Plans must leverage IT capital

Health plans are increasingly becoming aware of the staggering volume of data they can tap into through electronic health records and provider collaborations. From a business perspective, the data is a goldmine.

“I think we are just at the beginning of a new era of leveraging such information,” says Bruce Nash, MD, chief medical officer for CDPHP in Albany, N.Y. “Historically, plans have only had claims data to inform their strategies. Increasingly with the advances in the interoperability of clinical data we can identify target populations with specific diseases who are in poor control.”

Dr. Nash says as big data becomes integrated, plans will become more adept at managing the member stratification process, for example. Identifying specific members within a population based on a diagnosis or health event will allow the plan to target its outreach.

“This will allow plans to customize their communication in a manner that is best received by the individual member,” Dr. Nash says.

But not all plans are prepared to manage big data. The millions of provider/patient interactions the occur every day produce more information than most can handle. One key to mining such data is focusing on specific variables that can translate to improved outcomes for a specific population.

“The larger health plans, in particular, have long recognized the value of the data contained in their medical records, and many of them have established research units with the sole purpose of mining those data for insights on disease epidemiology, treatments patterns, utilization rates, outcomes and costs of care, and the like-all of which can be used to inform practice guidelines, reinforce cost-effective decision making, and improve overall health care efficiency,” says David Thompson, head of emerging businesses, Quintiles Outcome, a consulting firm.

He says in the future, more plans will participate in consortiums with other payers and providers to research larger populations with shared, de-identified patient data. The study results can be shared among the participants to improve care.