Signal through the noise

HilfertyThe term "Big Data" describes how the exponentially growing amount of information that’s available today is stored and analyzed, and it’s especially important in healthcare. Today, or very soon, everything from our individual genome analysis, to the medical services we get, to our personal habits-healthy or not!-will be available to dissect and analyze, making "Big Data" a critical tool for increasing the quality and lowering the cost of care.

Such ground-breaking developments with predictive analytics raise the question: What if?

• What if we could identify gaps in care and alert the patient’s doctor in real-time?

• What if we could predict who was most likely to need hospitalization in the near future?

• What if we could prevent people from even getting sick in the first place?

In fact, wisely used, sophisticated data analytics-capturing and transforming huge amounts of data into information that enables us to see micro and macro trends-allows one to predict what is going to happen, to intervene more precisely, and make changes when necessary.

As a healthcare organization that serves nearly 10 million people across 24 states and the District of Columbia, Independence is well-positioned to be a leader in so-called “Big Data.” Every time one of our members visits the doctor, checks into the hospital, or fills a prescription, this gives us data that we can use to reshape the face of care. And that data connects us to all the key players in healthcare-doctors, hospitals, patients, pharma, employers, and the individual consumer. Working closely with all of these partners, we analyze data and take action.

For example, using claims data, medication lists, lab results, and insights from our personal health coaches, we calculate a “likelihood-of-hospitalization” score for our members who have serious chronic illnesses. If a member’s score hits a certain threshold showing she is clearly at risk, our health coaches reach out to her and, if necessary, notify her doctor, who can then determine the best course of action for that patient.

We are also using data to help physicians identify gaps in care. Three years ago, we partnered with two other Blue insurers and a healthcare technology firm to purchase NaviNet, the nation’s largest real-time, secure communication network for physicians and hospitals. Today, through NaviNet we can notify physicians in real time if patients they are about to examine need an immunization, a health screening, or other critical preventive care.

That means we send the office an alert to share with your doctor detailing any gaps in your care-a missed mammogram or colon cancer screening, for example-that your physician can address right away. We also provide your physician a complete clinical profile showing any care you received across our entire network of physicians and hospitals-an unprecedented 360-degree view of your care.

Then there’s that question, “What if we could prevent people from even getting sick in the first place?

Eight percent of the U.S. population-25 million people-suffer from diabetes, a condition that is not only expensive, but potentially fatal. But what is more astounding is that an estimated 25% of Americans-79 million people-are on the verge of getting diabetes. Two years ago, we began collaborating with New York University and NYU Langone Medical Center to develop machine-learning algorithms that could use our claims data to spot cases of undiagnosed diabetes and to predict diabetes in patients. We see a future where data will be provided directly to the physician who then works with at-risk patients to take preventive measures to slow the rate of diabetes, not just in Philadelphia, but in the nation.

The challenges in healthcare are big and complex. At Independence, we are seeking-and implementing-innovations like data analytics that will revolutionize the entire system. And once we realize the full potential of these technologies and innovations, the question we’ll ask ourselves won’t be “What if?” It will be “What’s next?”

Daniel J. Hilferty is president and chief executive officer of Independence Blue Cross, one of the nation’s leading health insurers, and a Managed Healthcare Executive editorial board member.