Looking for an easier way to reduce costs and risk? Predictive analytics can help healthcare providers, payers, and services predict costs and risks through a combination of data, artificial intelligence, and machine learning.
Your organization can use the actionable insights generated from predictive analytics to plan for costs and risks associated with disease onset in patients, suspicious claims, increased demand for care, high-cost patients or members, and more.
Here’s how predictive analytics solutions can help your organization reduce cost and lower risk.
Predict disease onset and identify at-risk patients
Predictive analytics can help you achieve better outcomes for patients by predicting disease onset and progression as well as medical events. When you can “see into the future,” you can take the necessary steps to help prevent diseases and medical events and help keep patients healthy.
Lumiata, for example, can predict the onset of acute and chronic diseases like chronic kidney disease, COPD, type 2 diabetes, depression, and more within the next 12 months, predict hospitalizations within the next 12 months, and identify the patient’s risk factors.
With this information, you can intervene sooner and provide more specialized care to help prevent or delay disease onset and help save the patient a trip to the hospital. This not only helps you achieve better outcomes for patients, but it also saves money by avoiding costly treatments that might be needed if the disease had not been prevented.
Identify suspicious claims before they’re billed or paid
Billing errors cost payers and providers time and money. Payers don’t want to pay claims only to realize the claim was inaccurate and shouldn’t have been paid. Billing for inaccurate claims can cause providers to not get paid correctly or on the first time. Whether you’re a payer or provider, predictive analytics can help your payment integrity strategy by identifying suspicious claims before they’re billed or paid.
Lumiata’s predictive analytics identifies claims that don’t follow typical patterns of care. Payers can then review these claims before paying them to make sure they’re correct. Not only does this save payers money by helping them catch inaccurate claims before they’re paid, but it also allows them to review more claims in-house and send fewer and lower-cost claims to vendors for review, resulting in reduced vendor fees.
For providers, being able to catch inaccurate claims means providers can review and correct them, if necessary, before submitting them to make sure they’re paid correctly the first time.
Predictive analytics helps you predict suspicious claims and automates the claims review process to save you time and money. For our solutions, in particular, we believe the typical overpayment identification potential to be 30-40%.
Solve underwriting and pricing challenges
Setting optimal pricing is crucial to being able to attract new members, keep your current members, cover unexpected costs, and make a profit. Price your products too high, and you risk losing members and struggling to bring in new ones. Price your products too low, and you may have to spend more money than you had planned for when unexpected high-cost claims come in.
Predictive analytics can help your organization increase competitiveness by supporting your actuarial and underwriting efforts. With Lumiata’s cost and risk predictions, for example, you can predict risks like high-cost members, high-cost groups, and more so you can set prices that are high enough to cover predicted costs yet low enough to appeal to current and potential members. Setting optimal pricing can also help you slow market share erosion.
Predictive analytics also enables you to boost the accuracy of risk assessments and better detect anomalies in the underwriting process, helping you make better-informed decisions throughout the process.
Predict operational needs
When it comes to keeping your organization running smoothly and on budget, planning for risks and keeping costs to a minimum is important. Predictive analytics can help you gain visibility into potential risks and costs that you might not have seen otherwise.
Take readmissions, for example. Hospital readmissions can incur fees that quickly add up, negatively impacting your bottom line. Predictive analytics can help you identify patients who are likely to be readmitted based on potential disease-related complications and other risk factors. When you can identify these patients, you can take the necessary steps to help reduce the risk of complications and help keep patients healthy so they don’t need to return to the hospital, thus reducing your costs.
Predictive analytics can also predict the demand for care, allowing you to see when potential surges in demand will occur. When you know what kind of demand to expect, you can make sure you have the appropriate staff on hand plus any necessary products.
Additionally, predictive analytics can predict the need for specific types and amounts of products and supplies as well as predict appointment no-shows. All of this gives you better insight into potential costs so your organization can plan for them and work to mitigate them.
Lumiata offers powerful predictive analytics
To generate the best predictions, you need the best tools. Lumiata’s superior cost and risk prediction tools were custom-built specifically for the healthcare industry and consistently outperform legacy methods. We are modernizing how risk, care, and costs are managed across the healthcare industry.
We start by using our proprietary data preparation and cleansing process to cleanse and organize your data into a format that’s ready for machine learning. Then, you can use our Spectrum AI Model Catalog to dive into data science with access to more than 100 pre-trained models.
Our financial model suite is up to 80% more accurate than the nearest competitors’ cost prediction models, and our clinical suite is up to 65% more accurate than the leading carrier. You can also build your own models or have us custom-build a model for you.
Our tools help you leverage predictions to design care management based on patient and population risks, predict disease onset, catch billing errors, solve pricing challenges, predict operational needs, and more.
To see how Lumiata can help your organization reduce costs and lower risk through the power of predictive analytics, request a demo.