Technologies that turn healthcare data into knowledge make up a market that’s projected to grow more than 20 percent over each of the next five years. It’s quickly become a crowded space with startups and big players alike, but according to Pamela Peele, there are still some pain points left to be solved.
Peele is chief analytics officer at UPMC. At the MidAmerica Healthcare Venture Forum, she shared how the country’s second-largest payer-provider organization is using machine learning and data analysis to understand and manage its financial risk.
Insurers have been doing this for a long time, but she said recent shifts in the industry have driven health systems to seek out sophisticated analysis systems of their own to understand episodes of care and manage patient populations. That’s part of what’s driving innovation by healthcare IT companies.
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Here are a few pain points and opportunities Peele said she’s noticed:
- More provider systems are becoming part of ACOs and Medicare Shared Savings Programs, but not all of them are big enough to justify the billions of dollars of investment required to set up the infrastructure and systems to do sophisticated analytics. Or, the population of patients may not be big enough to do valuable predictive modeling. “The play that should be happening there is an analytic brokerage play,” she said. “Your 25,000 (patients) gets combined with (another’s) 25,000 until pretty soon you’ve got one broker who’s learning across all of this data and then pushing it back out.”
- Payers are looking for simulation modeling software, Peele said. Payers get first-line healthcare dollars, and it’s their job to manage how those dollars are used through various financial arrangements like bundled payments, physician networks and contract services. It would be helpful for insurers to be able to see how changing the service mix, or the place of service, or the contracting prices would affect the distribution of money. “At UPMC we build these internally because we can’t buy them,” she said.
- Medicine has traditionally focused on interactions between a patient and a provider. But that’s changing, and providers need disruptive applications to accommodate that workflow process. “We don’t have enough doctors to iterate around that model,” she said. “Where is the innovation that takes some (steps) away from formal medical providers and puts them with the individual and their caregiver and their family, so that they’re in charge of figuring something out, instead of ‘I’m waiting for the doctor to call me back.’”
- Activating the patient is another key step in disrupting the workflow. “I see the biggest opportunity, particularly with entrepreneurs, in the space is in patient engagement,” Peele said. “How do we get patients to change their behavior around the consumption of healthcare, because just providing them with more healthcare doesn’t improve their health status.”
[Featured image credit: FreeDigitalPhotos user Stuart Miles]
