Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.
It's taken a long time for the health care industry to embrace Big Data, but those days are over. What that ultimately means for the industry — care providers, insurers and, most importantly, patients — is still anybody's guess.
The policy journal Health Affairs just released a big monthly issue diving into how big data can shake up the massive and less-than-efficient health-care industry, which accounts for one-sixth of the American economy. The policy challenges are many, but so are the potential benefits to be realized from using data to make better health-care decisions.
A few things are driving health care's shift toward data. The proliferation of electronic health records in the past decade has made it easier for doctors to make clinical decisions and for health-care researchers to work in a much larger scale, writes Health Affairs editor-in-chief Alan Weil. Secondly, the industry is finally demanding it. Rising health-care costs and policy changes are forcing health care to transform into a system that's more and more rewarding providers for quality of care, as opposed to just volume. That change relies on data.
And what if data allowed for better predictions of who needs care and when? The shift to a quality-focused health-care system could drive the industry to rely more on predictive analytics, writes lead author David Bates, chief of general medicine at Brigham and Women’s Hospital in Boston. The same way that shopping Web sites can predict what you want to buy, health-care organizations could use big data to take better care of you. This could draw on traditional data already used in the health care sector, like clinical and genetic information, but also some of our gadgets. The authors offer an example:
It may make sense soon to ask patients with a smartphone to allow health care organizations to access data from their phones that will help identify patients who are not managing a chronic condition well or that will monitor people recently discharged from the hospital, since it appears that patients who are not making calls or sending e-mail with their usual frequency may be depressed or suffering from other issues.
Naturally, something like that — and any use of health care data, really — is going to raise some privacy concerns. And there don't appear to be accepted standards yet for how patients agree to have their information used with predictive analytics, according to another paper in this month's issue. For example, what happens if the analytic model recommends that certain patients don't receive treatment? How do you inform those patients, and then how could patients or doctors override the recommendation?
There are some complicated policy questions with no easy answers, the authors write. But this change won't happen overnight, and the payoffs are potentially big.
Coming back to Bates's article, he points out that having a better understanding of who's in the health-care system and what actually works could help better target care for the most expensive patients, reduce unnecessary re-admissions, avoid adverse events and more. And that ultimately means a higher-quality and less expensive health-care system.
Top health policy reads from around the Web:
California customers are suing over ACA plans. "California insurance giant Anthem Blue Cross misled 'millions of enrollees' about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a class action lawsuit filed Tuesday. As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica. Anthem spokesman Darrel Ng declined to comment directly on the lawsuit." Julie Appleby in Kaiser Health News.
Feds say they want to clamp down on private Medicare payments. "Federal officials, facing criticism they overpay Medicare Advantage plans for the elderly by billions of dollars annually, are seeking new power to recover excessive charges. The Centers for Medicare and Medicaid Services says its wants to set up a formal process to recoup overpayments' made to the health plans. ... A Center for Public Integrity investigation published last month found that Medicare paid the health plans nearly $70 billion in 'improper' payments — mostly inflated fees from overstating the health risks of patients — from 2008 through 2013 alone." Fred Schulte for the Center for Public Integrity.
Surprising price increases for some generics. "In recent years, generics have curbed the rise of drug prices, saving the American health care system billions of dollars. ... But increasingly, experts say, the costs of some generic drugs are going the other way. The prices paid by pharmacies for some generic versions of Fiorinal with codeine (for migraines) and Synthroid (a thyroid medicine) as well as the generic steroid prednisolone have all more than doubled since last year, EvaluatePharma found. In January, the National Community Pharmacists Association called for a congressional hearing on generic drug prices, complaining that those for many essential medicines grew as much as '600, 1,000 percent or more' in recent years." Elisabeth Rosenthal in the New York Times.