Healthcare in America is rapidly changing. According to the Centers for Medicare & Medicaid Services, healthcare costs soared to $4.3 trillion in 2021 and are predicted to reach $6.8 trillion by 2030. With the cost of care continuing to rise, the need to unlock the potential of care management to improve health outcomes is critical.
Many health plans don’t have the bandwidth or resources to identify which members their care management programs could have the most significant impact on and as a result, they have been seeing a reduction in the quality of care and an increase in potentially avoidable and expensive health incidents.
How do we improve the utilization of our current resources and offer better care? Many industry experts are experiencing the value of artificial intelligence (AI) as a great tool for streamlining care management.
Artificial intelligence is made up of systems or machines that mimic human intelligence to find the best and most efficient methods to perform tasks and find solutions. AI uses data to consistently improve its performance and can help organize information so that it is easier to digest and understand patterns. Many different industries, such as banking, retail, and manufacturing, utilize it, but it is the healthcare industry and the patients who use its services that are benefiting from it in amazing, unprecedented ways. Here’s how:
Traditionally, the healthcare industry has approached risk stratification reactively. Members aren’t engaged until they’ve already reached the point of clinical deterioration, and engagement is built to stop conditions from worsening rather than preventing them from happening. Engagement is also challenging as many members don’t trust their health plans.
AI can flip the script and approach patient risks before they become issues. For example, by pairing member and plan information with its large medical datasets, which can include EMRs, ER visits, lab data, pharmaceutical data, eligibility, prior authorizations, and patient questionnaires, Diagnostic Robotics can predict risks patients might incur if they don’t follow specific treatment pathways.
Health plans can focus on engaging with members who are more likely to engage and follow specific pathways towards prevention, which drives decreases in member deterioration and total cost of care.
After allowing AI to identify the most impactful patients, it can provide actionable insights into how to reduce avoidable events.
Diagnostic Robotics’ AI can generate novel combinations of disease states to help drive better health outcomes and determine which patients are most impactable. This expands the scope of addressable members beyond those with known ailments, allowing for truly proactive prevention. The streamlining of care outreach improves patient satisfaction and motivates them to take the necessary steps to avoid preventable health events.
Having a lot of member data and an array of risk models isn’t useful for risk stratification if they aren’t fresh. There are many different factors that must be considered when evaluating a member’s risk score and keeping up with those factors is critical for accurate prioritization.
Diagnostic Robotics’ proprietary AI models, which mine more than 60B claims data points, ensure top accuracy and precision by running continuously and adapting to address your members' unique health pathways, lifestyles, and external factors like seasonal changes. They can also provide nuanced insights into how a variety of disease states are linked and how together they can impact members’ deterioration and clinical treatment plans.
The healthcare industry has just scratched the surface of utilizing AI to its full potential. It has the power to provide predictive, proactive, and personalized healthcare at a lower cost for all and lighten the physician workload. AI can serve as a resource to reduce this burden by identifying avoidable health events before they occur, advancing continuity of care, and promoting patient compliance with care programs.
How will you apply AI to your care management strategies?
Learn more about Diagnostic Robotics AI-powered solutions here.
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