Delivering whole person care with connected data

How access to analytics can help improve patient outcomes and experiences

Soon after the covid-19 outbreak began, doctors started to notice a worrying trend that had nothing to do with the virus itself. People weren’t getting checked for cancer. In March, routine screenings for breast and cervical cancer dropped by more than 90% while colon cancer screenings fell by 86%. “No doubt much of these reductions are due to fear, and the call to delay non-essential services as we struggled through the early days of the pandemic,” noted Dr. Daniel Frank, chief medical officer at OptumCare, a division of the health services company Optum. “But it increased the risk of having more severe disease in the future.”

Speaking at a recent live event in partnership with the Washington Post, Frank detailed how his institution had responded by leaning on data. In Texas and New Mexico, Optum used clinical and population information to identify tens of thousands of high-risk patients; the organization then proactively sent them in-home colon cancer screening kits. Since then, Optum has been working to connect patients who need treatment to necessary care. This case study is indicative of a transformation happening in health care, Frank explained—one that harnesses analytics like never before.

Information is at the heart of quality health care. Yet for too long silos in the system have made it hard for providers, pharmacists and other stakeholders to have the insights they need about patients. Optum and other health system leaders are working to change that. As part of a broader effort to advance technological and integrative solutions to bridge gaps in the system, these groups are using data-driven initiatives to help deliver equitable, high-quality services. In the case of the cancer screening outreach, Optum relied on analytics to develop a targeted pool of patients who would benefit from a test-kit. It’s just one example of how access to information systemwide is enabling more intelligent and effective whole-person care for all.

A need to connect the data

The U.S. health system has a fragmentation problem. It is a constellation of world-class service providers, yet the components don’t always work as collaboratively as they need to, which impacts patient experiences and outcomes. “In a fragmented system, providers and patients generally don’t know what care gaps are critical and struggle to address them,” said Frank.

Ineffectual data sharing is often a consequence of this disconnect. The health system generates a ton of information about individuals and populations as a whole, but structures aren’t always in place to communicate it coherently. Basic interoperability remains an enduring concern. In a 2019 survey, fewer than four in ten respondents reported being able to successfully share their data with other health systems. Yet the issue is systemic as well as technical. Experts say that providers often share information selectively.

These obstacles have severe implications for patients. Physicians don’t have a complete picture of an individual or a population group, which impedes their ability to offer appropriate treatments. In the same 2019 survey, roughly 40 percent of respondents said that data-sharing issues undermine their capacity to develop new care models and improve population health. Another recent survey found that nearly three-quarters of those polled agree that physicians do not have the full range of information they need about patients.

This is beginning to change, however.

The analytics of effective patient care

Access to information is the foundation for more effective patient care. Health services leaders, including Optum, are committed to bridging gaps in the system to ensure data can be leveraged to deliver on this promise. This has been on display throughout the pandemic, during which institutional leaders have used analytics to guide their response. Optum, for example, developed a tool that crunches the numbers from a range of data sources—covid-19 testing results, de-identified electronic health records, pharmacy claims and more—to predict future hot spots.

“Data was critically important to inform our decisions to protect our frontlines and the patients they serve,” Dr. Omar Baker, executive vice president for strategic initiatives and innovation at OptumHealth, noted at the Washington Post event. “Having timely, validated and reliable data was critical.”

These data-driven solutions aren’t unique to covid-19, however; they’re transforming every aspect of health care delivery. The Optum Care Coordination Platform is an example of this transformation in action. The service helps organizations manage patient care effectively across the health care ecosystem. Among other features, it organizes diverse member information such as claims history and behavioral data to offer a complete picture of the individual. One health management organization using the platform, Benevera Health, has been able to reduce client hospitalization rates by 65 percent thanks to the consolidated and collaborative care approach.

These types of initiatives can even proactively guide treatment decisions, such as in the case of OptumRx’s Next Best Action. The program uses data analytics to help call center workers address patient concerns. It collates a range of inputs, including clinical data, demographic data and pharmacy claims, to produce a customized care recommendation for members. The AI-driven model has resulted in individuals accepting a given treatment option over 60% of the time.

Baker acknowledged that this is only the beginning in a system-wide effort to deliver more united care: “There’s a lot more work to come.”

Yet real changes are already happening. And while these analytics-based initiatives may seem abstract and disconnected, they’re guided by a mission that’s deeply human: to provide the highest quality treatments to all individuals. It’s the very core of whole-person care.

“What we’re trying to accomplish here with system integration is really about people,” Frank said. “We want to know who our patients are and so that we can do everything we can to prioritize their care.”

Read more from Optum:

Changing US health care for good

Why every aspect of your life impacts how healthy you are


The American Journal of Managed Care

Center for Connected Medicine

Pharmacy and Therapeutics Journal