How the healthcare industry can leverage data to fix a fragmented system

The healthcare sector is complex and fragmented, often with misaligned incentives or a lack of coordination that leads to ineffective distribution of resources. Fragmentation also has a negative impact on patient outcomes, costs and quality of treatments.

During VentureBeat’s Transform 2022 virtual conference, 30-year AI industry veteran Jana Eggers, CEO of Nara Logics, joined Sachin Joshi, SVP, data and analytics engineering at Evernorth (a subsidiary of Cigna), to discuss what Cigna is doing to improve that fragmented care and bring down healthcare costs by using data.

Cigna has created a platform that allows the company to automatically identify situations requiring clinical attention, implementing interventions tailored to a patient’s clinical conditions and engagement preferences. The platform also provides 360-degree visibility into patient activity, resulting in the ultimate care-coordination program.

Complexities, impediments and failures of the healthcare system

According to the World Health Organization, the qualities of the delivery system in the healthcare sector affect how fast, effective and suitable the medical care is for the patients. Patients often make a wise decision by choosing an outcomes-based model of care that assures clinical targets and connects a patient’s touch points throughout the care continuum.

However, Eggers noted that a lot of people have encountered complexity in the healthcare sector. Rather than looking at healthcare concerns from the patient’s perspective, she asked Joshi to look at the view from inside the healthcare system. This fragmentation from the inside out, Joshi agreed , is the main problem.

“I know we as consumers feel that every day when we go to get our labs done, go to our primary care physician …  go to get our prescriptions filled,” Joshi said. “Imagine trying to pull together that information to create better outcomes for our patients so that they’re not having to navigate all of those various channels without having the feeling that, one, they’re being intentionally priced gouged and, two, [wondering if] their whole health is being considered with all those different channels.” Joshi said that those on the inside see all of that and know there’s an ability to pull it together and offer solutions.

Joshi explained that coordination management is one of the methods used to address some of those issues. Evernorth’s Health Connect 360 is designed to look at the total population from a patient-management perspective Joshi said. That provides a macro-level view to customers. “Then at a micro level we can look at an outcomes-phased approach that delivers better patient outcomes from a health perspective by reducing costs.” 

The challenge with Health Connect 360, from a data perspective, is to be able to provide predictive modeling that allows Evernorth to target and improve those patient outcomes.

Joshi added that the important thing in this situation is to be able to offer each patient a customized treatment plan. He suggests a tailored strategy for customers that enables them to collaborate with the company, assess the level of investment and cost incurred to serve their patients — and then contrast it with the outcomes they were seeing previously.

Timely intervention

Joshi uses diabetes as an example: “It’s something that is common in the population, but maybe more common in certain employer segments versus others. So, what we’re able to do from our total population perspective is analyze that data across medical pharmaceuticals, third-party data, claims data, which is our own.  By integrating that data with third parties as well as digital devices, Evernorth is able to generate data at a macro level.

“Are we seeing that they’re filing less pharmaceutical [prescription] claims and purchasing less? Because we have that information, we’re able to then distinguish in that population, do outreach that then intervenes to ensure that adherence to medications or [that] prescriber directives are properly carried out to create a preventative sort of use case where we do outreach around glucose monitoring.”

He added that if someone is at risk for pre-diabetes or diabetes, based on predictive modeling and machine learning concepts, the company is able to outreach directly or through the providers so that they can intervene before someone ends up in the emergency room, which causes much greater consequences. This, according to Joshi, improves patient outcomes and also reduces long-term costs for their clients.

“Huge amounts of data have been the major challenge of the tech audience, as they’re very fragmented, they don’t line up well together,” Eggers noted. “The audience is working through their own challenges about how to power that data. I know there’s some power there, but I get stuck in the analytics or something.”

However, reiterating what Joshi suggested to solve that issue, Eggers said the tech audience should “get to an MVP you know [and] make sure you stay focused on the experience. Then make sure your team feels that experience that you’re trying to drive. Make sure that they know to be vulnerable and to try things and it’s OK to go with that middle ground because you’re not always going to get perfection.”

Don’t miss the full discussion on leveraging the power of data to fix fragmented care and lower healthcare costs.