Case Study: Regional Accountable Care Organization reduces ER costs with dotData AI

Healthcare: Improving Inpatient Utilization

Regional Accountable Care Organization needed a way to reduce poor inpatient utilization and costly emergency department visits, a major expense center for accountable care organizations. The challenge was to identify “at risk” Medicare beneficiaries early enough to encourage more appropriate primary care use instead of avoidable ED visits. dotData’s AI automation platform, dotData Enterprise, was used to help address this need.

Using dotData Enterprise and CMS Medicare Shared Savings Program CCLF data, dotData built a highly accurate model to predict which beneficiaries were likely to visit the ED within a 30-day period. In November 2020, the model’s top 2.5% of predictions captured 22% of actual ED visitors, representing $2.75M in ED costs; if half of those visits were redirected to primary care, the projected savings were about $1.4M for that month alone.