When it comes to managing risk adjustment for your ACO population, what does your current process look like? Perhaps you set your spending targets and create plans to control spending for the next year based on what CMS tells you. However, you don’t have visibility into the current state of your spending to see if you’re on track to meet shared savings goals, and you’re not able to identify intervention opportunities in a timely manner. Sound familiar? Luckily, we can help. Lumiata provides valuable predictions and actionable insights for a better customer experience.
Your current process is insufficient
Predicting costs and planning spending is crucial to keeping your ACO profitable, especially when you’re part of the the Medicare Shared Savings Program. However, you’re likely working with low-quality data that doesn’t give you the kind of detailed, actionable insights you need.
You can’t see your current spending, and you may find out two-thirds of the way into the year what your first third of spend was. Plus, analysis is often conducted in Excel or common BI tools and requires too many resources. You may also experience a three-month lag when looking for intervention opportunities and identify them too late, or have already resolved them by the time they’re brought to your team’s attention.
You notice some trends, such as higher than expected rates of musculoskeletal CVD or chronic diseases like diabetes, and share the info with providers to see if they can intervene. At the end of every quarter and year, you must do reconciliations to understand TCC to see what the cost would have been without intervention, resulting in a slow pace of learning.
This process is insufficient. Let us introduce a better alternative: Lumiata.
Lumiata provides actionable insights for your ACO
Lumiata offers AI products designed specifically for healthcare to help you predict and manage risks and costs. We provide cost predictions, risk predictions, and actionable insight to help your ACO manage spending and improve care. We start by collecting your data – including standardized codes and handwritten notes – and combine it into a single data set. We then clean your data and enrich it with our proprietary disease codes built off of clinical IP, and medical knowledge, including 100 million patient records, 35,000 physician curation hours, and 50 million articles mined from PubMed. With your data now ready for machine learning, you can use it along with our products to build high-performing data models and make predictions.
Lumiata offers a positive experience throughout your customer journey by providing a wide range of benefits for your ACO.
Benefit: Profit maximization through visibility of shared savings targets
With Lumiata, you can see your current spend and future spend right now, so you don’t have to wait to see if you’re on target. By having real-time data, you can adjust your spending plan as needed to help you stay on budget for the year.
Benefit: Timely insights so you can enable interventions that control cost
Imagine being able to identify wasteful spending patterns early in the process. You’d be able to take action sooner to help control costs. Lumiata enables you to quickly identify a variety of wasteful spending patterns, including pharmaceutical or clinical over treatment, poor coordination, and patient referral leakage. We also give you insights into actual and predicted costs by provider, benchmarked against similar populations; actual and predicted costs by category, benchmarked; and utilization data. This information allows you to more accurately plan your spending, intervene in a timelier manner, and recommend that providers offer lower-cost solutions to patients when possible.
Benefit: Identify high-cost claimants
Lumiata enables you to identify high-cost claimants early by making predictions at the individual level. You can see each claimant’s prescription medications, health conditions, and care utilization to predict diseases and medical events and identify at-risk patients who may lead to high costs. You can also predict associated high-cost but low-probability care events. Using this information, you can more accurately plan your ACO’s spending, intervene earlier, reduce utilization of pricy services, and avoid higher costs.
Benefit: Identify population-level risk factors and emerging trends
Lumiata analyzes population characteristics to help you predict emergency department visits, different types of doctor visits, procedures, medication prescriptions, and more, as well as the risk for developing specific diseases. We can help you identify population-level risk factors and emerging trends so you know what to keep an eye on while planning your ACO’s spending.
Benefit: Actionable metrics that pinpoint specific interventions
It’s not enough to simply have data; you must be able to use it to determine actionable next steps that can help you improve care and reduce costs. Lumiata provides actionable metrics that pinpoint specific interventions, allowing you to take the appropriate action in a timely manner. For example, we enable you to make individual-level cost, risk, and disease onset predictions so you can directly feed predictions into care and utilization management work streams. This also makes it clear what conditions or upcoming high-cost events you assist members with.
With Lumiata, you can help providers understand how to achieve high-value performance through identifying and targeting specific value “leaks” and introducing initiatives to improve consumer behaviors, treatment adherence, and referrals to high-value providers. Payers can also encourage behaviors through well-designed benefits and value-based insurance products.
Attribution methods with Lumiata
Lumiata provides you with the tools you need to get the most out of your data and plan for various costs and patient needs. For example, with Lumiata, you can use machine learning to better understand the impact of various reduction opportunities. You can also use our toggling tool to see the impact of your ideas, such as the financial result of switching to generic drugs. Our tools allow you to learn and experiment faster so you can make the best decisions for your ACO.
The Lumiata ExperienceWe pride ourselves on offering a valuable customer journey and experience. We’re dedicated to cleaning and enriching your data so it can be used with our machine learning and artificial intelligence solutions to provide you with actionable insights and helpful predictions. We enable you to see current and future spending so you know if you’re on target to meet shared savings goals. With Lumiata, you get the right insights at the right time so you can take the right actions. Want to see how Lumiata can benefit your ACO? Click here to request a demo.