New Program Identifies People Considering Surgery

Identifying people considering elective surgeries results in better medical decisions and lowers costs, according to a data analysis done by ConsumerMedical. Its combination of artificial intelligence (AI) and predictive analytics reduced surgical expenses by half and improved medical outcomes, according to the company.

In a paper, "Earlier Identification of Potential Surgery Candidates Results in Higher Engagement, Lower Costs," ConsumerMedical outlines the development and application of the new AI-powered model, and its results.

“Often patients are already on the pathway to surgeries that may not be necessary, without having evidence-based information on whether this is the best option for them, or knowing about other alternatives that would help them without the risks of surgery,” says Randy Hawkins, MD, chief medical officer and executive vice president of health analytics at ConsumerMedical. 

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Individuals identified in the early stages of the decision-making process were more than twice as likely to engage with the counseling services than those who were identified later-31.3% engagement versus 14.3% engagement. Claims savings for these individuals was more than double the savings from employees who were not identified early-$7.33 per employee per month, versus $3.05 per employee per month, the company reports.

The AI-powered model focuses on five types of surgery: lower back, hip and knee replacement, hysterectomies, and weight loss surgery.
“It’s estimated that more than 2.3 million people annually undergo one of the five surgeries we targeted for which patient choice, not clear clinical recommendations, are the deciding factor in getting the procedure,” Hawkins says. “It’s important we find ways to reach these patients because it’s also estimated that unnecessary medical tests and treatments cost an estimated $200 billion annually.

“The findings from our data analysis highlight that the issue of the impact of elective surgeries on cost and outcomes is one health plan leaders need to continue to examine,” he adds.