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FCamara, a Brazilian IT company focused on digital transformation, has been investing its resources in projects involving Machine Learning and Data Science to solve recurring problems in the health area.
Kleber Santos, partner and business director at FCamara, says that the increase in fraud cases and the lack of management of their own health have become a business opportunity. "In an attempt to mitigate the large sum of wasted resources in situations of losses due to mistaken charges by providers or fraud, operators have increasingly invested heavily in medical audit processes. The problem is that this manual process is slow, expensive and inefficient. Our bet is that this is a beautiful opportunity for us to use cutting-edge technology, especially those linked to artificial intelligence and data science", he emphasizes.
Smart platform for medical auditing
According to a recent study carried out by the IESS (Instituto de Estudos de Saúde Suplementar), in 2017, approximately 20% of hospital bills spent by healthcare operators in the country were unduly consumed by fraud and requests for tests that were not necessary. This number corresponds to about R$28 billion. With this data in hand, the company set out to solve a problem that significantly impacts the billing of these operators.
"Currently within the company we have a startup focused on creating a solution that aims to reduce losses inherent to fraud in health care providers, automating the medical bill audit process through the integrated use of Data Science and Machine Learning, covering from the scheduling of exams even the need for some surgical procedures. The project is being developed together with some partners in the healthcare field" says Joel Backschat, CTO of FCamara.
Also related to the fight against fraud, in addition to this initiative, a project is being developed in parallel that aims to reduce the shared use of cardholders and thus combat their misuse by other people who are not beneficiaries. "For this, we are creating a facial recognition system that compares the face of the person who is using the service at a given moment with all the other times that the same individual has already used, thus preventing this practice", emphasizes Leonardo Amorim, developer of project.
Health promotion through the use of wearables
Another project that is under development is related to the management of their own health, encouraging users to prevent diseases before they take hold and encouraging healthy habits. According to Leonardo Amorim, the project aims to promote health, so that users can follow different indicators, synchronizing all their wearable devices on a single platform. As a reward for a good performance, the user can be rewarded with small incentives, which will be offered in partnership with some health plan operators.
Solutions that generate value
In addition to promoting the use of technology "in-house", the company also added value with the use of Machine Learning in projects developed for clients. Still in the health sector, in a project developed for a giant in the diagnostic medicine sector, FCamara helped to send data to the cloud in a secure way, meeting both legislation and security requirements. "As the company has a large flow of information in its system, coming from the more than 30 brands added by the group, we helped in the creation and development of a robust Data Lake solution to carry out the unification of all the company's information that will serve as a basis for new systems to be developed." says Joel.
Kleber Santos, partner and business director at FCamara, says that the increase in fraud cases and the lack of management of their own health have become a business opportunity. "In an attempt to mitigate the large sum of wasted resources in situations of losses due to mistaken charges by providers or fraud, operators have increasingly invested heavily in medical audit processes. The problem is that this manual process is slow, expensive and inefficient. Our bet is that this is a beautiful opportunity for us to use cutting-edge technology, especially those linked to artificial intelligence and data science", he emphasizes.
Smart platform for medical auditing
According to a recent study carried out by the IESS (Instituto de Estudos de Saúde Suplementar), in 2017, approximately 20% of hospital bills spent by healthcare operators in the country were unduly consumed by fraud and requests for tests that were not necessary. This number corresponds to about R$28 billion. With this data in hand, the company set out to solve a problem that significantly impacts the billing of these operators.
"Currently within the company we have a startup focused on creating a solution that aims to reduce losses inherent to fraud in health care providers, automating the medical bill audit process through the integrated use of Data Science and Machine Learning, covering from the scheduling of exams even the need for some surgical procedures. The project is being developed together with some partners in the healthcare field" says Joel Backschat, CTO of FCamara.
Also related to the fight against fraud, in addition to this initiative, a project is being developed in parallel that aims to reduce the shared use of cardholders and thus combat their misuse by other people who are not beneficiaries. "For this, we are creating a facial recognition system that compares the face of the person who is using the service at a given moment with all the other times that the same individual has already used, thus preventing this practice", emphasizes Leonardo Amorim, developer of project.
Health promotion through the use of wearables
Another project that is under development is related to the management of their own health, encouraging users to prevent diseases before they take hold and encouraging healthy habits. According to Leonardo Amorim, the project aims to promote health, so that users can follow different indicators, synchronizing all their wearable devices on a single platform. As a reward for a good performance, the user can be rewarded with small incentives, which will be offered in partnership with some health plan operators.
Solutions that generate value
In addition to promoting the use of technology "in-house", the company also added value with the use of Machine Learning in projects developed for clients. Still in the health sector, in a project developed for a giant in the diagnostic medicine sector, FCamara helped to send data to the cloud in a secure way, meeting both legislation and security requirements. "As the company has a large flow of information in its system, coming from the more than 30 brands added by the group, we helped in the creation and development of a robust Data Lake solution to carry out the unification of all the company's information that will serve as a basis for new systems to be developed." says Joel.
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