In the evolving landscape of value-based care (VBC), accountable care organizations (ACOs) are continually seeking ways to optimize savings under the Medicare Shared Savings Program (MSSP). One promising strategy is the integration of artificial intelligence (AI) tools to drive higher patient participation in routine health screenings—an essential component in achieving better outcomes and cost efficiencies.
A proven AI-powered population health solution like Lightbeam can be a key component of your MSSP performance strategy. In Performance Year (PY) 2023, Lightbeam helped ACOs generate nearly half a billion in gross MSSP savings, driving cumulative savings beyond a $3 billion milestone since 2014. Therefore, integrating preventive screenings into a comprehensive care management strategy can significantly improve your MSSP metrics.
In a previous post on MSSP savings optimization from our Director of Advisory Services, Melissa Tyler, we discussed several high-impact recommendations for increasing MSSP metrics rapidly, including improving care transitions, strengthening data management, preventing avoidable ED visits, automating the patient feedback process, and focusing on preventative measures like regular screenings. Let’s take a deeper dive into how AI can streamline screening reminders, scheduling, and compliance—while also strengthening primary care provider (PCP) relationships and seamlessly closing care gaps in Hierarchical Condition Category (HCC) coding.
Using an AI-powered, data-driven platform like Lightbeam can accelerate member participation quickly and improve outcomes by automating administrative reminders to schedule preventative care screenings and vaccinations for the highest risk. The other key is chronic disease management—supporting routine diabetes, cancer, hypertension, heart disease, and depression. Regular check-ins and monitoring for medication adherence can significantly reduce emergency department visits and avoidable admissions.
Screening Power: The Benefits of AI Automation
Within VBC environments, the benefits of aggressive screening efforts are many, including proactive care of chronic conditions. Regular screenings for cancer, diabetes, hypertension, heart disease, and depression also enable early interventions, leading to fewer hospitalizations and ED visits, lower healthcare costs, and better patient outcomes.
In a compelling use case, a rural Georgia-based ACO implemented Lightbeam’s AI-powered solution to automate workflows and reduce avoidable admissions by 4% among a challenging patient population, also increasing staff productivity by saving 41 care management hours a week. And in another success story, an Integrated Delivery Network (IDN) in the Southwest achieved a 43% relative reduction in avoidable admissions among its high-risk Medicaid plan members by using Lightbeam AI’s 30-Day Avoidable Admission model, leading to estimated avoided healthcare costs of $640,000.
Chronic Disease Management Optimization
In the context of MSSP and preventative healthcare, we recommend focusing on five key screening categories—cancer, diabetes, hypertension, heart disease, and depression—as they significantly enhance early detection and intervention, potentially reducing hospitalizations and healthcare costs.
- Cancer
The highest impact screenings are for breast and colon cancer, which can potentially catch disease early when it’s more treatable.
As an example, Mohawk Industries leveraged Lightbeam’s AI-enabled platform to identify all female employees who were past due for breast cancer screenings. Partnering with providers, Mohawk offered onsite mammography through mobile programs, where a team member was flagged for a subsequent ultrasound that confirmed a breast cancer diagnosis. This is a great example of the power of ensuring the right services are in place at the right time for the right patient.
- Diabetes
Early detection of diabetes can help with disease management and prevent complications. Regular glucose screenings can identify pre-diabetes and diabetes in individuals at risk.
- Hypertension
Regular blood pressure checks can identify hypertension or pre-hypertension stages, allowing early treatment and prevention of complications such as heart disease and stroke.
- Heart Disease
Routine cholesterol screenings, along with blood pressure readings, can help identify heart disease risk. Adjustments in lifestyle, along with medications, can then help mitigate the risk.
- Depression
Depression is often comorbid with other chronic conditions, such as diabetes and cancer. Early intervention can initiate treatment and therapy to prevent the acceleration of negative mental and physical outcomes.
One Lightbeam Advisory Services client achieved a 39.45% decrease in per-member-per-month (PMPM) costs through enhanced chronic disease management and preventative care, saving more than $32 million for a cohort of more than 4,500 members.
Value-Based Care Performance Improvement
Preventive care helps avoid costly downstream services by identifying risk factors before they escalate. In addition to improving patient outcomes, AI-driven tools that optimize care quality and shared saving simultaneously support VBC performance objectives through:
- Targeting High-Risk Patients Through Predictive Analytics: AI-powered predictive models can aggregate and automate EHR data, SDOH data, claims history, behavioral patterns, and other data sources to identify those at highest risk of missing recommended screenings—automating outreach based on priority and ensuring resources are directed where they can generate the greatest value.
- Closing Gaps in Care with Workflow Automation: Lightbeam AI functionality provides seamless care gap identification in one location—automating clinical workflow integration and alerting providers during patient encounters. AI-enabled dashboards and smart registries ensure that clinicians have real-time visibility into which patients are overdue for screenings and can address these gaps proactively.
- Enhancing Telehealth and Remote Screening Capabilities: AI-enhanced telehealth platforms facilitate remote consultations and even assist in remote diagnostics. For example, AI algorithms can interpret retinal scans for diabetic retinopathy or analyze stool samples for colorectal cancer screening, expanding access to care and reducing logistical barriers to screening.
- Improving Risk Adjustment Documentation: Since MSSP metrics use risk adjustment to calculate expected spending for attributed beneficiaries, screenings (e.g., annual wellness visits, HCC coding-related screenings) lead to better documentation of patient conditions. This improves the accuracy of HCC scores, which increases the benchmark spending threshold, making shared savings much easier to generate.
- Enhancing Quality Measures: Quality scores directly impact shared savings eligibility and are a key driver of MSSP performance measurement. In fact, many quality metrics in MSSP are tied to preventive screenings (e.g., breast cancer, colorectal cancer, A1C control, BMI assessment). The result is that higher quality scores improve overall performance and protect shared savings opportunities.
- Strengthening Patient Engagement and Retention: Regular touchpoints like screenings increase opportunities for education, trust-building, and patient activation. Engaged patients are more likely to comply with treatment plans and follow-ups—producing better outcomes and improved attribution stability in MSSP.
Here are valuable quality measure resources to help you identify your priorities:
Quality Measures | CMS https://mmshub.cms.gov/
List of CMS ACO Quality Measures
As healthcare continues to shift toward VBC, AI will be an increasingly critical tool in optimizing patient engagement, preventive care, and overall care delivery. ACOs that strategically implement AI tools to enhance participation in routine screenings position themselves to maximize MSSP savings while delivering higher quality care.
To design the most effective solution, consult with a population health consultant, such as Lightbeam for a customized approach. Learn more about Lightbeam AI. Request a Demo.
