Recently a New York Times article http://www.nytimes.com * noted “At least that’s one of the curious connections to emerge from a health care analysis project at the insurance division of the University of Pittsburgh Medical Center.”
“It is at the forefront of an emerging field called predictive health analytics, intended to improve patients’ health care outcomes and contain costs. But patients themselves are often unaware of the kinds of intimate details about their households that insurers and hospitals may use to try to sway their treatment decisions.”
“The Pittsburgh health plan, for instance, has developed prediction models that analyze data like patient claims, prescriptions and census records to determine which members are likely to use the most emergency and urgent care, which can be expensive. Data sets of past health care consumption are fairly standard tools for predicting future use of health services.”
“The U.P.M.C. health plan has not yet acted on the correlations it found in the household data. But it already segments its members into different “market baskets,” based on analysis of more traditional data sets. Then it assigns care coordinators to certain members flagged as high risk because they have chronic conditions that aren’t being properly treated. The goal… is for the insurer to steer those patients to primary care physicians or specialists who can provide care that is more coordinated, more consistent and less costly than sporadic emergency-room visits. The system might pinpoint, for example, high-risk asthma patients who have not yet been prescribed inhalers — and try to manage their care before they end up in emergency rooms with asthma attacks.
* to read the full NYTs article “When a Health Plan Knows How You Shop by Natash Singer highlight and click on open hyperlink http://www.nytimes.com/2014/06/29/technology/when-a-health-plan-knows-how-you-shop.html?_r=0
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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
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