Author: Steve Ditto, Strategic Partnerships

Key Points:

  • More than 51% of all Medicare spending is on surgery
  • Surgical spending is a largely unaddressed area of cost and member experience
  • AI-enabled predictive insights can now enable Digital Surgical Management 

Surgery for the Medicare population is prevalent, costly, and risky

Medicare Surgery Facts:

  • 51% of Medicare spend is on surgery 
  • $22,500 cost per inpatient surgery
  • $20,000 cost of complications
  • 10% risk of adverse events

Medicare payments for surgery represent 51% of program spending. Many health plans have avoided tackling surgical spend in their Medicare Advantage (MA) populations because surgical care has been viewed as hard to address. That perspective may be changing as health plans need additional cost and quality improvements to be competitive and can no longer ignore such a large area of spend.

AI-enabled predictive insights at key decision points

Just as health plans used technology solutions to address cost and quality in chronic care management, the data and tools needed for surgical care management are becoming available. It’s now possible for health plans to implement AI-enabled predictive insights at key decision points to deliver high value “Digital Surgical Management”.

Key Decision Points

The future of surgery is predictive, personalized, and digital

Importantly, these perioperative surgical advancements don't need to be implemented as part of large, expensive, one-size-fits-all programs. AI-enabled predictive insights make it possible to deliver a personalized yet scalable “white glove” approach to surgical benefits. Imagine a zero premium product offering member-specific risk assessment, education on go/no-go decisions, and personalized care pathways to the most appropriate providers and settings – all funded by improvements in cost and quality made possible by AI-enabled predictive insights.

The business case for change

Based on published results, KelaHealth recommendations are accurate, accepted by surgical teams, and generate meaningful improvements in cost and quality. When KelaHealth’s predictive AI-models are applied to vascular, cardiology, and orthopedic surgeries, leading provider organizations are achieving more than $1 million in total cost of care savings for every 1,000 surgery patients. 

Based on the cost and prevalence of surgery in the Medicare population, this level of savings translates to $12 million in cost reductions for every 100,000 covered lives. 

AI-enabled Surgical Intelligence Platform 

Health plans have invested heavily in their digital platforms. The KelaHealth Surgical Intelligence Platform is well positioned to plug into these efforts, providing health plans with the digital experience increasingly demanded by the market.

The KelaHealth Surgical Intelligence Platform can also be extended to providers as a tool to help improve cost and quality under value-based contracts. Leading healthcare providers have integrated KelaHealth predictive insights into their electronic health record (EHR) and surgical workflow to make recommendations available at the point of care. 

The future of digital surgery is now

Few areas could benefit more from AI than surgery. As the population ages, the cost and prevalence of surgery is increasing and these advancements in Digital Surgical Management could not come at a better time. 

Schedule a time to speak with a member of the KelaHealth team and learn more about how we can help you and your organization.