Healthcare spending in the United States already exceeds $3.5 trillion and by 2026 it is anticipated to reach more than $5.7 trillion. As costs continue to skyrocket, health plans are focusing on innovations in technology and emerging data sources to decrease costs and increase the quality of care. Traditionally, health plans have depended on historical claims data paired with basic statistics and rules-based approaches to target resources towards reducing costs. However, in today’s world of rapidly expanding data, these techniques fall short. Fortunately, advances in artificial intelligence now allow traditional claims data to be combined with new and emerging data sources to provide a more comprehensive picture of member risk, allowing health plans to target preventative programs more effectively than ever.
ClosedLoop.ai is an AI-based predictive analytics platform that provides health plans with comprehensive predictive insights at both the individual and population level. The ClosedLoop.ai platform synthesizes data from a variety of sources including claims, provider, social, environmental, consumer, and more, so health plans can gain a comprehensive and transparent picture of members' total risk. Today, customers are using ClosedLoop to address a wide variety of predictive questions including:
TREND: Which members are likely to see large increases in their overall health risk over the next three to six months?
READMISSIONS: Which members are most likely to be readmitted to the hospital?
MEDICATION ADHERENCE: Which members are most likely to be noncompliant with medication plans?
PALLIATIVE CARE: Which members are most likely to benefit from discussions with a palliative care specialist?
ED OVER-UTILIZATION: Which members are most likely to benefit from establishing a relationship with a primary care provider?
DISENROLLMENT: Which members will most likely to disenroll?
FRAUD: How do new data sources allow health plans to spot fraud sooner?
PAYMENT INTEGRITY: How can AI help ensure proper reimbursement?
ClosedLoop.ai, a platform for more effective data scientists.
“Data scientists spend most of their work time (about 80%) doing what they least like to do: collecting existing datasets and organizing data. That leaves less than 20 percent of their time for creative tasks like mining data for patterns that lead to new research discoveries.”
- NIH Strategic Plan for Data Science