Driver: Increased number of patients seeking health insurance
Over the years, the number of people benefitting from various healthcare schemes has grown considerably. A couple of reasons contributing to the growth of the health insurance market include the rise in the aging population, growth in healthcare expenditure, and increased burden of diseases.
Restraint: Limitations in the data capturing process in Medicaid services
As per the US Department of Health and Human Services findings of 2018, national Medicaid data has shortcomings that could hinder the process of fraud detection in the public sector.
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Opportunity: Emergence of social media and its impact on the healthcare industry
The healthcare industry is changing at an incredible rate, and one of the major contributors to this change is the increasing popularity of healthcare communication through social media.
This vast network of healthcare influencers, leaders, patients, providers, organizations, and governmental entities creates a massive amount of healthcare data on a regular basis. This data, if segregated, segmented, and analyzed in a meaningful way, can offer incredible value for improving treatment efficiencies and health outcomes.
Challenge: Time-consuming deployment and the need for frequent upgrades
The deployment of fraud analytics solutions is a time-consuming process. The process involves creating user interfaces, new databases, and predictive models; evaluating and deploying models, and monitoring their effectiveness. In this process, data analysts continuously run algorithms until they get the most effective predictive model.
The market is segmented based on solution type, delivery model, application, and end user. Based on the solution type, the descriptive analytics segment accounted for the largest share of the market in 2019. Descriptive analytics forms the base for the effective application of predictive or prescriptive analytics. Hence, these analytics use the basics of descriptive analytics and integrate them with additional sources of data in order to produce meaningful insights.
The prominent players in Healthcare Fraud Analytics Market are IBM Corporation (US), Optum, Inc. (US), Cotiviti, Inc. (US), Change Healthcare (US), Fair Isaac Corporation (US), SAS Institute Inc. (US), EXLService Holdings, Inc. (US), Wipro Limited (India), Conduent, Incorporated (US), CGI Inc. (Canada), HCL Technologies Limited (India), Qlarant, Inc. (US), DXC Technology (US), Northrop Grumman Corporation (US), LexisNexis (US), Healthcare Fraud Shield (US), Sharecare, Inc. (US), FraudLens, Inc. (US), HMS Holding Corp. (US), Codoxo (US), H20.ai (US), Pondera Solutions, Inc. (US), FRISS (The Netherlands), Multiplan (US), FraudScope (US), and OSP Labs (US).