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Healthcare Analytics: Analytics in the post-ACA era

In search of a silver lining in the current healthcare environment.

In the last three years, data and analytics found tremendous support within many healthcare organizations.

Rajib Ghosh, Obamacare, healthcare policiesBy Rajib Ghosh

Following the 2016 presidential election, the first two months of the new year were quite tumultuous for the U.S. healthcare system. Interestingly, the Affordable Care Act (ACA) has survived so far, albeit the process to repeal the law has begun. Congress is divided on the best approach to repeal and replace ACA; an array of proposals is on the table. We have also heard from the president that the replacement of the law may not happen until 2018. Still, various facets of the law could be changed or removed without going through the full congressional voting process. Pundits fear that such disjointed attempts to repeal the law could produce dramatic impact both on the insurance market as well as the lives of people who are currently covered by the law. Clearly this uncertainty is not boding well with the healthcare marketplace, and we anticipate a slowing down of the industry’s overall job growth.

Leadership has changed both at the department of Health and Human Services (HHS) as well as the Center for Medicare and Medicaid (CMS). The latter change particularly could have a profound impact on how the senior and underserved populations of the country would receive healthcare in the future. Congress is considering converting Medicaid as a “block grant” program, which would effectively limit the amount of federal money allocated to states for delivering healthcare to the underserved. Medicaid grants to states currently is proportional to the number of Medicaid-covered lives. That could change under a “block grant” program. States that opted for Medicaid expansion during the previous administration now face a stiff challenge. If the grant is capped while a state’s underserved population increases, will a state leave the newly Medicaid eligible people out of coverage or will the state reduce payments to providers to allocate the same money over a larger pool of enrollees? For example, one in three Californians are now covered by Medicaid. With a limited pool of federal grant money for Medicaid, what will California do? If the state reduces payments to providers (or reduces per capita payment for enrollees), then access to healthcare will deteriorate as fewer provider organizations (both primary care and specialists) show interest in seeing patients. That will also crowd emergency rooms with non-emergency and uncompensated patient care. This could potentially have a serious impact on the bottom line of rural community hospitals which could close their doors for good.

Figure 1: Will the steady growth of employment in the healthcare industry continue in the post-ACA era? Source: trump-s-health-care-reform-uncertainty-could-see-jobs-shrink

Figure 1: Will the steady growth of employment in the healthcare industry continue in the
post-ACA era?

Is There a Silver Lining?

For a long time, healthcare futurists talked about utilizing data, analytics and eventually artificial intelligence at all levels within healthcare organizations. In the last three years, data and analytics found tremendous support within many healthcare organizations. Electronic health record (EHR) vendors built population health analytics products or services to augment their revenue streams. Many analytics companies, from startups to industry behemoths like IBM, put healthcare in the front and center of their business expansion strategy. At last year’s Healthcare Information Management System Society’s (HIMSS) annual conference, more than a hundred analytics companies exhibited their products to over 40,000 global attendees. Clinical analytics claimed the spotlight; operational analytics did not make much noise. I anticipate that the current environment will make operational analytics great again as organizations look inward to build efficiency and minimize waste. This will also spread from hospitals to health centers to payers. In other words, the entire value chain of healthcare.

In this environment, will artificial intelligence (AI) become the new moonshot in healthcare?

AI and machine learning have made significant progress toward maturity during the last two years. Many industries are looking at AI as their future. While AI is expected to grow at a CAGR rate of 62.9 percent during the next five years, a new report suggests that healthcare will serve as a key area for that growth. Given that not enough money may be available to take care of the underserved of the nation, we could think of using AI as a tool to tackle regular primary care and chronic conditions. If human longevity continues to rise as predicted, the burden of chronic diseases will be ever-increasing. Can AI become a savior in such a scenario?

Clearly, AI technology needs to go beyond what it can do now, but imagine what could happen if IBM, Google, Facebook and Microsoft further democratize their AI software stack and invest in the rapid grow of AI-based expert systems. Community health centers or retail clinics could then use such systems to tackle the uninsured population at a fraction of the cost. If the current congressional proposals become the new norm, then the uninsured population will increase again. As a society, shouldn’t we accelerate the AI technology to prevent catastrophe in the lives of so many people? I consider that a greater societal good than, for example, developing autonomous vehicles. I think self-driving cars and trucks is a great idea, but we need to rethink our priorities.

Personal Wellness and Precision Medicine

While precision medicine is the future of medical science, personal wellness will need a renewed focus in the near term. Both use data but with different goals. Precision medicine targets personalized intervention to cure a disease such as cancer based on genomic data; it is very expensive and still in the realm of research. Personal wellness tries to prevent such diseases from happening or delay their onset. It could be accomplished with the data that is available to us now. The data can be easily acquired and computed cheaply by today’s technology such as cloud, sensors and smart phones. We could do low-cost, preemptive intervention within the underserved population, enable people with technology and guide them to make better decisions in their daily lives. I would hope that more small- and large-scale analytics and wearable analytics companies focus on this population segment to prevent high-cost interventions like emergency room visits. States facing a deficit in their Medicaid funding could drive such initiatives in partnership with technology companies, and that can happen now.

It is unclear what will happen in a year from now. I see states like California gearing up to resist new health policies from Washington. I see private technology companies of the Silicon Valley resisting the travel ban. I hope all political parties will sit down together to create a comprehensive plan to work in lock step and creatively address the funding deficit and care delivery challenges of the near future. Human society can then become what it should be – humanitarian.

Rajib Ghosh ( is an independent consultant and business advisor with 20 years of technology experience in various industry verticals where he had senior-level management roles in software engineering, program management, product management and business and strategy development. Ghosh spent a decade in the U.S. healthcare industry as part of a global ecosystem of medical device manufacturers, medical software companies and telehealth and telemedicine solution providers. He’s held senior positions at Hill-Rom, Solta Medical and Bosch Healthcare. His recent work interest includes public health and the field of IT-enabled sustainable healthcare delivery in the United States as well as emerging nations.

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