Healthcare in the U.S. is politically contentious and expensive.
Early attempts to repeal and or replace the Affordable Care Act only exacerbated tensions within an already deeply divided Congress, with just enough Republicans joining Democrats to prevent the G.O.P. from repealing and/or replacing the bill which was passed along similarly partisan lines in 2009 and signed into law the following year.
Meanwhile, healthcare costs continue to rise. According to a special report from Modern Healthcare titled “The Transformation Imperative,” costs in the U.S. totaled $3.2 trillion in 2015. At the same time, government health programs are lowering reimbursements and employers are shifting employees to high-deductible plans.
There are, however, some bright spots on the healthcare horizon in the form of innovations that have the potential to lower costs, streamline processes and produce improved patient outcomes. The common thread is Big Data.
One example is the New York-based insurance network startup Oscar, co-founded by Joshua Kushner, younger brother of presidential adviser (and First Son-in-Law) Jared Kushner.
Oscar takes its methods and its aims from Silicon Valley. Its goal isn’t to have the biggest provider network, but the most optimized one. It’s achieving that goal through its use of Big Data.
As explained in an article from Wired Magazine, Oscar is as much a technology company as it is an insurance organization. It uses insurance claims along with patient and physician data to find specialists who fit the needs of Oscar and its customers – “not just any available pediatric endocrinologist but one who performed procedures Oscar’s members needed, who didn’t screw up very much, who referred to the right people and had openings for new patients.”
Suppose that specialist stops seeing new patients, or makes some questionable decisions. Oscar is set up to scan physician data daily to discover any changes in their physician’s qualities so that poor performers can be weeded out and replacements found.
Creating a better model for health insurance is ambitious, but even that pales in comparison to the goal of Dr. Farzad Mostashari’s startup Aledade.
Mostashari, formerly the national coordinator for health information technology at the Department of Health and Human Services under the Obama administration, wants to “reduce the cost of health care while improving how patients are treated and save the independent primary care doctor,” according to a New York Times article.
While the primary care physician is ostensibly at the center of a patient’s treatment, patients might visit many facilities and see several other physicians, with no standardized process for the information to be transmitted to the primary care physician.
Aledade’s software puts the primary care doctor in the quarterback position so to speak, by collecting patient data from these other sources to create a comprehensive overview that includes a list of specialists a patient has visited, tests that have been ordered and the overall cost of the provided care on the health care system.
The software also assembles a daily to-do list for physicians and their practices, “a set of easy steps for the practice to take — call this patient, order this vaccine — to keep on top of patients’ care, and, in time, to reduce its cost,” according to the Times.
Data also allows for the personalization of healthcare, whether that’s for an individual or for a population, thus saving money and lives as resources are more accurately allocated.
The Modern Healthcare article included the story of Kathy Halamka, who was diagnosed with stage 3 breast cancer. Using the open source search tool Shared Health Research Information Network, her providers accessed 6.1 million records to find similar cases and discover what treatments had produced the best outcomes. This approach resulted in Halamka being cancer-free nine months after her diagnosis.
Whether applied to a single patient or a large group, the use of data from specific patient populations has been shown to improve healthcare outcomes.
Chicago’s Oak Street Health, a system of 20 primary-care centers, serves primarily low-income Medicare patients. Clinical and social data are used to create care plans, with each patient assigned a care team that includes a physician, nurse practitioner, registered nurses, medical assistants and a social worker known as a “care manager.”
The model allows Oak Street to “invest resources in all of those things that allow you to manage chronic illness more effectively and treat people in a better venue,” Mike Pykosz, Oak Street’s CEO, told Modern Healthcare. “By doing that, you can actually lower the overall cost a lot.”