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Case Management Can Help Government Agencies Use Predictive Analytics

Joshua Hoffman
June 17, 2015

Business process management solutions are empowering public sector agencies to connect data and processes across organizational boundaries. This is proving incredibly valuable as government organizations strive to integrate big data into everyday operations - BPM tools provide the underlying infrastructure to help agencies customize apps and services to use big data efficiently. Such functions are proving especially important as agencies work to use big data to create predictive analytics plans that support fraud prevention.

A recent GCN report explained that agencies like theCenters for Medicare and Medicaid Services have begun to invest in predictive analytics as a way to prevent fraud from occurring in the first place, an issue that is of growing importance in the public sector.

"Predictive analytics can be invaluable in fraud prevention."

Understanding the fraud problem facing government agencies

Citing data from a 2012 research paper from industry expert Stephen Parente, the news source explained that approximately 10 percent of health care spending coming through the government was fraudulent. For the three years between 2009 and 2012, that amounted to between $75 and $250 billion in losses.

According to the report, the Centers for Medicare and Medicaid Services are among the agencies pushing against the rise of fraud, Through a combination of big data, dynamic case management tools and related technologies, the organization has been working to model fraud detection and prevention solutions.

At this point, there is significant potential for predictive analytics to be used in fraud prevention, but there is still an underlying problem in that fraudsters are continually developing new strategies and practices to stay ahead of the government. This makes continual evolution critical as organizations need to work hard to stay ahead of the constantly changing schemes used by fraud practitioners. Dynamic case management comes into play here, as the technology gives organizations the communication tools and workflow management functionality they need to keep pace with threats.

Process management solutions can help organizations make sense of large, complex data sets.

BPM can serve as a case management enabler

Government agencies trying to improve case management can use BPM solutions as application development platforms to build case management functions into the apps and services employees are using everyday.

Giving users freedom to customize these features through low-code development kits ensures that employees will have access to the case-related information and collaboration tools they need without having to jump through operational hoops to get there. The result is a transformed operational environment in which workers can use analytics, communication tools, built-in audit trails and process automation functions to prevent fraud.