Take diabetes for example. It is one of the most prevalent chronic conditions in America. In fact, according to the CDC more than 100 million adult Americans are now living with diabetes or pre-diabetes. Not only is it the seventh-leading cause of death in the U.S., it is an incredibly costly disease both in financial and quality of life terms. It can also lead to – or complicate – other chronic conditions as well.

The key issue is that once a member/patient is diagnosed as a diabetic, he/she is always considered a diabetic, and will require greater clinical and financial resources. If payers can unwind their Rubik’s Cube of data to identify which members/patients are trending toward acquiring diabetes, however, they can recommend interventions and work with members/patients (and their providers) to halt or even reverse the trend.

Payers can also use that data to identify which “Diabetes 101” interventions are likely (or unlikely) to work for a specific member/patient based on others who fit a similar profile or persona, so they can create alternatives. Suggesting an expensive medication for a diabetic member/patient who lives in an underserved community and is faced with the dilemma of paying rent or paying for medication is unlikely to drive member/patient compliance. Identifying that challenge through demographic or SDoH data will alert payers to look into alternatives.

Incorporating artificial intelligence (AI) into the analytics makes working with individuals and populations even more effective. It’s like having someone who already knows how to solve the Rubik’s Cube guide you through the process.

The advantage of AI is that it can work through that mountain of diverse data and uncover subtle relationships a human might miss, such as noticing that members/patients who respond that they have a pet on their self-assessments tend to be more compliant to their plans of care than those who do not.

By sharing that information, payers can help providers produce better health results for members/patients, again while reducing their own costs. It’s a win for everyone.

Taking action
Unlike providers, payers also have one other advantage: the financial resources to do something with the information once they have it.

In the value-based care era, providers know they must be proactive around member/patient health, especially for those who fall into the high-risk category. Yet it is difficult for most of them to dedicate the resources required to improve member/patient engagement to a significant degree.

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