Cost and Outcomes Drive Better Use of Data

Overall, I would describe healthcare companies as trying to figure out how to drive the best outcomes at the lowest cost while maintaining a positive consumer experience.  This isn’t easy.  One area of opportunity that companies increasingly look at is how to use data to become smarter. 

• Can I build a predictive model of response curves?  Who’s likely to respond?  Who’s likely to take action?
• Can I develop a segmentation model that works?  How will I customize my communications after the segmentation?
• Can I rank and prioritize my outreaches?  Should I do that based on risk or based on potential value? 

Ultimately, I think this is driving companies to be a lot smarter and to look at how they use both medical and pharmacy data.  For example, I’ll point to both CVS Caremark and Prime Therapeutics in press releases from earlier this year. 

“The ActiveHealth CareEngine offers evidence-based information that can be used to improve the health care of our members and enables us to take our programs to the next level by seamlessly incorporating medical data,” stated Troyen Brennan, EVP and chief medical officer of CVS Caremark. “This agreement will enhance our existing programs to identify issues related to gaps in care, potential drug-to-drug interactions and duplicative care — information that is important to bring to the attention of the member’s physician.”  (article that this is sourced from)

Smart use of medical and pharmacy data is one of the most powerful tools we have to improve outcomes and increase value for our members and clients,” said David Lassen, PharmD, Chief Clinical Officer at Prime. “Through ongoing partnership with health plan clients, Prime is uniquely positioned to view the entire spectrum of patient care, and we can leverage that information to help manage cost and to improve outcomes. We are very excited to collaborate with Corticon on the development of this clinical platform.” (press release)

The next step will be to integrate PRO (patient reported outcomes) from sources like connected devices and PHR (personal health records) that might show blood pressure, workouts, calories, or other data points that could help companies determine when to intervene and how to add value to drive an outcome.

Additionally, another key is continued work in the outcomes-based contracting world and bonus areas such as Star Ratings where the financial value is tied in the short-term to outcomes.  This creates a burning platform for smarter use of data and use of a broader set of data to understand and impact care.