Lin Chen, Director, Cambia AI Engineering; Alex Lou, Cambia Data Scientist; and Laura Frey, Cambia Data Scientist
AI is the new electricity, according to computer scientist and Landing AI CEO and Founder Andrew Ng. At Cambia, we are embracing the new electricity combining AI, data science and machine learning with human touch and empathy to create a person-focused and economically sustainable health care system.
One example is using AI to augment and optimize the manual review process for claims. AI significantly reduces the number of claims to review using a filter system to identify which ones are at the lowest risk for being audited.
Ng also said that 90% of the success of applying AI comes from one area of machine learning: supervised learning -- mapping an input to an output. In the claim review case, we formalize the problem as a probabilistic filtering problem by building a model to predict whether a claim will have no finding. The model produces a score, and we tune the score to determine the threshold to flag the claim to review, based on the risk the business is willing to take. This machine learning task can be likened to finding a needle in a haystack: rather than searching for needles (actionable claims), we use AI to remove as much hay (unactionable claims) from the stack as possible. This results in auditors being more efficient in finding actionable claims.
Building trust and confidence is key for AI adoption in health care. To ensure a successful delivery, Cambia’s AI and Data Science team closely partners with the Cambia Audit team who ensures our claims are processed properly. The effort includes tight communication, providing offline metrics, building an experimentation platform, and conducting manual reviews to ensure the quality of the machine learning model. The metrics after deploying the model into production show increased return on investment, with less work for the auditors who are uncovering the same number of issues.
Just as electricity changed the world, AI has the potential to transform health care. That’s why Cambia is embracing the use of these innovations in our standard operations with a sense of urgency.
