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Finding Actionable Insights from Healthcare's Big Data
The document discusses the potential benefits and challenges of utilizing big data in healthcare, particularly focusing on actionable insights in population health management. It highlights key opportunities to reduce costs and improve care through effective data usage while addressing challenges such as technology limitations and data silos. Case studies illustrate how organizations can transform insights into action to optimize healthcare outcomes.
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Finding Actionable Insights from Healthcare's Big Data
- 1. Insight. Action. Measure. Finding actionable insightsin healthcare’s Big DataAugust 5, 2015 © Medullan, Inc.
- 2. 2page© Medullan Inc. HeatherRitchie VP, Product Management Heather leads product strategy and roadmap at zakipoint Health. Her expertise is in defining product strategies and customer experiences for healthcare technology solutions. Your Guides Today Ryan Rossier VP, Product Innovation Ryan leads the product innovation team at Medullan. His expertise includes market research and analysis, program management, agile delivery excellence, and lean start up.
- 3. 3page© Medullan Inc. Today’sDiscussion What are the possibilities? What are the challenges What’s an insight? What’s an actionable insight? Case studies How we see the world: Insight. Action. Measure. Q&A 1 2 3 4 5 6
- 4. 4page© Medullan Inc. BACKGROUND: Healthcaredata So, where can data help in healthcare? 160 Exabytes = 1.3B Terabytes Would take Watson 82 years Real-time capture, real- time results Data sources and types are on the rise Can I trust the data?
- 5. 5page© Medullan Inc. Wherecan data help in healthcare? There is massive potential benefit locked in healthcare’s data. Population health management Precision medicine Care optimization R&D productivity
- 6. 6page© Medullan Inc. Wherecan data help in healthcare? There is massive potential benefit locked in healthcare’s data. Today we’ll focus on Population Health. Population health management Precision medicine Care optimization R&D productivity
- 7. 7page© Medullan Inc. Whatare the opportunities in Population Health? Bend the curve of avoidable costs Value comes from the market’s ability to effectively use its data to invoke the right actions. Time Cost Identify at-risk members Validate efficacy and refine Design interventions `!
- 8. 8page© Medullan Inc. Data Volume Value Theinsight value chain
- 9. 9page© Medullan Inc. InfoData Volume Value Theinsight value chain “has context,
- 10. 10page© Medullan Inc. InsightInfoData Volume Value Theinsight value chain “has context, is well understood,
- 11. 11page© Medullan Inc. ActionableInsightInsightInfoData Volume Value The insight value chain “has context, is well understood, and delivers value if addressed.”
- 12. 12page© Medullan Inc. ActionableInsightInsightInfoData Volume Value The insight value chain Ability to take an action that will have an Impact “has context, is well understood, and delivers value if addressed.”
- 13. 13page© Medullan Inc. Keychallenges in getting to actionable insights Technology limitation Lack of experience and skill set Unclear measures and metrics The best efforts of today don’t effectively turn data into actionable insights. Data relevance result No clear ROI Cultural shift required Data silos
- 14. 14page© Medullan Inc. Whatmakes something insightful? Answers questions specific to a broader problem or need Unearths an issue or opportunity that you were not aware of Can be understood by all stakeholders An insight’s value is not proportionate to the volume, variety, or velocity of its source data. so what pharmacy wellness Health Coach member profile explanation of benefits incentives Plans enrollment claims statements secure messagingphysician finder physician finder personal health record Benefits Helps you predict what might happen if no change is made
- 15. 15page© Medullan Inc. Whatmakes something actionable? Has a high potential of being actualized Offers clear benefit if acted upon Benefit can be tracked and measured Specific contributing factors are understood Not all actions return the same benefit or require the same effort. It’s important to prioritize. so what
- 16. 16page© Medullan Inc. INSIGHT#1: Spouses Driving Cost Trend The spend trend for spouses was getting worse, but was changing that trend actionable? 0 100 200 300 400 500 600 700 800 2011 2012 2013 2014 Spouses Employees Dependents PMP COSTS
- 17. 17page© Medullan Inc. INSIGHT#1: Spouses Driving Cost Trend 0 100 200 300 400 500 600 700 800 2011 2012 2013 2014 Spouses Employees Dependents PMP COSTS ✔ Contributing uncovered using existing analytics solution ✔ Agreement was reached at the employer that this was a priority ✔ Analytics partner determined benefit opportunity and track intervention impact ✔ Current wellness partner could utilize current touch points to augment current program YES.
