Insurer Uses Personal Data To Predict Who Will Get Sick

Insurer Uses Personal Data To Predict Who Will Get Sick

5:31pm Jun 09, 2015
Carol and John Iovine say the health coach their insurer assigned John after he had a torrent of grave health problems in 2014 has helped them get the medical care he still needs. And it's helped keep him out of the hospital.
Carol and John Iovine say the health coach their insurer assigned John after he had a torrent of grave health problems in 2014 has helped them get the medical care he still needs. And it's helped keep him out of the hospital.
Todd Bookman/WHYY

The first thing out of John Iovine's mouth is an apology.

"You got to forgive me if I don't remember too much," he says. "I had a stroke."

Signs of that stroke are everywhere — the bed in the dining room, a shower installed in the pantry. John is thin, and sits in blue pajama pants in the wheelchair he uses to get around.

He may, however, have overstated his memory problems.

"We went to Harding ... that's the school right up here," he says. It was 1952, and that's where he saw the woman who would become his wife — "this girl, in this long red sweater, and her red hair. And I said, 'That's the girl for me,' " he says of Carol Iovine.

"I came out on top," he says, laughing.

Carol, who is sitting next to her husband, explains that John's stroke came in the middle of a bad run of health. First, he developed an ulcer, she says. Then he needed a bowel resection. After that came the stroke — and more.

"He had pneumonia, jaundice, sepsis; clot in the right lung," she adds. All of that hit between October 2013 and January 2014.

John, a former house painter, spent 79 days in the hospital — some of that unconscious, and nearly all of it stuck in a bed.

"Aw, man — it was hell," he says.

Sink Or Swim

John Iovine finally went home in April of last year, after several months in a rehab facility.

And this point in patients' recovery — when they've been discharged and have to sink or swim on their own — is the stage that everyone in the health system is paying special attention to right now. For too long, too many people like John Iovine would take a dive at this stage, and end up back in the hospital again.

The industry calls these returns to the hospital preventable readmissions, and they are a huge drain on finances, costing Medicare alone $15 billion annually. That's why Medicare launched an initiative a few years ago that penalizes hospitals that see too many patients readmitted too soon. And in turn, that spurred many hospitals to pay more attention to the problem.

Now insurance companies are also taking a stab at a solution.

"We are trying to identify which patients are likely to be hospitalized in the next three months — so that's our target," says Somesh Nigam. He's the chief informatics officer for Independence Blue Cross, a Philadelphia-based insurance firm.

Independence Blue Cross, he says, is working to identify all those among its customers who are sick or frail enough to be on the edge of hospitalization.

To do so, the company runs algorithms on the huge amounts of health data at its disposal: billing claims, lab readings, medications, height, weight and family history. It also throws in information about the client's neighborhood, including poverty rates.

"The health care data we provided to build these algorithms is equivalent, I think, to five Wikipedias," says Nigam.

The computer algorithm sifts through all that information and pops out a score for each individual patient, identifying those it deems at highest risk.

Independence Blue Cross then assigns each high scorer a staff member — what it calls a "health coach," who will work at no charge to the client to see what extra services may be helpful.

"This coordinated effort then works for the patient," Nigam says. The coach may assemble health information tailored to the patient's needs; make medical appointments; resolve medication issues, or maybe help arrange transportation to the doctor's office. Sometimes the coach helps arrange for a home care nurse.

"And all of that," Nigam says, "is beginning to show a pretty significant drop in hospitalization rates in our region."

Independence Blue Cross has identified 18,000 clients for this sort of extra attention and, as just one sign of success, has already seen a 40 to 50 percent reduction in expected hospital admission rates for people with congestive heart failure.

Early successes include the Iovines.

Carol Iovine's life changed, too, after her husband's stroke: She's having to manage his new medications, and help John shower and get to the toilet. They need to hire a wheelchair-accessible van for each appointment and therapy session, of which there are many.

She says having the support of John's health coach has made a big difference in helping her manage her husband's needs.

"He was supposed to get blood work, and they wanted me to take him to the ER to get blood work," Carol remembers. " 'Uh-uh,' I said. 'No way.' "

She called their health coach, Donna Crockett, and told her the problem. "And the next thing," Carol Iovine says, "a nurse was here taking blood."

Big picture: The money the health insurance plan spends on having Crockett arrange a visiting nurse, or streamline appointments is nothing compared to the cost of a hospital admission.

Writing The Rules

That promise of savings has a lot of health care specialists taking a harder look at the useful potential — and possible drawbacks — of these predictive computer formulas.

"There is a lot of interest in the area right now," says Glenn Cohen, a professor at Harvard's law school, who has written about the legal and ethical concerns raised by the collision of health care and big data. "It is a great coming together of the health care world and the computer science world, as well as the patient experience world."

Still, he has some qualms.

"There are questions of whether people whose data is going to be used to build the engine have the right to opt out," Cohen says. "Do they have to affirmatively opt in? Do they have to even be notified it's being used?" These are still grey areas, he says.

