Case Study: Discovery Health improves predictive risk management with Presidion

Predictive Analytics Used To Craft Preventive Programs That Keep Members Healthier and Costs Lower

Discovery Health, South Africa’s largest healthcare insurance provider, needed a better way to refine clinical risk management, tap new data sources, and identify health risks proactively to maintain its cost advantage. The company turned to Presidion and an analytics-based predictive risk management solution to improve its ability to target preventive programs and control care costs.

Presidion implemented a predictive analytics solution using IBM SPSS tools and IBM PureData System for Analytics to extract insights from clinical, demographic, billing, and unstructured member data. The result cut predictive model run times by more than 99%, from nearly a day to minutes, improved risk-model accuracy, helped Discovery Health better target at-risk members, and enabled recovery of more than USD 25 million from fraudulent claims and billing errors.

Discovery Health

Matthew Zylstra

Risk Intelligence Technical Development