- 18. 18page© Medullan Inc. INSIGHT#2: Gaps in Care Worsening for Diabetics Diabetic costs doubled in 1 year for essentially the same population. Was that insight actionable? $- $3,000 $6,000 $9,000 $12,000 $15,000 Total Health Plan Claims Pharmacy Claims Office Visit Outpatient Inpatient Medical Claims 2014 2013
- 19. 19page© Medullan Inc. $-$3,000 $6,000 $9,000 $12,000 $15,000 Total Health Plan Claims Pharmacy Claims Office Visit Outpatient Inpatient Medical Claims 2014 2013 INSIGHT #2: Gaps in Care Worsening for Diabetics ✔ Contributing factor quickly identified - increasing gaps in care contributing to >1600% PMPY inpatient claims increase. If gaps in care continued, the trend likely to continue ✔ Agreement that the benefit opportunity, (short and long term), made this worth pursuing ✔ Existing analytics partner was able to provide data for partner plan review, as well as vendor opportunity assessment if that becomes the right action. YES.
- 20. 20page© Medullan Inc. HOWWE SEE THE WORLD: Insight. Action. Measure INSIGHT OUTCOME & LEARNING RIGHT PEOPLE RIGHT INTERVENTION, RIGHT TIME RIGHT REFINEMENTS Identify the right people and get them to act with the right intervention. 1 2 3 ACTION MEASURE
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- 22. 22page© Medullan Inc. Joinus for the next in our 3 part series #1 INSIGHT Finding Actionable Insights Aug 5, 2pm #2 ACTION #3 MEASURE Getting Members to Act Aug 19, 2pm Measuring Effectiveness Sep 9, 2pm See info.medullan.com/webinars for more details.
- 23. 23page© Medullan Inc. Thankyou! Ryan Rossier rrossier@medullan.com Heather Ritchie Heather.ritchie@zakipoint.com
- 24. See Clearly |Take Action | Save Money We have one goal. To enable every company, regardless of size, to understand and lower its healthcare costs.
- 25. 25page© Medullan Inc. BetterLives I N N O V A T I O N F O R We improve the healthcare experience through human-centered digital solutions
Editor's Notes
- #2 Good afternoon everyone and thank you for joining us. I’m excited to be hosting this first of three webinars about finding insights, taking action, and measuring impact.
- #3 Before we go too far I want to introduce your guides for the day. To my left is our guest panelist Heather Ritchie who leads product strategy for zakipoint health. Zakipoint health has one goal: To enable every company, regardless of size, to understand and lower its healthcare costs. She recently comes to Zakipoint with over 10 years of experience developing consumer products and customer experiences in healthcare and has lead product teams at notable companies such as WebMD and Anthem Blue Cross. I am Ryan Rossier, VP of Product Innovation here at Medullan. Medullan improves the healthcare experience through human-centered digital solutions. Everything we do centers around our purpose: to Innovate for Better Lives. I have been with Medullan for over 6 years helping define and execute Medullan’s lean digital strategy and agile development offerings. Before Medullan I worked at GE for 6 years in information management leadership.
- #4 Our agenda today starts broadly looking at the overall opportunities and potential of data in healthcare, then we'll focus in to discuss some of the challenges organizations face as they try to get the most out of their data, then we’ll build back up culminating in a couple of case studies that Heather will share that ties everything together. We look forward to taking your questions at the end.
- #5 Data is everywhere and we are only making more of it, especially in healthcare. By one study’s count there are 160 Exabytes of healthcare data in the world today. That's 1.3 Billion Tera bytes.. It would take our friend Watson, over at IBM 82 years to crunch through the world’s healthcare data… and it’s only going to get bigger, some experts say 44 times by 2020. The number of sources producing data is one reason for the explosion. In addition mandated adoption of electronic medical records, the prevalence of connected devices and wearables, the affordability of genetic and genomic testing, and even social media is resulting in tons of data being created….. Usable ONLY IF it can be captured, organized and analyzed. This rise of real-time, automatic data capture has also increased the potential for real-time and right-time analysis. Examples here include frequent diabetic glucose monitoring, blood pressure readings, and EKGs. This ability to receive metrics data and take action swiftly based when that data is out of range has great potential in healthcare. And to round this out, many consumers of the data are asking – can I trust it? So where can this explosion of data help?
