How Can Lumiata Help Predict High-Cost Members In Healthcare?

Wouldn’t it be great if you could identify high-cost members before they incurred the costs? Consider the benefits of having such predictions readily available. Payers and providers could adjust care management plans to improve member and patient care and prevent hospitalizations and other expensive events. Your organization could better allocate resources, optimize your cash flow, and more. Good news – this isn’t a hypothetical scenario. Lumiata can help predict high-cost members for your business. Here’s how.

First, we clean your data.

Lumiata provides advanced analytics to solve some of healthcare’s highest costs and issues. To do that, we start by cleaning your data and preparing it for machine learning. “Garbage in, garbage out” doesn’t do anyone any good, so this is a crucial first step.

We collect your raw data in the form of medical records, claims, doctors’ notes, and more. Our platform automatically ingests, cleans, and organizes disparate data sources into a consumable data format, preparing them for machine learning. During this process, patient data from various sources are combined to create one comprehensive historical health record.

We then enrich these historical health records using our Lumiata Disease Codes based on 35,000 curated hours of clinician analysis and input. This enrichment process enables our machine learning capabilities to predict healthcare costs and manage risk to improve member and patient care and manage your finances—quality data in quality insights.

Next, we make predictions.

Once your data has been cleaned, enriched, and prepped for machine learning, we use it to provide valuable insights that help you predict high-cost members. Our Spectrum Model Catalog contains more than 100 prediction tools specific to healthcare that can help produce intelligent analytical data. This data can be used to identify and mitigate risk, improve cost management, support clinical and operational efforts, and more. 

Financial prediction models

We offer several customizable financial prediction models, with the most popular being high-cost member prediction, group cost prediction, and stop-loss prediction.

High-cost member prediction

Lumiata proactively identifies high-risk patients and their risk factors to help you more effectively manage and treat their conditions, resulting in actionable insights to reduce risk and increase margins. Users can see each claimant’s health conditions, prescription medications, and care utilization to identify expected high-cost claimants. This ability to see at-risk patients allows healthcare providers and payers to adjust patients’ care management plans and ensure they are in the correct care pathway in order to provide more effective treatments, improve care, and reduce costs. Our high-cost member prediction model is 65-80% more accurate than other leading actuary cost prediction models.

Group cost prediction

Our new and renewing group cost prediction model helps solve underwriting and pricing challenges by providing underwriters, actuaries, and account executives with accessible, accurate healthcare cost predictions for insured groups. Our prediction model is up to 20% more precise than other top prediction models, allowing users to manage their books and their cash flow better.

Stop-loss prediction

Lumiata uses practical algorithms and top-notch prediction capabilities to offer AI-powered cost predictions. We can also flag high-risk conditions to help users optimize stop-loss underwriting.

Clinical prediction models

Two of our most popular clinical prediction models are disease onset prediction and medical events prediction.

Disease onset prediction

Lumiata can identify members who are likely to develop one of 100+ diseases in the next 12 months, including acute and chronic diseases. This prediction model helps identify people who may become high-cost members, allowing healthcare providers to improve primary care and reduce future costs. 

Medical events prediction

This prediction model allows users to identify risks based on a patient’s historical record and implement an intervention if needed. Lumiata helps healthcare providers and payers identify potential high-cost members, optimize clinical resource allocation, and plan future increases in the demand for care.

Operational prediction models

Our most popular operational prediction models include hospital admission prediction, hospital readmission, and emergency department visits.

Hospital admission prediction

Lumiata provides insights into patients at risk of being admitted to the hospital in the next 12 months by analyzing their pre-existing conditions. With this insight, providers and payers can provide outpatient preventive care, reduce the risk of hospital admissions and their associated costs, and reduce the risk of secondary complications.

Hospital readmission

Hospital readmissions are harmful and expensive.. Lumiata helps providers and payers reduce the risk of hospital readmissions, their associated costs, and secondary complications by identifying risk factors that make a person more likely to be readmitted. This gives providers and payers time to provide members/patients with proactive care management.

Emergency department visits

This model helps predict emergency department visits by analyzing patient population characteristics. With a more accurate view of expected patient volume, emergency departments and hospitals can better coordinate patient flow through the system and more wisely schedule elective procedures that require hospital stays.

Predictions support action

Our prediction models give you the insights you need to identify risks and predict high-cost members. Armed with this information, your organization can take action and adjust the patient’s care management plan and get them on the proper care pathway. If you see that a member is at risk of developing a disease, you can take steps to improve their health and prevent the onset of the disease. If you see that several people are at risk of hospitalizations, you can improve their care or guide them to a suitable facility. Insights provided by Lumiata allow you to identify high-cost members, manage risks, and manage and plan for costs, all while improving patient care and outcomes.

See how Lumiata can predict your high-cost members.

Don’t let high costs blindside your organization. Lumiata can predict your high-cost members by using artificial intelligence and machine learning to extract valuable insight from your healthcare data. From disease onset to group costs to hospital admissions and more, we identify your high-risk members and their risk factors so you can address these issues effectively and efficiently. Want to see how Lumiata can predict your high-cost members? Click here to request a demo.