Insuria – ENG

They enable greater governance of healthcare spending by enhancing three critical aspects for health insurance providers.

The Dangers of Anarchic Growth in Healthcare Spending:

Factors such as advances in medical science, the emergence of new therapies, and the epidemiological shift toward aging populations with a higher prevalence of chronic diseases are dangerously driving up healthcare spending.

In many cases, it is increasingly common to hear that the sustainability of healthcare systems is at risk because this growth in spending does not follow logical parameters but rather takes on an anarchic nature.

According to international evidence, up to 40% of healthcare spending is avoidable with technology and processes such as Value-Based Healthcare (VBH). Designing and planning user-centered health systems with aligned incentives between payers and providers has proven to be the best paradigm for achieving efficiency and equity

is avoidable with VBHC
(Value-Based Healthcare)
0 %

We Improve Clinical, Economic, and Population Indicators

Value Proposition

At AVEDIAN, we develop specific technology that, when combined with Diagnosis-Related Groups (DRGs), enhances critical aspects for health insurance by enabling greater governance of healthcare spending:

360° Strategic Information

Using international methodologies, we analyze hospital case studies and costs, apply benchmarking, and use AI to suggest the best care processes for each patient profile.

At AVEDIAN, we develop specific technology that integrates and standardizes all clinical, care, and economic information generated in hospitals using DRG (Diagnosis-Related Groups) methodology.

The result is strategic and relevant information for any decision-maker, providing 360° evidence on the organization through dashboards ranging from simple to complex.

The involvement of management areas in the continuous improvement of results drives operational excellence in clinics and hospitals.

Pain Points We Address

New Contracting and Payment Models

Fee-for-service payment has proven to be ineffective in balancing cost control and promoting improvements in population health. Additionally, fee-for-service encourages high levels of waste (also known as avoidable spending) because the incentives are aligned with overbilling of services.

In contrast, Outcome-Based Payment Models with DRG modules are the gold standard in the most developed healthcare systems worldwide. These models minimize waste in usage rates by better aligning interests with provider networks, effectively controlling costs while promoting a care approach focused on achieving the best possible outcomes.

Access to High-Cost Medications

The prices of new medications continue to rise, outpacing inflation and affordability. Health insurers seek to manage this increase while ensuring equitable access. A growing solution is value-based purchasing of medications, where costs are tied to outcomes. Payers pay more for effective treatments and can replace ineffective medications, incentivizing pharmaceutical companies to improve treatment effectiveness. Additionally, this approach generates more data on drug effectiveness, which facilitates the development of new treatments.

Population Risk Management

The phenomenon of epidemiological transition requires a proactive approach based on evidence and clinical guidelines. Understanding the patient journey and designing a user-centered value proposition are key for organizations managing patient populations.

Advanced analytics with integrated, standardized, homogeneous, and comparable data allows for effective population risk management, creating a preventive approach that helps control healthcare spending.

Our Products and Services

For Health Insurance

Hospital Outpatient DRG Aggregator

DRGs (Diagnosis-Related Groups) are patient classification systems that group episodes through rules and algorithm engines based on clinical similarity and resource consumption criteria.

What Does It Allow Insurers to Achieve?

Population Risk Aggregator

These tools classify, measure, analyze, and explain the clinical and economic risk of groups within a population, making it easier for decision-makers to implement strategies to improve population health.

What Does It Allow Insurers to Achieve?

BRMS - Business Rules Management System

An advanced tool for managing business rules used in decision-processing systems within complex environments.

What Does It Allow Insurers to Achieve?

Datalake

A centralized repository that allows the storage of all structured and unstructured data at any scale.

What Does It Allow Insurers to Achieve?

Advanced BI Analytics

Dynamic analytical dashboards that allow information to be approached from different perspectives, facilitating internal organization to develop reports on all structured variables within the systems.

What Does It Allow Insurers to Achieve?

AVIA - AI Solutions Lab

The AI solutions lab, AVIA, not only optimizes the operational efficiency of hospitals and insurers but also supports value-based healthcare models, focusing on improving patient outcomes, reducing costs, and ensuring the sustainability of the healthcare system.

What Does It Allow Insurers to Achieve?

Contracting and Payment Platform (PCP)

The “patient journey” or care process includes at least three instances requiring specific decisions, all managed on the same platform.

What Does It Allow Insurers to Achieve?

What Does It Allow Insurers to Achieve?

What Does It Allow Insurers to Achieve?