Predictive Analytics On Medicare/Medicade Cost Outcomes

LIGHT2 (Leveraging Information Technology for Hi-Tech and Hi-Touch Care) is a federally funded project using 24 “Nurse Care Managers” to manage the health of 10,000 Medicare and Medicaid patients. Its goal is to reduce exacerbations of chronic diseases, which would improve health outcomes while lowering healthcare costs. Analytics support (“Hi-Tech”) support for the Nurse Care Managers (“Hi-Touch”) has been used to classify patients by past utilization and costs, but these are imperfect predictors of future exacerbations and increasing utilization. Mining the large available health histories of these patients, along with demographic and other data, reveals some expected and some surprising factors which are associated with high risk of increased healthcare utilization. Clinical implementation of these prediction rules will validate their usefulness.