A new report on potential uses of big data for controlling cost in the hospital setting has just been published
. The report, from Brigham and Women’s Hospital in Boston, appeared in the July 2014 edition of Health Affairs
. Six areas of potential benefit were discussed:
- High-cost patients
- Preventable readmissions
- Triage upon hospital admission
- Decompensation of clinical condition while in the hospital
- Adverse events, particularly renal failure, infections, and adverse drug reactions
- Treatment optimization for those with chronic disease involving multiple organs
As the authors point out, these are six key areas for intervention to lower healthcare costs in the hospital setting, and using more diverse data sources to analyze these opportunities will be useful.
As I reflect on this report, it strikes me that this type of report would have probably not been published several years ago. Healthcare reform, particularly changes in the payment methodology, is driving this type of research. I understand the need to minimize the healthcare spend and agree these are six key areas for research. But, in my opinion, the more important clinical issue is the improvement in the quality of care and probable saving of lives from better care. This is the real issue and opportunity.
All six of these areas are a result of missed opportunities to improve care. These areas are inter-related: high-cost patients are often a result of those who are readmitted multiple times for the same condition, suffer complications, are inappropriately triaged, and have missed diagnoses or have adverse events. Some of these problems can be prevented medically, but some of these issues have broader root causes. Take readmissions – many cases are due to socioeconomic factors such as inability to pay for medications, poor access to outpatient healthcare, or inability to pay for home care. Doctors and hospitals have historically not been paid to consider and manage these non-medical factors that lead to increased medical cost. While no physician wants complications to develop in their patients, hospitals and physicians have never before been penalized if this happened, so there has not been a focus on preventing these complications. New payment incentives are driving these changes and new approaches to care are developing. The promise of higher pay for better value in healthcare of populations, not for providing more services to individuals, is leading to new solutions in these six areas. “Big data,” meaning information about socioeconomic factors, living situations and other new data sources, and then using these data in predictive algorithms, will improve our ability to care for populations, not just treat individuals.
At Truven Health Analytics, we use data to understand high-cost medical care. As we work with the payers of healthcare, especially large employers, part of our study is high-cost patients. I consistently find these cases to be complex, often involving advanced cancer cases or complicated heart failure cases. Closer oversight of these patients, team-based care, and better methods to predict and manage complications is warranted in many of these cases. Accountable Care Organizations (ACOs), with a patient-centered focus and a population health strategy, are promising new approaches to improving care. The tragedy of many of these cases however, is the missed opportunity to prevent these cases from ever occurring. If screening guidelines were followed more universally, advanced colon cancer would almost never happen. Heart failure is usually due to multiple heart attacks that could be prevented by paying closer attention to decreasing risk factors. Not all high-cost cases can be prevented, but many could be avoided.
Why, as a nation, are we not doing a better job in managing the health of our population? The most obvious answer is because we aren’t focusing on and prioritizing disease prevention among our population. Up to 70% of healthcare costs are due to preventable disease, but our healthcare system hasn’t been paid to focus on this issue. But change is apparent. The healthcare industry is undergoing more rapid change at this time than I’ve ever seen in my 30+ years of being a doctor. The new clear message is this: the way to manage costs is to improve the quality of care for entire populations, including new ways to prevent disease. Technology in the form of implementing integrated electronic health records, using more diverse data streams, re-designing healthcare delivery, and better predictive analytics are all tools to improve the quality of healthcare in the U.S. This is the right path to reduce costs.
Michael L. Taylor, MD, FACP
Chief Medical Office