How healthcare use data to improve fragmented system


Healthcare is complicated and fragmented. There are often misaligned incentives, ineffective coordination, or poor distribution of resources. 

VentureBeat’s Transform 2022 conference saw Jana Eggers (CEO of Nara Logics), a 30-year veteran of the AI industry, join Sachin Joshi (SVP, data analytics engineering at Evernorth, a subsidiary of Cigna) to discuss how Cigna is working to improve fragmented healthcare and lower healthcare costs using data.

Cigna created a platform to help identify clinical situations and tailor interventions to patients’ clinical conditions. It also gives 360-degree views of patient activity, which allows for the best care coordination program.

Healthcare system failures, impediments, and complexity

The World Health Organization states that the quality of the healthcare delivery system can affect. The patient’s ability to receive medical care quickly. Effectively. And efficiently. Patients make wise decisions by choosing an outcomes-based care model that meets clinical targets and connects patients throughout the care continuum.

Eggers pointed out that many people have experienced complexity in the healthcare industry. Instead of looking at healthcare issues from the perspective of the patient, she asked Joshi for a view from within the healthcare system. Joshi agreed that this is the main problem.

Joshi stated that consumers feel this every day. When they go to their primary care physician to have their labs done. And then go to the pharmacy to fill our prescriptions. Imagine trying to bring together all that information in order to improve outcomes for patients.

Joshi said that coordination management is one method to address some of these issues. Joshi explained that Evernorth’s Health Connect 360 is designed for a comprehensive view of the population from a patient management perspective. This provides customers with a macro-level view. “A micro-level view can be taken to see an outcomes-phased approach which delivers better patient outcomes, from a health perspective, and reduces costs.

From a data perspective, the challenge of Health Connect 360 is to be able provide predictive modeling that allows Evernorth’s to target and improve patient outcomes.

Joshi said that it is important to be able offer each patient a personalized treatment plan. He recommends a customized strategy that allows customers to work with the company to assess the investment and cost required to treat their patients. Then they can compare it to the results they have seen in the past.

Interventions are timely

Joshi uses diabetes to illustrate his point. “It is something that is more common in some employer segments than others, but it’s something that is very common in the general population.” From a population perspective, we can analyze the data across medical pharmaceuticals, claims data, and third-party data. Evernorth can generate data at a macro-level by integrating the data with digital devices and third parties.

Are we seeing that people are filing fewer prescription [prescription] claim and buying less pharmaceuticals? We have this information so we can then identify the population and do outreach to ensure medication compliance or [that] prescriber directives were properly executed to create a preventative use case.

He said that predictive model and machine-learning concepts can be use to determine. If someone is at high risk of developing diabetes or pre-diabetes. Joshi says this improves the patient experience and reduces long-term cost for clients.

Eggers stated that “Huge amounts” of data has been the main challenge for the tech audience.  It is difficult to see how they can be match up. “The audience is attempting to solve their own problems about how to power this data. I find myself stuck in the analytics or some other aspect of data management.

Eggers reiterated the suggestion of Joshi to fix the issue. Eggers suggested that the tech audience “get to an MVP you understand [and] keep your eyes on the experience.” Make sure that your team has the same experience you are trying to create. It’s okay to let your team know that you are willing to fail and that it’s okay to accept that there is no perfect solution.

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