Approximately 1.71 billion people worldwide have musculoskeletal conditions, which are the leading contributor to disability, according to the World Health Organization.[I]
Musculoskeletal disorders can be a huge problem for people, causing pain and limited movement, affecting mental health and wellbeing, and more. These disorders also pose problems for healthcare providers and payers, as they can lead to the need for expensive surgeries, medications, rehabilitation, and more. Being able to prevent the onset of musculoskeletal disorders and avoid surgery and other costly treatments is a win-win for all parties involved. Fortunately, this is possible.
Lumiata can predict the onset of diseases, identify patients and members who are at high risk of developing musculoskeletal disorders or needing surgery, and predict expenses, helping your organization manage risk, improve care, and reduce costs. Here’s how we do it.
First, we prepare your data
When it comes to using your data to generate insights, if you put garbage in, you’re going to get garbage out. To make sure you get the best possible insights, we validate and normalize your data using our reference coding systems data. We can also transform healthcare-related codes from one coding system to another if the data contains mixed coding systems across time. Next, we perform a comprehensive data cleaning process, which identifies and removes data that’s incorrect, incomplete, duplicate, or improperly formatted.
Your data then goes through our highly customizable disease tagging system, a clinical IP that identifies leading indicators for chronic and/or catastrophic conditions linked at the individual person level. We also enrich your data with our data, which has been drawn from 130 million patient records, 35,000 physician curation hours, and 50 million published articles. We then create Lumiata Person360 records, longitudinal records of each person in your data. With your data now ready for machine learning and artificial intelligence, it can be used to make predictions and identify high-risk patients.
Next, we predict diseases, disorders, and medical events
Lumiata can predict the onset of musculoskeletal issues, including the need for back surgery within the next 12 months. To do this, we look for key risk factors for back surgeries, such as essential hypertension, low back pain, spinal stenosis of the lumbar region, cervicalgia, type 2 diabetes, and more. We can also predict hospitalizations, readmissions, diseases, and medical events.
Our Spectrum AI Model Catalog consists of more than 100 pre-trained, customizable models to help you solve real healthcare problems. Lumiata’s clinical model suite is up to 65% more accurate than the leading carrier and can be used to gain insights into chronic condition management, disease onset, hospitalization, and more. We also have a financial model suite that’s up to 80% more accurate than the nearest competitors’ cost prediction models. This suite includes models for high-cost members and patients, group cost, stop-loss, and more. For organizations that want to build their own models, we offer the Lightning AI Model Builder, which supports friction-free, no-code machine learning productivity.
Our predictive analytics give providers and payers actionable insight so you can make informed decisions based on real data. By seeing high-risk patients, their key risk factors, and predicted health events, you can improve the quality of care, manage risks, and reduce your organization’s costs.
Predictive analytics help providers improve care
Predictive analytics tools are powerful resources for healthcare providers. When you can identify high-risk patients and predict health issues and events such as musculoskeletal disorders and back surgeries, you can address patients’ key risk factors in a timely manner. Perhaps you change a patient’s prescription medications to prevent or slow the progression of existing health issues or educate patients on what they can do on a daily basis to improve their health. By intervening sooner and updating patients’ care management plans, you may be able to prevent the disorder and/or the need for surgery. Even if surgery is unavoidable, you can be sure to provide appropriate after-care to help prevent readmissions, saving providers and payers money.
Payers also benefit from these predictive analytics. When providers are able to help keep their patients healthy and avoid expensive procedures and medications, payers avoid having to help cover the associated costs.
The ability to predict issues and improve care also benefits patients, of course, as they can have their risk factors addressed as soon as possible, helping them stay healthy. They may even be able to avoid surgery, pain medication, and physical therapy, which can be expensive as well as physically and emotionally exhausting leading to additional issues.
Predict expenses and reduce costs
Musculoskeletal disorders can increase costs for care providers, payers, and patients. Surgeries are expensive, and pain medication and rehabilitation services can take a toll on the wallet, too. Identifying high-risk patients and members and predicting medical events can help organizations plan for and reduce costs.
As a provider, when you can predict surgeries and hospitalizations, you can update your resource allocation accordingly to make sure you have what you need ahead of time. You can also make quality aftercare a priority to avoid readmissions.
As a payer, when you can see which members are at risk of developing musculoskeletal disorders or needing surgery because of them, you can set prices accordingly. This helps ensure your prices are low enough that people will still choose your plans instead of moving to a different carrier, yet are high enough to cover the costs of predicted medical events and needs.
Musculoskeletal issues are expensive for patients, too. Insurance may not cover the full cost of medications, surgeries, physical therapies, and other needs associated with musculoskeletal diseases. When patients can more effectively address their risk factors and do so in a timely manner, they can potentially avoid these costly procedures and services. At the very least, they can keep in mind that needing these services may be a reality for them within the next year and can begin financially preparing for them.
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We’re on a mission to democratize AI in healthcare to reduce costs and improve the quality of care. Want to see how Lumiata can solve your organization’s specific needs? Click here to request a demo.