In-depth analysis of over 110 million claims reveals the top conditions to watch for in the year ahead

SAN FRANCISCO, Jan. 10, 2023 /PRNewswire/ — Prealize, an artificial intelligence (AI)-enabled predictive analytics company, today announced the release of its much anticipated, third annual State of Health Report.

Prealize’s 2023 State of Health – In The Aftermath identifies the top at-risk conditions and utilization spikes that healthcare leaders and stakeholders across the industry must prepare to proactively address in the upcoming year. The report also presents predictive findings and explores the top contributing factors of many utilization increases.

As we approach the third anniversary of the global pandemic, a picture of our changing landscape has finally begun to crystallize. While the vast majority of Americans have quietly resumed a “new normal” for daily life, the world of healthcare lags behind, continuing its slow recovery. Though great gains have been made in COVID-19 vaccinations and treatment, rampant staffing shortages persist, care teams continue to burn out, and hospital operating costs have hit a historic high – while margins have reached an all-time low.

“This year’s predictions reflect just how unequipped we are to handle the lingering and persistent effects of COVID-19. For the first time, we’re tracking substantial connections between SARS-CoV-2 infection and extreme comorbidities, such as acute myocarditis or cardiorenal syndrome, said Linda Hand, CEO Prealize Health. “We are seeing the long-term effects of a system built on episodic care. These volume increases underscore the crucial need to invest our resources, energy, and focus in holistic and preventative care. Without investing in workflows and preventative care for the whole person, we cannot expect our national health to improve.” 

The report forecasts conditions that are predicted to be at risk for increased utilization in 2023. These include:

• Prealize Health’s predictive models forecast large spikes in cardiovascular utilization across the board. Conditions including cardiorenal syndrome (29% increase), cardiomyopathy (26% increase), cardiac block (20% increase), ischemic heart disease (19% increase), chronic heart failure (13%) and cardiac dysrhythmias (8%), and valvular disorder (7%) will be increasingly common in 2023.

• Behavioral Health, intellectual & developmental disorders, substance abuse and overdoses are predicted to increase. Care utilization for pediatric substance abuse is predicted to have a 24.5% increase, while intellectual & behavioral disorders are shown to have a 13.7% increase.
• Chronic Conditions, such as COPD, Diabetes, Obesity & Asthma will significantly increase. Prealize predicts a 21% increase in COPD utilization across all age groups. Diabetes is also expected to see a substantial uptick, up 13% from the year before, while obesity is predicted to increase by 11%. Asthma’s prevalence is predicted to increase 6% year-over-year.
• A dramatic increase in obstetric emergencies for mothers that are covered by Managed Medicaid. For this population, the risk of pregnancy with complications is forecast to increase 33% in 2023. While time may reveal how limited care access will impact outcomes, generally higher levels of stress and depression, rising incidences of obesity and gestational diabetes, and a national disruption to family planning services may likely contribute.

In Prealize’s annual analysis, another telling trend also emerged. Across care types, preventive primary care physician visits and specialty care visits tended to decrease in the weeks and months following a COVID diagnosis. In turn, just as preventive office visits decreased, the utilization of care for severe conditions increased. Based on these findings, it is more important than ever for health plans to seize the opportunity and help catapult the industry into the future of care delivery.

“With the industry at a crossroads, plans can lead the way by embracing predictive analytics to help forecast risk, mitigate costs, inform and motivate members, and equip caregivers with proactive and preventive care options,” said John Coughlin, Vice President, Informatics & Analytics, Sentara Health Plans. “Predictive analytics is the best tool available for organizations looking to drive transformational change.”

For more information on Prealize Health, and its insights, solutions and results, please visit prealizehealth.com. 

The 2023 predictions featured in this report are based on Prealize’s analysis of data from more than 3.6 million lives and over 110 million claims  between Jan 1, 2019 and Oct 31, 2022, the latest time frame for which claims data was available at press time. To ensure that the sample reflected the broader U.S. population, the analysis included patients of all ages across multiple lines of business, including Commercial, Medicare Advantage, Medicaid and Managed Medicaid.  To predict future healthcare costs and utilization at the individual level, Prealize uses advanced artificial intelligence, specifically proprietary supervised machine learning models, trained on four or more years of medical claims, prescription claims, lab data and population outreach data.

Prealize marries state-of-the-art AI-enabled data science with “next-best action” health insights. Based in San Francisco, the company was founded by two industry thought leaders from Stanford University. Committed to transforming healthcare from reactive to proactive, reducing healthcare costs and enabling more people to live healthier lives, Prealize partners with health plans, specialty care management companies, healthcare technology companies, employers, and providers across the nation to positively influence the health trajectory of millions of people. For more information, visit www.prealizehealth.com or email info@prealizehealth.com.

For More Information
John Gonda
616-309-4888
jgonda@sage-growth.com

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SOURCE Prealize Health