It’s the old 80/20 rule, or, in health care’s case, the 85/15 rule. Roughly 15 percent of patients drive 85 percent or more of costs for health care and insurance providers. Managing these patients effectively can significantly improve bottom-line results — and there is plenty of room for improvement.
The medical industry constantly seeks answers to help those in need with continuous breakthroughs for treating everything from Parkinson’s disease to prostate cancer. Here’s the economic flipside of innovation: without evidence of the economic benefits such as reducing downstream illnesses, insurance companies will not reimburse patients for clinical trial treatments. This leaves patients in the unfortunate position of choosing their wallets or their health. As patients face these choices they will demand more details about costs, risks and benefits of their decision.
Enter Big Data
Let’s first look at how technology can empower patient care while helping insurance companies remain profitable. The path for insurance companies to obtain the much-needed evidence for these new, revolutionary treatments is already being accelerated with the depth of data available today. For example, insurers can use data from the millions of medical claims an insurance company processes to analyze the number of patients with prostate cancer (or any other diagnosis), the age of onset, gender, each of the disease stages, the types of treatments and the results of each. Insurance companies can identify trends based on various factors to determine whether a patient fits a profile in which receiving the new treatment is likely to reduce downstream illnesses. Using data for preventive, early treatment trials could ultimately cost the insurance company far less money in the long term.
Health systems can analyze government data (e.g., HealthData.gov, Centers for Disease Control and Prevention, U.S. Food and Drug Administration), financial data, pharmacy data and other factors that can affect the quality and cost of care. Linking these various data sets can answer important questions such as the following:
- Which hip prosthetic delivers the best outcomes from both cost and quality-of-life standpoints?
- How can we find and eliminate variations in care delivery to improve outcomes and lower costs?
- Why did patients who were treated at a particular hospital have better quality of care and financial outcomes than those who were treated at other hospitals?
Take It Up a Notch
Healthcare CEOs are guiding their companies through the recent changes associated with the Affordable Care Act, and recognizing that big data can positively affect the bottom line. They do not want to make another short-lived IT investment; they want insights and answers that improve their ROI. Given the tremendous amount of data available, health care companies need a partner that can take the right mix of information and interpret the data for them. Doing so might seem simple, but most companies, if not all, are missing the boat.
For example, IBM is acquiring companies and building new platforms to bring more data sets to companies, but they aren’t taking that next step to deliver much-needed insights as a service. Although offerings such as IBM’s data lake model, Explorys, stores native data so it can be queried for relevant information about a specific business question, the healthcare industry is in need of companies providing custom-built insights that will positively influence patients and the health care industry.
Now turn to GNS Healthcare, they are moving toward insights as a service versus selling a platform where the client has to gain the insights on their own. The company overlays their “clinical” data with economic data to determine new treatments and efficacy at a finer level. This type of analysis opens up the ability to determine what works for patient A might not be the right treatment plan for patient B due to genetics or drug interactions.
This urgent need for insights creates tremendous business opportunities for companies specializing in health care data collection. The players that can diverge from a traditional IT business model and instead focus on where health care clients are headed to better leverage true insights will be in demand. Insights help clients understand their own customer populations and predict treatment success. Not only does this make business sense, it also offers patients access to the latest treatment options to improve overall quality of life.