The Luminary

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The value of predictive analytics for payers

As artificial intelligence and machine learning become more widely used across the healthcare industry, predictive analytics is proving to be a valuable tool.

Think of it like a crystal ball. Predictions can help you foresee financial and clinical events so you can minimize risk. When you’re able to predict events like high-cost claims or disease onset, you can better prepare for the future.

Predictive analytics offers a variety of benefits for payers, including insights to help you reduce costs, increase competitiveness, improve your member experience, and grow your business. 

AI, Lumiata, Prism. Predictive Analytics

Reduce costs 

Planning an organization’s budget takes valuable time and energy. However, high costs that occur unexpectedly can quickly throw a wrench in your budget and cause you to spend more money than you were anticipating. What if you could see these costs before they occurred? 

Predictive analytics enables you to predict costs so you can prepare for them. With Lumiata, for example, you can predict when a high-cost claim will occur within the next 12 months. You can also predict high-cost members and groups. These insights make it easier to plan for expenses and manage to spend. They also allow you to take informed action, such as more accurately pricing your products. 

Increase competitiveness 

People have a lot of options when it comes to choosing a health insurance payer and plan. This makes it crucial to have competitive pricing. If you set your prices too high, you risk losing current members and failing to bring in new members. If you set your prices too low, however, you risk being unprepared for unexpected high-cost claims. 

Fortunately, predictive analytics can give you valuable insights to help you set optimal pricing. Cost predictions like those from Lumiata can alert you to potential high-cost claims, members, and groups, so you can factor them in when planning your organization’s budget. Being able to properly price your products high enough to cover high costs yet low enough to appeal to members can help you afford potential expenses, keep current members, and attract new members. 

Improve your member experience 

Providing a great member experience can encourage current members to stay with your organization. Members want to feel valued. If they feel like you’re not being supportive of their health and wellness journey, or if they’re frustrated by unaffordable prices or the perception that you won’t cover necessary tests or procedures, they may seek coverage elsewhere when the opportunity arises. 

Predictive analytics provides actionable insights that you can use to improve your member experience. As we recently discussed, cost predictions can help you see potential expenses so you can plan for them while setting pricing. No one wants to spend more than necessary on health insurance, so competitive prices can contribute to a great member experience. This can help attract new members and entice current members to stay with your organization.

Clinical predictions can also be helpful when creating a quality member experience. For example, with Lumiata you can predict when and why the disease will start within the next 12 months.

You can also predict disease progression and medical events, such as those related to “The Big 5” chronic conditions: diabetes, asthma, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF). When you see these predictions, you can alert healthcare providers to the clinical risks so they can intervene and work to keep their patients healthy.

When patients feel like they’re being properly cared for and that providers and payers are taking their health seriously, they may be more likely to have positive feelings towards the organizations involved in their care. 

Playing a role in keeping people healthy not only provides your members with a better member experience but also helps prevent the need for costly treatments associated with diseases or medical events. Not having to cover these costs saves your organization money, and you can pass these cost savings on to your members in the form of better prices. 

Grow your business 

Predictive analytics can be a valuable resource for payers aiming to grow their businesses. As you know, using cost predictions to inform your pricing strategy can help you set competitive pricing that attracts new members and encourages existing members to stay. Using clinical predictions to inform providers of health risks so they can keep patients healthy helps prevent the need for your organization to pay for expensive treatments. 

By reducing costs in these areas, your organization can take the money you would have spent and put it towards other high-value areas. That may be spending money on resources to help improve internal processes, spending on programs that improve the member experience, or some other project that supports your business goals. Whatever you choose, having more money gives your organization more opportunities and can help your business grow. 

What can Prism by Lumiata do for you? 

When you want to benefit from predictive analytics, be sure to choose the right tool. Prism by Lumiata is a revolutionary self-service deep learning approach that requires minimum data for maximum results. With as few as 50 member records, you can start generating valuable financial and clinical predictions. We can even customize the predictions to your specific member population. 

With Prism, you can: 

● Predict high-cost claims and members 

● Predict when diseases will onset or progress 

● Prevent future encounters with 60-80% accuracy 

Prism is powered by a deep learning model that predicts costs and more than 130 diseases over precise timelines. The model is built on over 130 million claims and electronic health records. Prism outperforms the traditional machine learning approach, and its cost model identifies high-risk patients 40% better than traditional risk score models. 

Our cost and disease predictions give you actionable insights to help you set optimal pricing, manage spending, be more competitive, achieve favorable outcomes for patients, reduce healthcare costs, and more. 

Request a demo Predictive analytics provide a ton of value for payers. Ready to see how valuable Lumiata’s insights can be for your organization? Request a demo to learn more.