- #6 We have broken the opportunity down into four areas. First is population health, which aims to manage the the health outcomes of a group. Key to that is the ability to collect and analyze clinical, social, and physical, and economic data to identify and predict risks which must be addressed. Care optimization leverages the technological advancements of connected devices and online collaboration to extend the exchange of data between a care team and patient to gain insight into a patient’s experience in between clinical visits. Precision medicine adds an individual’s genetic makeup and variability to the mix, to help prescribe individualized treatment and prevention plans. And R&D where statistical tools and algorithms are being used improve clinical trial design and patient recruitment to better match treatments to individual patients, thus reducing trial failures and speeding new treatments to market among other things The real bottom line is that there’s tremendous potential in all of these areas, and we’d like to dive a little deeper into our recent experience with Population Health Management.
- #7 We have broken the opportunity down into four areas. First is population health, which aims to manage the the health outcomes of a group. Key to that is the ability to collect and analyze clinical, social, and physical, and economic data to identify and predict risks which must be addressed. Care optimization leverages the technological advancements of connected devices and online collaboration to extend the exchange of data between a care team and patient to gain insight into a patient’s experience in between clinical visits. Precision medicine adds an individual’s genetic makeup and variability to the mix, to help prescribe individualized treatment and prevention plans. And R&D where statistical tools and algorithms are being used improve clinical trial design and patient recruitment to better match treatments to individual patients, thus reducing trial failures and speeding new treatments to market among other things The real bottom line is that there’s tremendous potential in all of these areas, and we’d like to dive a little deeper into our recent experience with Population Health Management.
- #8 So peeling back that onion one more layer – what are the opportunities in PHM? It’s not a new concept by any stretch, and the tenets remain the same, but it’s the ecosystem and available data which is changing rapidly, increasing the options you have to proactively managing your population’s health. Here are a few areas we’re interested in: It still all starts with identify at risk members before they get sick/injured/or in trouble – this concept is old, but what’s new is the data we have to identify the risks and the technology we have analyze and monitor the data for risk factors. - EXAMPLE The next is designing interventions tailored to those at risk. This is about meeting people where they are and designing interventions which maximize the probability of a desired outcome. This all starts with a solid understanding of all of the factors contributing to a person’s risk profile - EXAMPLE Analysis of your process capability is just as with digital there are better ways than ever in the uncontrolled environment to tie interventions to outcomes; when they worked, when they didn’t, and where the stumbling blocks were that may have caused failed adoption. And finally, now more than ever we have the ability to quantify the impact that an at risk population is having on a payer’s bottom line, and we’re able to show the impact interventions are making before the annual report is published. All of this is possible, but none of it is plausible unless those with the data are able to effectively mine it for the right insights, and then invoke those at risk to take action.
- #9 So before we go further I’d like to define the terms you’ll keep hearing from us this afternoon, in what we call the insight value chain. Start with data: raw facts, numbers, and observations Information: adds a layer of context and interpretation to facts, which then enables someone analyze the data with more meaning By definition an insight is about an understanding of why something is the way it is; the root cause; And finally actionable insight the most valuable, but often rarest link in the chain, adds the idea of measurable value to the deep understanding insights provide. The bottom line is that the real value lies in our ability to identify the opportunities which we believe we can do something about and if accomplished will be benefit all stakeholders involved.
- #10 So before we go further I’d like to define the terms you’ll keep hearing from us this afternoon, in what we call the insight value chain. Start with data: raw facts, numbers, and observations Information: adds a layer of context and interpretation to facts, which then enables someone analyze the data with more meaning By definition an insight is about an understanding of why something is the way it is; the root cause; And finally actionable insight the most valuable, but often rarest link in the chain, adds the idea of measurable value to the deep understanding insights provide. The bottom line is that the real value lies in our ability to identify the opportunities which we believe we can do something about and if accomplished will be benefit all stakeholders involved.
