Healthcare Data Analytics Gone Wrong - InformationWeek
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Paul Cerrato
Paul Cerrato
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Healthcare Data Analytics Gone Wrong

Healthcare providers need to keep their eye on the right patients as they look for ways to boost revenue and reduce risk.

Ever since the Centers for Medicare and Medicaid Services (CMS) decided to penalize hospitals financially for avoidable readmission of patients within 30 days of their discharge, health systems have been coming up with inventive ways to keep patients out of the hospital while also trying to bring in more revenue.

Most of these approaches make sense. They've created population health management programs that analyze patient data to spot those at high risk for readmission, for instance, and then offer preventive measures to those patients. They've created care-coordination systems to make sure discharged patients arrive safely at their next destination, whether it be their home, a rehabilitation unit, or a nursing facility. Most hospitals have also redoubled their efforts to educate patients at discharge so that they understand how to take their medications and see the value of making follow-up appointments with their primary care physicians.

But some healthcare providers are going too far in their attempt to maintain a healthy revenue stream while trying to absorb the CMS penalties or reduce the risk of incurring them. A recent New York Times article points out that some providers are using the services of data analytics vendor MedSeek, which "offers services intended to help hospitals 'virtually influence' the behavior of current and would-be patients." The vendor helps healthcare providers refine their marketing by analyzing metrics such as age, sex, race, income, culture, religious beliefs, and family status. The goal: Help providers "scientifically identify well-insured prospects."

(Source: Ragesoss)
(Source: Ragesoss)

[A better approach, or a privacy violation? Big Data Helps Insurer Pinpoint At-Risk Patients.]

The Times quotes a blog post from Bill Andrae, a MedSeek VP, that suggests providers should reach out to "all high-value men and women" to notify "profitable individuals 18 and older" about their services, and to urge them to schedule screening procedures and appointments. (MedSeek has since taken down the post.)

There are at least two problems with this tactic: First, as clinicians cater to the worried well, they'll spend fewer resources on sicker, less affluent patients who really need the added attention. Second, it's going to result in a lot of unnecessary, expensive tests that offer very little return on investment -- at least for patients.

The list of unnecessary, even potentially dangerous screening procedures continues to grow. Experts now say that PSA screening to detect men at risk of prostate cancer doesn't work. Several oncology researchers also question the value of mammography screening for women in certain age groups. And recently, 17 medical specialty societies identified 90 tests that aren't worth the cost.

Obviously healthcare providers need to find ways to offset diminished reimbursements, but persuading gullible patients to waste their or their insurer's money on useless procedures isn't the answer.

Here's a step-by-step plan to mesh IT goals with business and customer objectives and, critically, measure your initiatives to ensure that the business is successful. Get the How To Tie Tech Innovation To Business Strategy report today (registration required).

Paul Cerrato has worked as a healthcare editor and writer for 30 years, including for InformationWeek Healthcare, Contemporary OBGYN, RN magazine and Advancing OBGYN, published by the Yale University School of Medicine. He has been extensively published in business and ... View Full Bio
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User Rank: Moderator
7/2/2014 | 1:43:07 PM
It's all about money& the scoring of America..
I might the only one here that used to write code but the query process is an addiction looking for value and then looking for money.  There is value in data but must be used correctly and average consumers gets duped in marketing at times and you end up with broken models like the Bloombert Big Gulp idea and he didn't know where to stop when the model was failing and same thing in healthcare as people are duped and push failed models that won't work, for the sake of making money.  I have been calling it an epdidemic in the US for a couple years now as my data mechancis logic mixed with years in sales combines and it's crystal clear.  The executive at the hospital who's been duped by Axiom and Mastercard is good example of danger duping out there.

Here's a nice Quant I communicate with, she'll tell you the same thing and it was a guest post from outside of healthcare..bonus reading at the bottom where Axciom decided to crawl out of their shell and address me on Twitter too:)

The curation of videos at the Killer Algorithm page by people smarter than me will help you figure some of this out so you don't get duped as often, happens to all of us.

Heck I put it out there for consumers and banks reading it like crazy.  Long and short you can't sit there for profit and shove a broken model down people's throast for the sake of making money as people don't work that way.
User Rank: Ninja
7/2/2014 | 12:05:33 AM
Re: Health still needs handshake ethics
It is a deliate issue. There is a burden of unnecessary avoidable costs, on the other side what if a paties sues for not bing asked to do a test for his cancer at early stage. I believe, both parties are trying to play safe. The cost will go down when all will depend and trust each other.
Thomas Claburn
Thomas Claburn,
User Rank: Author
7/1/2014 | 7:00:47 PM
Re: Health still needs handshake ethics
I hope consumers can hold healthcare companies accountable. Too often pricing is opaque, alternatives are in short supply and are limited by real-world considerations (like provider distance).
User Rank: Author
7/1/2014 | 3:14:59 PM
Re: Health still needs handshake ethics
It is cruel to impose likely unnecessary tests on healthy "profitable" people. Period. We already put up with too many tests, some done to guard against liability. Tests cause stress while you wait to take them and then while you wait for results.

There are many good doctors in this world. This "more tests" line of thinking does not sound like it came from a compassionate doctor but a number cruncher.
Charlie Babcock
Charlie Babcock,
User Rank: Author
7/1/2014 | 3:04:06 PM
Health still needs handshake ethics
As the world becomes more digital, there appear to be more and more companies that forget the ethics of face to face exchanges. In health care, patients can probably detect the self-interested behaviors and will hold the companies perpetuating them responsible. It's not like Facebook. It's more like reality.
David F. Carr
David F. Carr,
User Rank: Author
7/1/2014 | 11:44:21 AM
How deep is the issue of healthcare analytics misuse?
Is this an example of a public relations snafu or is it truly a deep problem with the way the incentives in the healthcare system are being reshaped. We've heard plenty about the "perverse incentives" of the bad old fee-for-service healthcare system. But are the new incentives going to create problems that are as bad or worse?

On the other hand, as long as healthcare organizations need to be self-sustaining, they do need to weigh their mix of profitable services vs. charity cases. So I'm of two minds about whether this is a phenomenon that really is bad or just sounds bad when exposed in the press.
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