- Government Use Case
Delivering Equitable Health & Human Services
How Profisee helps state and local governments improve access, equity and outcomes in public health and human services
By mastering patient, provider and program data, governments can deliver equitable
access to Medicaid, Medicare and other health and human services. Profisee ensures constituents receive the right care and benefits, eliminates duplication and fraud, and improves the accuracy of immunization and public health records.
Data Domains
Patient, Provider, Program, Facility
Business Problem
Inequitable Access, Fraud & Waste, Inefficiency
Teams Impacted
Human Services, Public Health, Agencies
MDM Impact
Fraud Prevention, Trusted Public Health Data
Business Problem
Data Strategy
Outcomes Business Problem
Effects of Inaccurate Health & Program Data
- Inequitable Access: Vulnerable residents miss benefits or care due to siloed, out-of-date, or incomplete program and patient records.
- Fraud & Duplication: Duplicate or inaccurate records lead to fraudulent Medicaid claims or misuse of public health services.
- Inefficient Operations: Agencies waste staff time reconciling inconsistent program and provider data instead of delivering services.
- Poor Disease Surveillance: Inconsistent immunization and public health data slows detection and response to outbreaks.
- Lapses in Care: Changes in patient demographics or provider program participation can result in lapses in chronic care, leading to negative outcomes and excess costs.
Data Strategy
How MDM Can Improve Services Delivery
- Citizen & Patient 360: Creates a single, consolidated, trusted record of patients, families and program beneficiaries, automatically combining data from third-party sources, other agencies, and internal systems.
- Fraud Detection: Matching and survivorship rules prevent duplicate Medicaid claims and flag suspicious claims and participation.
- Provider Integration: Connects healthcare providers, pharmacies and agencies with consistent data for care delivery and reporting.
- Analytics & AI Readiness: Trusted data feeds surveillance tools, program evaluations and AI-driven models for anticipating community health needs.
Outcomes
Government KPIs Positively Impacted
- Improved Access: Eligible constituents receive health and human services faster, with fewer gaps or delays.
- Reduced Fraud: Duplicate and fraudulent enrollments are prevented, and fraudulent claims more accurately identified, protecting taxpayer dollars.
- Greater Efficiency: Agencies spend less time fixing or manually verifying data and more time serving constituents.
- Stronger Public Health: Accurate population health data strengthens surveillance, immunizations and overall community well-being.
