Data Science & AI
AI-Driven Oncology Care Optimization for the Healthcare Industry
Industry: Healthcare
Location: USA
An enterprise-grade, AI-enabled oncology care optimization platform that streamlines the creation, validation, and cost modeling of cancer treatment regimens. Through integration with real-world payer data, clinical rule engines, and fee schedules, the platform enables providers and payers to align on value-based care models. It features end-to-end support for regimen permutation, real-time adherence tracking, and shared cost calculation via a Care Optimization Engine (COE), Opportunity Model, and Operational Monitoring System.
Challenges
- Fragmented clinical workflows with inconsistent regimen logic across providers
- Manual regimen and cost modeling processes were time-consuming and error-prone
- Inability to trace regimen-to-cost impact for bundled payment or shared savings contracts
- Lack of real-time visibility into adherence, cost variance, and quality metrics
Results
- Automated regimen permutation and validation across 200+ oncology scenarios, reducing setup time by over 70%
- Accurate treatment cost modeling with per-day and per-drug breakdown, improving payer negotiation readiness
- Enabled provider-specific fee schedule generation and transaction mapping across five Medicare pricing types
- Real-time patient monitoring with adherence tracking and cost performance alerts, reducing reconciliation lag by 40%
- Delivered payer-facing billing files and variance reports within 48 hours post-treatment block close
70%
SHG Automated regimen permutation and validation across 200+ oncology scenarios, reducing setup time by over 70%
UTILIZED TECHNOLOGIES
