Payers have been busting out of their traditional role as benefit administrators and claims payers and becoming more like healthcare delivery partners. In this newer role they are sharing data with providers, helping them perform more efficiently and connect with individuals.
That was one of the observations in a recent report about insurers and healthcare data analytics by PriceWaterhouseCoopers. As payers and providers strive to improve patient outcomes and reduce costs they are finding opportunities to use the data at their disposal to create “actionable information.”
Dr. Somesh Nigam, the chief informatics officer at Independence Blue Cross, spoke with MedCity News in a phone interview about some of the ways it is using big data, including through its collaboration on projects with Penn Medicine.
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“Big data is our bread and butter. We can use large volumes of data for predictive analytics to assess who is most likely to be hospitalized. We can also use it for wellness to help change behaviors…Data will play a huge role in providing patient-centered care. It will obviously play a huge role (for) accountable care organizations that institutions are looking at, including Penn.”
Historically, providers and payers have looked at problems like changing behavior and improving outcomes within their own silos, but those strategies have only met with moderate success. But now that the silos are coming down, spurred by the Affordable Care Act, it’s changing the way payer and providers work together. Here are five ways Independence Blue Cross is using its data with other providers.
1. Mining aggregated claims data The insurer is providing aggregated claims data to providers from various sources including inpatient and outpatient care, emergency rooms, and pharmacies to help coordinate care. It can provide historical lab data and related clinical information to help providers develop effective treatment approaches and fill missing care gaps.
2. Using claims data to improve adherence Independence Blue Cross is collaborating with Penn Medicine Innovation Center physician Dr. Kevin Volpp on a project designed to increase medication adherence amongst patients after admission for acute myocardial infarction, using a combination of wireless technology, social and financial incentives (including a daily lottery) and remote support. Medication adherence for patients with acute myocardial infarction tends to be less than 50 percent so increasing adherence could significantly reduce hospital re-admissions and other complications. Nigam said the insurer has been tracking patient adherence using its claims data, but providers get a lot of information on patient adherence too. “The idea is if we collaborate, we can identify who has suffered a heart attack and can initiate an appropriate intervention.”
3. Increasing coordination IBX analyzes aggregated health care data to assess effective care approaches that provide superior outcomes. This analysis is also used in its discussions with providers to improve quality and increase coordination. It publishes this information in healthcare journals to share best practices. As a recent PriceWaterhouseCoopers report on advancing healthcare informatics points out, it fits in with a wider trend of insurers working to build trust by developing technology and practices that better serve providers and members, resulting in more data sharing. With more patient health information, insurer databases can feed the analyzed data back to clinicians who use it to enhance patient care and reduce costs.
4. Patient centered medical homes Its work with primary care practices towards establishing patient care medical homes to improve chronic conditions is aimed at enabling more personalized, coordinated and effective care. “We support PCMHs via provider incentives through our quality improvement program as well as through health informatics support, including reports showing: gaps in care, screening status, hospitalization alerts and drug adherence measures.”
5. Collaboraing with startups to develop tools to boost collaboration One area where IBX and Penn Medicine are collaborating is on Philadelphia’s first health IT accelerator — DreamIt Health. They are not only serving as advisers on the program, but will provide access to resources of their respective institutions. Getting access to providers and payers is the most daunting challenge for entrepreneurs in healthcare. Among the tools it is seeking to develop are applications for large-scale data analytics using claims, clinical data, and other information to improve wellness and treating illnesses as well as consumer engagement tools like gaming apps. The February 8 deadline for applicants is rapidly approaching.
