligibility, healthcare providers must render first medical aid and health care services to all groups of patients not depending on their financial responsibility. However, in order to improve collection rates, increase Medicaid revenue, reduce bad debt, agency fees and other expenses, it is extremely important to correctly identify the best way to render health care services of high quality from financial, legal and logistical standpoints. Thus, health care providers need adjustable decision support tools powered by proven Artificial Intelligence (AI) methods to avoid wrong segmentation and medical errors, and increase bottom line.

Alyuda uses its extensive experience in AI to create tailored solution for health care service providers. These solutions enable healthcare providers to intelligently segment and prioritize patients, including both patients that have no third party payer (no insurance) and patient that have a third party payer and are responsible only for the remainder of the charges. By analyzing financial and credit data combined with detailed historical patient information, Alyuda medical decision-support software enables healthcare providers to understand the financial responsibility of each patient, segment out patients that qualify for charity and ensure that Medicaid eligibility is never missed. With Alyuda medical decision-support software, healthcare providers may consistently see measureable improvements due to the ability to:

  • Establish robust patient solvency metrics and scorecards;
  • Identify key factors that impact on the solvency of patients;
  • Create models of solvency and evaluate each patient using fully automated capabilities;
  • Define decision policy or charity policy rules using visual decision flow tools (no IT department required to change or amend rules);
  • Analyze patients and segment them according to different criteria, based on collection risk and "propensity to pay";
  • Identify low income patients that qualify for charity care or financial assistance;
  • Make a decision on the priority of patients and the kind of their treatment.

The Alyuda medical decision-support software can be used with equal efficiency as middleware between different Health Care solutions or as a standalone application. In the latter case, the solvency models created with Alyuda medical decision-support software can be easily integrated with any software supplied by other vendors owing to specialized Application Programming Interface (API) and Data Gateways.

Practical efficiency of Alyuda medical decision-support software is proven by many well-known Health Care Providers, who was able to achieve exceptional results by using just Alyuda software. Among Alyuda successful customers you can find Walter Reed Army Medical Center, Medtopia and many others.

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