Fuzion Analytics: Untying the Complexities of the Long Term Care Insurance Industry

Patrick Bogan, CIO
The Senior Health Insurance Company of Pennsylvania, a noted Long Term Care (LTC) insurance carrier, realized that analytics can provide insight into the LTC industry that is experiencing rapid increases in claims and negative impacts on financials. This realization lead them to set up Fuzion Analytics in 2012, offering powerful LTC analytics solutions to understand claims trends, identify potential fraud, gain insight into core business drivers, and ultimately, follow the pulse of business.

Fuzion Analytics provides web-based business intelligence dashboards; fraud detection with case management and workflow applications; advanced data mining and predictive modeling capabilities; and robust data storage mechanisms with advanced integration software. Since no two LTC carrier’s requirements or data are identical, Fuzion starts with conducting an assessment of the clients’ individual business requirements and data assets, followed by identifying and customizing the services that best support each of client’s unique set of needs. Fuzion Analytics also acquires a variety of external third-party data including demographic data, economic data, geocoding information and even prescription drug data, and integrates it with the client data to enhance the results. “Fuzion’s number one priority is the success of our customers, not selling costly and unnecessary software and services. Fuzion works with the client to understand their specific business needs. We then tailor our services to meet those needs,” says Patrick Bogan, CIO, Fuzion Analytics.

Our goal is to offer competitive advantage for our clients by utilizing their data assets to drive better decisions in real-time

“In an industry where fraud and abuse in LTC insurance is estimated to be upwards of $500 million annually, unfortunately, very little has been identified to-date,” says Bogan. Sentinel, the fraud identification and case management solution from Fuzion studies the patterns of thousands of prior claims and is effective at identifying patterns that are not expected or typical. By using data from multiple LTC insurance carriers, Fuzion Analytics is able to better evaluate the risk of fraud than any company would in a standalone environment.

Another challenge faced in Long Term Care is when a policyholder goes on claim. The carrier must set aside from $25,000 to as much as $1 million for that claim, depending on the specific policy benefits. It’s not hard to imagine the impact on financial performance of a carrier when a spike of unexpected claims occurs. Fuzion assists their clients in such situations. With the company’s solutions, a carrier was able to identify that a spike in reserves was taking place within a certain product benefit, but the paid claims dollars were not following that same pattern. Through detailed analysis, it was determined that the claim reserves being established were higher than what they actually should have been. These findings provided the carrier with the opportunity to revise their reserves to the appropriate level improving their financials by several million dollars. All Fuzion Analytics solutions are delivered via the cloud in a Software-as-a-Service (SaaS) model. The significant advantage for clients with a SaaS solution is that there is no software or infrastructure to install or maintain within their organization. “Their IT department does not even need to be involved, except to provide the data to Fuzion. This approach allows carriers to see value from the Fuzion Analytics solutions much quicker than atypical software installation,” says Bogan.

Since Fuzion Analytics is the first of its type offering big data analytics solutions to the LTC insurance sector, the company faces little or no competition. Looking ahead, Fuzion plans to develop additional models for predictive analytics and data mining as well as development of a consortium model that allows carriers to study and contrast their business’ performance against the industry overall.

Fuzion Analytics

Carmel, IN

Patrick Bogan, CIO

Fuzion Analytics is a data mining and analytic services organization dedicated to serving the informational needs of the Long-Term Care insurance industry.