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With healthcare utilization for preventive care, chronic care, and emergent care significantly decreasing in 2020 due to the COVID-19 pandemic, a new report explores key medical conditions payers and providers should proactively address in 2021. One key finding is that the year ahead will see an influx of newly diagnosed and later-stage conditions.
The report, from Prealize, an artificial intelligence (AI)-enabled predictive analytics company, identifies the top at-risk conditions based on Prealize’s claims analysis and predictive analytics capabilities. For the study, Prealize accessed claims data for more than 581,000 patients between March and August 2020. These patients represent a wide range of ages across commercial, Medicare, and Medicaid coverage, and the data was compared to claims from the same time period and patient population in 2019. Prealize then applied over 50 machine-learning (ML) models built into its platform to project diagnostic and utilization trends for 2021. These ML models assess over 30 clinical drivers of future healthcare utilization to predict a patient’s risk for being diagnosed with a clinical condition or needing a clinical procedure, up to 18 months before a claim is filed, according to company officials.