Embrace AI, Lumiata

Embracing AI in Your Organization in 2022

How can you embrace AI in 2022?

Data is a valuable resource that’s made even more valuable with the application of artificial intelligence (AI). With AI, your healthcare organization can generate actionable insights from your data to help you be more effective in the tasks at hand, whether that’s providing the best care possible, setting an effective pricing strategy, or other healthcare-related activities.

If you aren’t already using AI, what’s holding you back? Perhaps the process of getting set up with an AI solution seems intimidating.

Perhaps you don’t have the full support of the necessary people at your company. Whatever the reason, now’s the time to make a plan for incorporating AI into your activities.

Here’s how you can embrace AI in your organization in 2022.

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Use AI to predict high-cost members and increase competitiveness

One way to embrace AI in 2022 is to incorporate it into your actuarial and underwriting efforts. When creating your pricing strategy, for example, it’s crucial to understand the risks you’re taking on and potential costs, however, these aren’t always easy to see. By using AI to predict high-cost members and groups and improve the accuracy of your risk assessments, you can set optimal pricing and increase your organization’s competitiveness. 

Lumiata’s Spectrum AI Model Catalog includes a financial model suite that’s more accurate than the nearest competitors’ cost prediction models by up to 80%. This suite includes a high-cost member or patient model, a group cost model, and a stop-loss model. You can use these models to make precise risk and cost predictions, identify high-cost members and groups and detect anomalies in the underwriting process. With a clearer look into your data, you can set competitive prices that are high enough to cover potential costs yet low enough to keep current members and encourage new members to join. 

Use AI to guide risk-based care management design 

When it comes to planning care management, AI is a valuable resource. With the right AI-powered tools, you can generate actionable insights to guide your decision-making, help you provide higher quality care, and help achieve better outcomes for your patients. 

One way to embrace AI in 2022 is to use AI for care and disease management. Lumiata’s Spectrum AI Model Catalog, for example, includes a suite of clinical models that’s more accurate than the leading carrier by up to 65%. The suite includes models for chronic condition management, disease onset, hospitalization, and more. With the disease onset model, you can predict the onset or progression of numerous acute and chronic diseases within the next 12 months. When you can identify patients who have risk factors for these diseases, you can

address their specific needs in a timely manner to help keep them healthy and reduce costs. The ability to predict health issues and hospitalizations allows your healthcare organization to plan for volume surges and increased demand for care, allowing you to optimize clinical resource allocation. You can also use our AI products to gain insights into disease-related complications, allowing you to address these risks and reduce hospital admissions. 

Use AI to make sure payments are made correctly 

Healthcare payers and providers both benefit from claims being billed and paid correctly. AI can be used in each organization’s payment integrity strategy to ensure proper payments are made in a timely manner. 

For payers, paying a claim only to later realize that it was incorrect or shouldn’t have been paid can be frustrating. Lumiata’s AI solutions detect outlier claims that don’t follow typical patterns of care and flag suspicious claims before you pay them. We can also determine the best claims for your internal teams to review, enabling you to focus on auditing higher-cost claims and send 

less significant claims out for vendor review. This results in fewer vendor fees and fewer incorrect claims being paid. 

For providers, it can be frustrating when claims aren’t paid correctly the first time. Our AI solutions can screen your claims for suspicious patterns in care or billing to ensure you’re only sending payers accurate claims. This allows you to get paid correctly the first time for the services you provide. 

Tips for preparing for AI 

Embrace AI, 2022, Lumiata

If embracing AI in your organization seems daunting, here are a few tips to consider as you plan for 2022. 

Take the right steps: Plan, build, ask 

When preparing for an AI project, start by creating a plan for how and when you will begin incorporating AI into your routine. Then, set up an internal team that will focus on shepherding this new AI discovery process together. This team might include an IT/software expert; domain expert, actuary, or case manager; and a business owner to help drive progress forward and see it to completion. If you get stuck, ask for help. If you’re working with Lumiata, we’ll always be here to help you through the process. 

Prep your data 

Develop an understanding of your data and see what data assets you have vs. what’s missing. Your data may include claims data, engagement data for case management, audio call center

lots, and other forms of structured and unstructured data. Before using AI tools, you’ll also want to clean your data and prepare it for machine learning. Lumiata can handle these steps for you. 

Start small 

Getting quick wins will help you gain support from other people in your company and help build momentum. Pick a well-motivated use case for which to apply AI. One example is using AI to help competitively price your products. 

Create a study 

Create a strategy for evaluating whether or not an AI model or process is improving upon an existing solution. Try running a study, using either live or retrospective data. Select a goal for what your model is going to estimate, such as cost over 12 months, and measure the outcomes. You can then look at the results to decide if any changes need to be made. 

Embrace AI, 2022, Lumiata

Stay focused 

Know what you’re trying to improve and why. This helps you stay focused on what’s important. 

See what AI can do for you 

Ready to embrace AI in your organization in 2022? Click here to view our upcoming panel.