Insurer IT: Data, Analytics and Artificial Intelligence Top Charts
By Diana Manos. Originally Published in Health Plan Week by AIS Health
Technology will be crucial in helping health plans to connect care teams, integrate behavioral health and primary care, and identify and analyze key data that can help them target where to focus energies in improving patient populations. Here are seven predictions AIS Health gathered about the role technology — including the addition of artificial intelligence (AI) and smarter analytics — will play for health plans in the coming year.
(1) Health plans will need data, and lots of it. Koorosh Yasami, founder and chief strategy officer for HealthBI, a population health management IT company, tells AIS Health that “an escalating need for actionable data — the only kind that can actually bring down costs while improving quality — will compel health insurers to merge data resources with providers. This will call for deeper integration with electronic health records, and integrations that facilitate data interaction/data pulling and pushing,” says Yasami, who prior to founding HealthBI served as senior director of business intelligence and architect at UnitedHealth Group.
(2) Plans will need to move from unstructured to structured data. “There will also be a heightened focus on closing care gaps, at scale, for high risk members [that will] drive a migration from unstructured data to structured data,” Yasami says. “Traditionally, any available data, such as images, pdfs, and even paper claims, is used in an attempt to close those gaps. This is too time consuming and error-prone, so we’ll see a major shift to structured data like the clinical care document serving as the ‘engine’ for care gap closures.”
(3) Plans will continue to use technology to integrate care teams. Research has shown that integrated care teams are essential to better outcomes, Yasami says. “And to that end, payers will be making use of technology that connects all conceivable members of a care team, keeping them in the loop on the patient’s health needs in time to avoid an acute health event.”
(4) Plans will play a central role in integrating behavioral health and primary care. “States like Arizona are giving integrated clinics a 10 percent boost in reimbursement; I think we’ll see other states follow suit,” Yasami says. “Providers will look to payers to provide the technology that connects primary care and behavioral health care teams.”
(5) Plans will turn to smarter analytics to help improve population health. Lewis Levy, M.D., chief medical officer for Teladoc, Inc., a telehealth platform that recently acquired medical consultation company Best Doctors, tells AIS Health that “analytics will get even smarter, as value and efficiency demand it. Today, many leading health plans are turning to analytics to help identify populations at risk. However, 2018 should see major steps toward even smarter analytics, driven by newer algorithms that ensure the right patients are on the right treatments. This new paradigm in healthcare dictates that it is not enough to simply identify high-cost patients within a population, but tailored interventions must also result.”
Plans will need to ask: “Are there other co-morbid conditions requiring a different level of intervention? Can the identified patient’s entire medical history be reviewed before a one-sizefits-all approach is taken? The former shotgun approach of analytics will give way to a much more individualized system fueled by expert physicians and analysts,” Levy says. “This year will produce major steps toward smarter analytics that identify patients on higher risk medications, and then proactively determine if the current course is working or if a change is needed.
Smarter analytics directly affects every health plan’s concerns with value, efficiency, and outcomes.”
(6) Plans will look more and more to AI. In 2018, health plans will use AI to achieve a higher quality of care, Levy predicts. “The world is abuzz with renewed excitement about the potential artificial intelligence might have on healthcare transformation. Artificial intelligence presents a grand frontier for health care, but only as long as it is married to medical excellence. Cognitive computing is only as good as the data that goes in and the experts that interpret what comes out. In 2018, that enthusiasm is warranted with the advancements made by Watson Oncology, and better patient experiences that simplify answering questions that begin, ‘What is the best way to get care for…?'”
(7) Plans will need to up the ante on privacy and security. Robert Lord, cofounder and CEO of Protenus, a privacy company that publishes a monthly Breach Barometer report, tells AIS Health that this year, health care organizations will once again be the most targeted sector for breaches. Because of this, health plans will need to truly make health data security a priority in 2018. “Health data breaches are not just an IT problem, but an enterprise problem,” Lord says. “It’s a patient trust and satisfaction problem. These breaches ultimately affect an organization’s bottom line and have a lasting impact on their reputation.”
Protenus’ Breach Barometer reports showed steady trends in health data breaches throughout 2017, and “we should expect the same trends will continue into 2019,” he says. “Healthcare organizations should expect to see a continued decline in patient satisfaction if health data security is not a priority in 2018.”