The field is so new it doesn't yet have established standards for how this information should be handled, Cohen says.

Independence Blue Cross says it follows federal health privacy guidelines regarding anonymity, and is only using the information to better serve its members. But it doesn't ask the clients who subscribe to its health plans if they want to opt in.

"The data is only used to improve or coordinate care," Nigam says. "And that is something that you would agree is our role."

Health-wise, coordinated care seems to have made all the difference for John Iovine. He hasn't been hospitalized in the year since Independence Blue Cross assigned him a health coach.

The insurer says the early results are so promising that the company is expanding its efforts. The firm is partnering with New York University's Langone Medical Center on a next target — Type 2 diabetes. The goal is to spot people who are most at risk of getting diabetes before they start showing symptoms — and then intervene, in hopes of preventing the illness.

This story is part of NPR's reporting partnership with WHYY and Kaiser Health News.

Copyright 2015 WHYY, Inc.. To see more, visit http://www.whyy.org.

Transcript

ROBERT SIEGEL, HOST:

And now health and your data for this week's All Tech Considered.

(SOUNDBITE OF MUSIC)

SIEGEL: Information about you and your health is tracked with more efficiency than ever. Doctors and insurers hope that that will help improve treatment and lower costs. WHYY's Todd Bookman has the story of one Philadelphia insurer and how it's using all the information it gathers about people.

TODD BOOKMAN, BYLINE: The first thing out of John Iovine’s mouth was an apology.

JOHN IOVINE: You've got to forgive me if I don't remember too much. I had a stroke.

BOOKMAN: Signs of that stroke are everywhere. His bed is in the dining room. There's a shower installed in the pantry. John's thin, in blue pajama pants, sitting in a blue wheelchair. But the memory issues - I think he's overstating them. He still remembers laying eyes on something special back in 1952.

J. IOVINE: We went to Harding, and that's the school right up here. And I seen this girl in this long, red sweater and her red hair, and I said, that's the girl for me (laughter).

BOOKMAN: Carol Iovine, redhead and wife, is on a plastic-covered couch right next to John. His stroke, she says, came in the middle of a really bad run.

CAROL IOVINE: He had pneumonia, jaundice, sepsis, clot in the right lung and all the above between 10-16 '13 to January 3 of '14.

BOOKMAN: John spent 79 days in the hospital.

J. IOVINE: Oh man, it was hell.

BOOKMAN: After a few months in a rehab facility, he was finally sent back home. And this moment in a patient's recovery when they seemingly have to sink or swim on their own, this is the moment that everyone in the health system is paying a lot of attention to right now.

SOMESH NIGAM: We are trying to identify which patients are likely to be hospitalized in the next three months.

BOOKMAN: This is Somesh Nigam, chief informatics officer for Independence Blue Cross. He says the company wants to find customers most at risk like John Iovine, the ones sick or frail enough to be right on the edge of hospitalization. And they're doing it by crunching all the data at their disposal - billing claims, lab readings, medications, height, weight, family history plus neighborhood information like poverty rates.

NIGAM: The health care data that we provided to build these algorithms is equivalent to, I think, five Wikipedias.

BOOKMAN: They take that five Wikipedias' worth of data, run the algorithm, and out pops a score - high scores for people most at risk; low numbers, the opposite. Independence then notifies the primary care physicians and hospitals that treat the high scores. Plus, Nigam says, it assigns them what they call a health coach whose job is simply to see what these people need.

NIGAM: This coordinated effort then works for the patient to try to get them the right level of education, physician appointments, medication issues, perhaps transportation to go to a doctor, even home care.

BOOKMAN: Big picture - the money spent on a health coach is nothing compared to the cost of a hospital admission. Nigam says they've identified 18,000 people for extra attention, and he says they've already seen a 40 percent reduction in expected hospital admission rates in patients with congestive heart failure. Glenn Cohen is a professor at Harvard Law School and says a number of big health systems are experimenting with algorithms.

GLENN COHEN: They've got their pulse on the future. We have huge amounts of data to inform clinical practice.

BOOKMAN: But he cautions that this collision of health care and big data brings up a number of concerns, like whose information is it and who gets to see it?

COHEN: And so there has to be a certain amount of discussion with patients. At the very least, I think it's incumbent upon a system to allow patients to know that their data is being used in a different way.

BOOKMAN: Cohen says the field is too new for there to be accepted standards yet for how this data should be handled. For its part, Independence Blue Cross says it follows federal anonymity guidelines. But it doesn't ask people to opt in. It just does it, says Somesh Nigam.

NIGAM: The data is only used to improve or coordinate care, right? And that's something that you would agree is our role.

BOOKMAN: Coordinated care has made all the difference for John Iovine. He hasn't been hospitalized in the year since Independence Blue Cross assigned him a health coach. For NPR News, I'm Todd Bookman in Philadelphia.

SIEGEL: That story came thanks to our reporting partnership with WHYY and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

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