“Healthcare runs on lists.”
We say that a lot at Lumiata. You’ll see it on our website, in our presentations, even in how we introduce ourselves. Here’s why.
We are in a red zone
I had the incredible opportunity of attending the 2017 Health Evolution Summit earlier this year. It’s an annual gathering of industry leaders deeply involved in transforming healthcare. The discussion point that interested me the most was around accelerating business transformation. One of the key messages was, “We are in the red zone. We can’t get to value fast enough. Too many people can’t afford the care we need.”
This message resonated strongly with me. Every day, I hear about broken or stale business processes in healthcare that are ripe for reinvention. The downstream effects of failing to accelerate are more financial waste, suboptimal care and poor health for people across the country. We can’t afford to move slowly.
How to apply radical reinvention in day-to-day healthcare operations
To transform healthcare’s operations today, in a fast, meaningful and measurable way, we need to look at the common denominator that drives revenue, cost, utilization and care management activities. Therefore, one of the core questions for us at Lumiata, is:
What does radical reinvention mean for the day-to-day of a Chief Analytics Officer, or a Director of Risk Adjustment, or a Manager of Analytics, or a Director of a Care Management program at a payer organization?
It starts with lists.
Lists are that common denominator. They drive the prioritization of actions needed in an industry that faces huge supply and demand constraints. I once heard a program director at an ACO say their providers are extremely list-oriented. Once they have a list they trust, it’s their primary tool for more effective and targeted care coordination and prioritization.
But, these lists have very low ROI. The program director went on to say that their providers often do not trust the accuracy of their lists, because they offer no clinical explanation of why certain patients have been flagged for certain diseases. While these lists are expensive to produce, providers rarely act on them. The result of inaccurate lists is low visibility of the current and future health states of members and the cost implications, little improvement in capture of coding opportunities and correcting missed diagnoses, which translates to inefficiency, financial waste, and poor risk, care and cost management.
Therefore, although seemingly mundane, healthcare’s lists are a core nugget of productivity and efficiency where we can apply pointed innovation–from chart-pull lists and provider lists associated with risk adjustment, Star ratings and quality management, to chase lists and utilization lists that drive care management and revenue management.
What if health plans were able to automatically and continuously derive highly accurate lists from their disparate sources and types of data? Could that give them continuous visibility of highest-risk members, coding and care management opportunities, which they could use as a collaboration tool for providers?
What would our world look like?
More timely and effective use of data, more accurate risk adjustment, improved Star ratings, higher quality of care, less focus on labor-intensive, redundant tasks, and therefore better allocation of resources.
Artificial intelligence can create smarter,
more accurate, and more timely lists that drive business processes
We need to move beyond traditional analytics. Most solutions today are unable to handle the complexity of health data, don’t surface the most important next steps that bring the greatest bang-for-buck, and don’t provide any transparency into models. At Lumiata, we are using AI to build a medical “brain” that can be applied toward the day-to-day processes in list generation and application–from data preparation that is able to ingest and standardize more and disparate sources of data, to predictive analytics that enrich data with medical knowledge and apply deep learning to create more clinically-relevant models, to generation of lists that are more contextual and can be tailored based on business objectives.
Here’s how we do it:
We’re excited about the possibilities. Transforming healthcare’s lists is our first step toward a greater vision of ultimately embedding AI across the healthcare spectrum. By starting with healthcare’s lists, we transform business processes with tangible gains in the near-term, for better care for those who need it the most, and more efficient operations for health plans that are pivotal to healthcare access.
By: Ash Damle, Founder and CEO