Suva saves thanks to Big Data

Suva uses data analysis tools to intercept invoices with unjustified claims before they are paid and to identify discrepancies. Since the beginning of the year, it has been able to calculate key figures for service providers such as hospitals and doctors. To do this, software analyzes the billing behavior of comparable service providers. Rolf Schmidiger, strategy manager at Suva, gives an example: "If a doctor prescribes vitamin tablets for each of his patients, regardless of whether they are appropriate or not, the system alerts us and we clarify this case."

290 000 invoices rejected

Suva saved over 200 million Swiss francs in 2015 through the use of Big Data technologies. That is 40 million francs more than in the previous year. "Our primary goal as a self-supporting company is to use our customers' premium money correctly and fairly," says Daniel Roscher, member of Suva's Executive Board. Suva therefore continuously uses the latest technologies to track down unjustified claims in a largely automated manner. In 2015, it checked 2.5 million invoices from a total of 600,000 ongoing cases. It rejected around 290,000 invoices.

Misuse of medicines blows the whistle

Starting in summer 2016, Suva will be able to use new algorithms to systematically identify the misuse of medications. Today, the accident insurance company checks whether the price of a painkiller is right and whether it fits the diagnosis in question. Now it will also automatically know whether the dose is within a reasonable range. This will help detect patients with addictive behavior who use tricks to obtain more medication than has been prescribed.

Since 2013, Suva has already been able to systematically identify benefits that do not match the specified injuries. These are, for example, medications that have no connection with the accident, such as those for flu, diabetes or gout. The system also finds inconsistencies in coding under the Swiss DRG per-case system. "There are cases that lie on the border between two diagnosis groups and fall into either one or the other category due to a minimal difference," says Rolf Schmidiger. The cost consequence, however, could be several 10,000 francs. One such cost driver can be the order of the diagnoses mentioned (the first diagnosis is interpreted as the main diagnosis) or an additional overnight stay in hospital. Here, too, Suva analyzes the typical course of medical cases from millions of data. If a case deviates from this, the system sounds the alarm.

More accidents than in the previous year

The number of reported occupational and non-occupational accidents increased slightly in 2015 compared with the previous year. Of the approximately 463,000 accidents, slightly more than 180,000 occurred during work and over 265,000 during leisure time. Occupational accidents continued to decline, but non-occupational accidents increased by 1.5 percent. One reason for the slight increase may have been the good weather last summer. People did more outdoors and had more accidents as a result.

More medical costs, stable daily allowance costs, fewer new pensions

Treatment costs also increased slightly in 2015: Medical and therapeutic services for insured persons cost 1.190 billion Swiss francs (previous year: 1.165 billion). This corresponds to an increase of a good 2 percent.

In addition to medical expenses, Suva paid out daily allowances of CHF 1.303 billion in 2015, 0.7 percent more than in the previous year. At the same time, it issued 1605 new disability pensions, which is less than in the previous year (1714). The total cost of new disability pensions also fell, by 20 million to 517 million francs. On average, a new lifetime disability pension last year required a mathematical reserve of 322,000 francs (previous year 313,000 francs). The average degree of disability increased slightly to 28 percent.

(Suva)