Move Your AI Initiatives Forward with Lumiata’s Solutions

Artificial intelligence and machine learning can transform your data into a valuable resource for predicting health issues and events, reducing costs, and improving care. At Lumiata, we offer machine learning and AI products that were custom-built for the healthcare industry to help payers and providers get the most out of their data. Read on to see how our solutions address your most urgent challenges.

Actuarial & Underwriting

How helpful is your data when it comes to assessing risk? Utilizing machine learning and other intelligent technologies can help you build a data-enabled underwriting strategy that includes more accurate risk assessment and cost predictions.

At Lumiata, our machine learning and artificial intelligence (AI) solutions are designed to help you boost risk assessment accuracy and increase competitiveness with precise cost and risk predictions. We can also help you detect anomalies in the underwriting process to improve system reliability, identify high-cost group models to support underwriting, and slow market share erosion resulting from sub-optimal pricing.

We’ve helped our partners:

  • Identify twice the number of high-cost members as our partner’s legacy tools
  • Reduce risk by $70M/year as compared to Wakely
  • Implement solutions in less than two months

We believe that intelligent technologies will transform underwriting, and that payers who get on board with machine learning now will be rewarded for years to come.

Care and Disease Management

Chronic and complex diseases can make providing high-quality care complicated. What if you could use your data to improve care management and achieve better outcomes? Lumiata’s machine learning solutions help you identify and reduce risk, lower costs, and improve care.

Our prediction models enable you to predict the onset of chronic and acute diseases and intervention-intensive conditions as well as identify high-risk patients so you can adjust care management plans accordingly. Doing this in a timely manner helps you reduce costs and improve outcomes. Our solutions also make it easier to review any patient’s prescription medications, health conditions and care, as well as optimize clinical resource allocation based on your data.

We’ve helped our partners:

  • Improve visibility into personas of Chronic Kidney Disease
  • Predict disease onset and at-home patient success
  • Reduce risk and increase margins by keeping clinic care to a minimum
  • Plan for future volume surges and increased demand for care

By enriching your data for machine learning and implementing our prediction models, we help you identify risks and warning signs and predict undetected diseases and health events so you can improve care and disease management.


The COVID-19 pandemic affected every aspect of our lives. As we begin transitioning into the “next normal,” make sure your data tools are equipped for our post-pandemic world.

Lumiata helps payers predict pandemic-related impacts on individual and group costs, forecast hospitalizations, ICU admission and readmissions, and calculate COVID-19 incidence by region or hospital system.

We help providers enhance clinical decision making by informing physicians of patient medical status, use epidemiological models to forecast the recurrence or resurgence of COVID-19, predict hospitalizations, ICU admissions and readmissions, and calculate COVID-19 incidence by region, system and community.

We’ve helped our partners:

  • Address cost-bloomers due to the pandemic
  • Address COVID cost peaks and valleys
  • Predict post-pandemic disease onset and progression

To improve your potential accuracy in managing the impacts of the pandemic, our COVID-19 data set includes medical, mental health, and prescription drug claims through July 31, 2020. We can support you as you adapt to this new era in healthcare.

Data Management as a Service

As the needs of the healthcare industry evolve, interoperability becomes increasingly important. Lumiata’s data management solutions support healthcare organizations’ functions and their relationships with stakeholders.

We start by preparing your data for machine learning in minimal time. Our data model – backed by more than 60,000 hours of development – transforms your data into a structure that our machine learning models can use. We then use your data in combination with our own to predict undetected diseases.

We can also support your interoperability initiatives through our data mapping and normalization capabilities, as well episoding and member grouping, cross coding and disease tagging, and helping you improve healthcare data quality checks. Lumiata also generates Person360 records – longitudinal records of your patients that allow you to access historic profiles via SQL queries, platform filters, or a Jupyter notebook.

We’ve helped our partners:

  • Get their data right from the start
  • Evolve from mediocre model performance to stellar performance and tangible results
  • Smoothly transition from machine learning to deep learning
  • Achieve an up to 80% boost in accuracy of predictions over leading models

With data management as a service, you can easily prepare your data for interoperability and keep up with changing needs.

Payment Integrity

Wish you could catch billing errors before paying? Lumiata helps you spot incorrect claims before they’re paid and before they reach vendors. Our solution is especially beneficial for payers, as we can help you identify suspicious claims before you pay them, empower your internal team to catch more suspicious claims, and enable you to send fewer and lower-cost requests to vendors. We can also help providers ensure claims are paid correctly the first time.

We’ve helped our partners:

  • Automate the claims review process
  • Identify more suspicious claims
  • Increase incremental savings opportunity
  • Reduce money paid to vendors

We accomplish all of this through a payment integrity approach that uses machine learning and artificial intelligence to spot suspicious claims before they’re paid or reach vendors. We believe the typical overpayment identification potential to be 30-40%.


As technology changes, telemedicine plays a bigger and bigger role in how patients receive care. Make sure your data is ready to support your telemedicine initiatives.

At Lumiata, we collect data from your EMRs, handwritten notes and more and enrich it for machine learning. Your data can then be used with our prediction models, enabling you to predict diseases and health events before they happen and intervene sooner for better outcomes.

Through increased data precision, we can help you improve your telemedicine strategy and operations and shape business continuity plans that rely on remote care. We can also help you personalize the patient telemedicine experience, better manage chronic disease no matter the location, and inform population and care management initiatives that use telemedicine.

We’ve helped our partners:

  • Predict major health events, allowing our partners to reach out to at-risk patients ahead of time
  • Identify at-risk patients, allowing our partners to proactively alert physicians of these patients
  • Understand patient needs so they can build telemedicine strategies that positively impact outcomes

To make the most of telemedicine and telehealth, payers and providers need a fresh approach to data that leverages the potential of machine learning. Lumiata supports this approach.

See What Lumiata’s Solutions Can Do For YouWant to learn more about how our solutions can benefit your organization? Click here to request a demo.