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SCAN Health Plan Leverages AI Based Predictive Models to Improve Identification of High Risk Members

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In collaboration with KenSci, the first phase of the project will deploy solutions that aim to predict preventable hospitalizations among members

SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage health plans, announced the first phase launch of artificial intelligence (AI) based predictive models designed to improve health outcomes and inform benefit and service design. This implementation will improve SCAN’s ability to identify high-needs members and provide tailored interventions to help avoid or reduce hospitalizations.

“At SCAN our goal is to support our members at every stage of their journey and utilizing advanced technology, such as AI, enables us to do so on a much more proactive basis,” said Josh Goode, SCAN chief information officer. “As our members’ needs evolve, the KenSci platform allows us to better interpret the needs behind the data so that we can respond with programs and services to help keep them healthy and independent.”

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As a part of the first phase implementation, SCAN and KenSci, a system of intelligence for healthcare, have launched explainable AI models for healthcare, enabling SCAN to identify members at risk of Hospitalization for Potentially Preventable Complications* (HPC) as well as those eligible for Nursing Facility Level of Care (NFLOC). The platform provides SCAN with insights, proactively identifying members potentially at risk for specific disease states allowing for early interventions. In addition, SCAN is using machine learning (ML) techniques that are routine across consumer applications but new to healthcare in helping identify gaps in care to improve the management of chronic conditions.

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“The volume and veracity of data opens up immense possibilities for healthcare organizations to transform the way they support their plan members,” said Samir Manjure, co-founder & CEO, KenSci. “We are excited to work with SCAN and appreciate their expertise in developing these tools to meet the needs of seniors. Together, there is tremendous opportunity to impact the health of older adults.”

“Data is a critical asset in modern healthcare and harnessing it appropriately provides invaluable insight,” said Moon Leung, SCAN senior vice president and chief informatics officer. “By leveraging KenSci’s AI expertise, we believe we can utilize our data to improve health outcomes and quality of life for many of our members.”

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