- #11 So before we go further I’d like to define the terms you’ll keep hearing from us this afternoon, in what we call the insight value chain. Start with data: raw facts, numbers, and observations Information: adds a layer of context and interpretation to facts, which then enables someone analyze the data with more meaning By definition an insight is about an understanding of why something is the way it is; the root cause; And finally actionable insight the most valuable, but often rarest link in the chain, adds the idea of measurable value to the deep understanding insights provide. The bottom line is that the real value lies in our ability to identify the opportunities which we believe we can do something about and if accomplished will be benefit all stakeholders involved.
- #12 So before we go further I’d like to define the terms you’ll keep hearing from us this afternoon, in what we call the insight value chain. Start with data: raw facts, numbers, and observations Information: adds a layer of context and interpretation to facts, which then enables someone analyze the data with more meaning By definition an insight is about an understanding of why something is the way it is; the root cause; And finally actionable insight the most valuable, but often rarest link in the chain, adds the idea of measurable value to the deep understanding insights provide. The bottom line is that the real value lies in our ability to identify the opportunities which we believe we can do something about and if accomplished will be benefit all stakeholders involved.
- #13 So before we go further I’d like to define the terms you’ll keep hearing from us this afternoon, in what we call the insight value chain. Start with data: raw facts, numbers, and observations Information: adds a layer of context and interpretation to facts, which then enables someone analyze the data with more meaning By definition an insight is about an understanding of why something is the way it is; the root cause; And finally actionable insight the most valuable, but often rarest link in the chain, adds the idea of measurable value to the deep understanding insights provide. The bottom line is that the real value lies in our ability to identify the opportunities which we believe we can do something about and if accomplished will be benefit all stakeholders involved.
- #14 There are several key challenges organizations face preventing them from realizing the value and benefit of their data. From technology limitations, to a lack of organizational alignment and the ability shift to a data-driven culture it’s often more than one of these hurdles facing an organization, which can sometimes feel insurmountable. It doesn’t have to be. Now I’ll turn it over to Heather who will share her thoughts on how to get started.
- #15 The difference between data/information and insights is that an insight: Answers questions that matter, such as “Is my population getting recommended preventive care given who they are and their health status?” “And are they getting care from the best place for their health needs?” “Are they engaging in the programs best suited to address their health needs?” Uncovers areas that you were not aware were having a material impact. For example, you identify that gaps in care are most prevalent for a very specific subset of your population, one that you thought was not a problem. 3) Highlights opportunities to address issues before it is too late…addressing current risk levels for a specific population that will likely result in increasingly worse outcomes and higher costs if no intervention is taken. 4) Supports all stakeholders in reaching a shared understanding of the issue or opportunity, achieved through data visualization and interactions across multi-dimensional data sets that can be jointly understood by business, operations, clinical, and other involved parties that need to align and collaborate for a successful intervention. Ultimately an insight needs to clearly tell a story of what is going on and why that matters. The impact of that story is not necessarily tied to having multiple and varied data sources offering real-time information…only where combined data delivered near real-time matters to the question does this really matter. If in the end, even having lots of integrated data available in real-time, the question being asked is ‘so what?’, then you still just have information.
- #16 But even insights, as clear as they may be, may not be actionable. It may be clear what the opportunity or problem is, and even who this applies to along with some of the contributing factors; but other factors ultimately impact whether an insight is actionable: A more robust understanding of the factors behind an undesireable trend or outcome is critical to identifying the specific action to take. It is this understanding that enables intervention design more likely to have the desired impact. And this level of understanding can also enable engagement by connecting individuals to interventions/programs where others ‘like them’ [retail ‘people like you’ approach] have had success and good outcomes An opportunity is just that until actualized. If material barriers exist to taking an action---such as resource limits or misalignment across the business, or lack of technology to deliver the designed intervention---an action may not be immediately achievable until other barriers are removed or resolved. Actualized outcomes should benefit key stakeholders, whether those outcomes are health improvements, financial, or even convenience and improved experience. And the expected benefit of the action should be able to be clearly defined. Once defined, it is critical that activities can be tracked and actualized benefit can be measured against expected outcomes to understand if the intervention is working and if adjustments are required. And not all actionable insights are equal. By evaluating expected benefit against the effort to intervene and likelihood of success, one can prioritize where to focus first, then next, and next again…and also assess what not to go after.
