Bringing down the skyrocketing costs of healthcare isn’t just a matter of paying for quality instead of volume.
It also has to do with predicting accurately who are at risk of becoming sick and then delivering the right treatment before they do so. What facilitates this kind of knowledge gathering? The magic of big data.
In a sign that payers are rapidly adopting tools and practices to be able to manage the health of their population and lower costs, a Massachusetts big data analytics company announced Thursday that it is partnering with marquee health insurance firm Aetna to help prevent metabolic syndrome. Those who have that disorder are at significant risk of developing heart disease, stroke and diabetes.
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GNS Healthcare has developed a proprietary supercomputer-driven technology called Reverse Engineering and Forward Simulation (REFS) that is being combined with Aetna’s claims data to help identify people who are at risk for metabolic syndrome earlier than before, evaluate those that already have the disorder and “pinpoint” effective treatment for individual members, according to a GNS news release.
The technology will create data-driven models used to evaluate members based on five conditions: large waist size, high blood pressure, high triglycerides, low HDL (good cholesterol) and high blood sugar. If a member demonstrates at least three of the five conditions, they have the disorder, while someone with one or two of them is at risk of developing the syndrome.
Based on the individual’s health information, the model will be able to predict which new condition the member will exhibit and within what time. For instance, the model may show that a member with high triglycerides and low HDL will likely develop hypertension in the next 12 months, GNS said.
“Multiple big data methods can identify at-risk people. We are different because we not only identify people at risk, but we also can identify the most effective intervention for each person,” said Colin Hill, CEO and co-founder of GNS Healthcare, in a news release.
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The collaboration underscores Aetna’s philosophy that the insurance company is willing to work collaboratively with tech and other companies to solve the challenges of the healthcare industry.
“We’ve come to terms with the fact that we need to bring in people from outside our own walls who can think about things more innovatively than people at an insurance company,” Mary Wofford, an Aetna executive, told audience members at the federal government’s Datapalooza in June.
