Which Palmetto GBA department plays a role in almost every line of business and every contract?

Our Medicare Statistical Analysis Department (MSAD) — a team of biostatisticians, statisticians, mathematicians and epidemiologists. This group of more than 40 employees, along with our data management warehouse team, works behind the scenes analyzing data to identify trends, inconsistencies and patterns. They perform extensive data exploration and employ a wide range of statistical and analytical techniques to reduce payment errors, address program vulnerabilities, protect federal dollars and promote provider compliance.

Members of the MSAD team (left to right): Imelda Go, Shana Chappell, John Obal, Dumbiri Stone, Vincent Onyame, Michael Petzold, Sukgoo Pak, Carol Stone, Sanoussy Diallo, Albert Harrison, Chieh Wu and Alex Arnold.

From Reporting to Quality Assurance

For many contracts, the MSAD team only provides operational reports to identify areas that can benefit from improved efficiency or workload management. But for others, they develop in-depth and specialized analysis and reporting. This includes building models like network analysis with Medicare claims data to identify fraud, waste and abuse.

MSAD provides quality assurance and evaluation for artificial intelligence tools being leveraged in operational areas, like the Medical Review Department. The analytics team has monthly meetings with Medical Review clinicians to review billing trends. The analytics team searches provider, specialty and service-level data for outliers based on standard deviations and trends. The clinicians review the information and determine if there is possible fraud or abuse or if the outlier is something they would expect, such as flu shots in the fall. The analytics team and clinical team collaboration can also identify providers who are performing procedures that could potentially harm a patient. This close collaboration is an added value to our customers.

Experience and Flexibility That Matters

Having both analytics and data management capabilities differentiates Palmetto GBA from many of its competitors. Palmetto GBA could not complete this analysis and reporting work as efficiently without the data warehouse and support from the database team—12 members of MSAD with vast data-retrieval experience. They are the engine that keeps the process running smoothly. This deep bench of analytical expertise and experience with a variety of claim types gives Palmetto GBA the flexibility to meet our customers’ needs.