- #17 I would know like to walk you through two examples of where insights have led to action for a mid-size employer we have been working with. Although this employer knew that spouses were a cost driver for them, they had no idea by how much or the diverging trends between total cost (which is actually trending downward) and spouse costs continuing to increase and at a higher rate. But was this insight actionable? Yes, because: ---contributing factors could be well understood using existing analytics solution in place Nearly 80% of spouses were female, with 7 of this group accounting for 12 of the top cost cases for this employer Existing engagement program had just released a spouse component, but it could now be further tailored based on additional population insights around care utilization and conditions ---risk of doing nothing until next year was agreed by all as too high a risk ---benefit opportunity---for employer, for wellness partner, and for spouse population---could be determined and intervention impacts can be measured ---wellness vendor could act by augmenting existing program infrastructure and engagement points already in place This highlights the import of evaluating opportunities beyond financial or health benefit…the existing partnerships were able to fast track this intervention, making it a priority over other identified opportunities.
- #18 I would know like to walk you through two examples of where insights have led to action for a mid-size employer we have been working with. Although this employer knew that spouses were a cost driver for them, they had no idea by how much or the diverging trends between total cost (which is actually trending downward) and spouse costs continuing to increase and at a higher rate. But was this insight actionable? Yes, because: ---contributing factors could be well understood using existing analytics solution in place Nearly 80% of spouses were female, with 7 of this group accounting for 12 of the top cost cases for this employer Existing engagement program had just released a spouse component, but it could now be further tailored based on additional population insights around care utilization and conditions ---risk of doing nothing until next year was agreed by all as too high a risk ---benefit opportunity---for employer, for wellness partner, and for spouse population---could be determined and intervention impacts can be measured ---wellness vendor could act by augmenting existing program infrastructure and engagement points already in place This highlights the import of evaluating opportunities beyond financial or health benefit…the existing partnerships were able to fast track this intervention, making it a priority over other identified opportunities.
- #19 Significant cost per case increases for diabetic cohort, with costs increasing to be on par with the national benchmark* of $13,700 per year Gaps-in-care specific to diabetes management were found as the inpatient cost trend driver Analysis on the diabetic cohort for this employer identified that higher rates in gaps in care for care specific to diabetics, with these patients not getting the necessary supplies to complete home glucose monitoring or getting clinically recommended annual screenings for feet, eyes, or urinalysis. Again, a clear path to act was identified…first stop was to be their health plan partner to determine what could be done further to support this sub-population. Based on that discussion, the decision will be if augmentation of condition management is needed, and the employer is well-equipped to act as they have the data needed for partners to assess program opportunity prior to implementation. If asked: none above 50%, and latter 2 below 10% for getting recommended care: Members in Group #Not Meeting Metric % Meeting Metric Annual dilated eye exam 36 33 8.33% Annual foot exam 36 21 41.67% Home glucose testing supplies in last 12 months 36 16 55.56% Annual microalbumin urine screen 36 34 5.56%
- #20 Significant cost per case increases for diabetic cohort, with costs increasing to be on par with the national benchmark* of $13,700 per year Gaps-in-care specific to diabetes management were found as the inpatient cost trend driver Analysis on the diabetic cohort for this employer identified that higher rates in gaps in care for care specific to diabetics, with these patients not getting the necessary supplies to complete home glucose monitoring or getting clinically recommended annual screenings for feet, eyes, or urinalysis. Again, a clear path to act was identified…first stop was to be their health plan partner to determine what could be done further to support this sub-population. Based on that discussion, the decision will be if augmentation of condition management is needed, and the employer is well-equipped to act as they have the data needed for partners to assess program opportunity prior to implementation. If asked: none above 50%, and latter 2 below 10% for getting recommended care: Members in Group #Not Meeting Metric % Meeting Metric Annual dilated eye exam 36 33 8.33% Annual foot exam 36 21 41.67% Home glucose testing supplies in last 12 months 36 16 55.56% Annual microalbumin urine screen 36 34 5.56%
- #21 So in closing, we believe insight, and specifically actionable insight, is the first step in a the continuous cycle of improving population outcomes to Insight, Action and Measure. With actionable insights you’re equipped to know a worthwhile opportunity to address and the right people to target. With action you deliver the right intervention in a way that maximizes a members chance to engage with you, and with measure you’re validating efficacy of your interventions, and constantly optimizing for the future benefit of your population. I want to thank you all for listening and we’d love to take your questions at this time.