IDNames

Insufficient provider data and
identity variations creates havoc
across the healthcare industry

INDUSTRY OVERVIEW

Healthcare organizations aspire to capture, analyze and maximize the data within their systems to create business value. The market is crowded with companies that advertise the ability to do this by slicing and dicing data from every perspective. The Healthcare sector processed over $3 trillion in reimbursements last year with an estimated $1 trillion in waste, fraud and abuse. The sheer magnitude of this problem brings a crushing burden to the healthcare industry. IDNames helps in targeting this market opportunity with its precision data foundation of linked entities.

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IDNames Network Directed Healthcare

IDNames.Services can incorporate any number of provider networks and then masters each network creating the ability to model any network by geography, provider type, specialty and performance measures. Develop condition specific networks targeted for a patient’s holistic care; i.e. Diabetes, Breast Cancer, MSK. Extract provider categories from networks and insert specialized carve-out networks; i.e. mental health, radiology, dental, pharmacy, orthopedic to support improved patient compliance with lower costs.

Profiles to Understand Patient & Provider Behaviors

The IDNames Precision Data and Analytics Workstation supports the identification of healthcare insights through a user-friendly highly configurable front-end web browser. If prescription claims are loaded, the IDNames can produce a performance profile of every pharmacy and prescriber associated with a pharmacy and a healthcare profile for every patient who submitted a claim. Patient and attending physician real-time alerts to needed actions and related opportunities optimize the care journey.

Fraud, Waste & Abuse

The misuse of drugs through fraud, waste and abuse impacts all participants including patients, prescribers, pharmacies, hospitals, health plans and PBMs. IDNames has individuals, prescribers, pharmacies and their addresses, etc; and when combined with prescription details the scope of the possible analytics is almost limitless. For example, with IDNames verified addresses including rooftop latitude and longitude, there is the opportunity for extensive geographic analysis. IDNames is able to generate provider, patient, drug and claims profiles by state and metropolitan area and can reveal drug seeking behaviors by identifying unusually far distances traveled to multiple sites of care. Using these baseline profiles, the dispensing/consumption habits for brand/generic drugs by age group, therapies, conditions, etc can be computed and applied to all participants. Just a few of the many analytic opportunity areas are identified in the diagram below.

IDNames.Services Data Sources

The IDNames Precision Data and Analytics Workstation supports the identification of healthcare insights through a user-friendly highly configurable front-end web browser. If prescription claims are loaded, the IDNames can produce a performance profile of every pharmacy and prescriber associated with a pharmacy and a healthcare profile for every patient who submitted a claim. Patient and attending physician real-time alerts to needed actions and related opportunities optimize the care journey.

Number of SourcesNumber of RecordsUpdated
CMS ProvidersOne source with 5+ years of history recorded~6M NPIsWeekly and Monthly
Organizations and Related Individuals~35~20M Organizations ~100M IndividualsMonthly and Quarterly
US Population~100~300MMonthly and Quarterly
Additional Population Sources~14~430MMonthly