Prescription opioid misuse and opioid use disorder (OUD) are significant health problems in the US and impact stakeholders across the healthcare sector. The Center for Medicare and Medicaid Services’ (CMS’s) whitepaper summarizes these issues and outlines strategies to handle the crisis and reduce impacts of this epidemic. Although there are several initiatives at the federal, state, and local level to combat this problem, proactively identifying fraudulent and risky behaviors of various healthcare entities can help with preventive measures. This whitepaper outlines a framework for healthcare data analytics platform using Cloud, artificial intelligence (AI) and machine learning (ML) technologies to enable real time/predictive analytics and gather deep insights into opioid crisis.
This framework includes capabilities to:
Enable streaming healthcare data ingestion from multiple sources in disparate formats and store information in centralized data lakes;
Identify and automatically extract prescription, drug, and other healthcare information from medical documents;
Provide real-time data analytics and insights into fraudulent and risky behaviors of various healthcare entities including patients, providers, pharmacies, etc.;
Help proactively identify and predict fraud and abuse of opioid prescriptions based on historical drug usage and other data patterns; and
Provide a secure platform for storing personal health information (PHI), personally identifiable information (PII) data and guidance to ensure compliance with Health Insurance Portability and Accountability Act (HIPAA) and other healthcare regulatory requirements.
