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Analytics Magazine

Healthcare Analytics: Rise of the empowered patient consumer – courtesy of analytics

May/June 2014

Rajib GhoshBy Rajib Ghosh

As of this writing, 7.5 million people have signed up for their own health insurance policies via Healthcare.gov or 14 state-run health insurance exchanges. In addition about three million people have enrolled in state Medicaid programs. Private enrollment outside of those insurance marketplaces is also growing and could be substantial. In other words – all signs indicate that more and more people are apparently taking control of their own health – the holy grail of consumer-driven healthcare. Clearly, if we seek control over our cost of insurance, we have to be careful about our personal health choices. Shouldn’t that be the case anyway?

Well, that’s not how we do things in the United States. Based on a report by the Congressional Budget Office, more than 50 percent of Americans or 156 million people were covered by employer-sponsored insurance plans in 2013 [1]. Government-run programs such as Medicare and Medicaid cover 31 percent of the population who are poor, disabled or over 65 years old [2]. The government safety net is one of the most prized albeit expensive possessions of the American public.

Despite the fact that more people are taking money out of that safety net than are putting in and a threat that the Medicare fund will be depleted by 2037 – the American public is unwilling to do anything drastic about the safety net. Still, that leaves quite a large number of people who either have to buy insurance on their own or remain uninsured. One estimate shows that about 44 million people in the United States have no health insurance and 38 million have inadequate insurance. While those numbers are huge for a developed nation, for a lot of people there is no “shared responsibility” for health per se. Most people don’t “own” the care of their health; it was provided and mostly paid for by someone else.

Changing Workforce, Changing Insurance Coverage

All of that is changing. Some of it started to change when the availability of employer-sponsored healthcare coverage started to decline a decade ago. According to a 2010 report, the number of people with employer-sponsored health insurance was down 10.6 percent from what it was in 2000. By 2013, the decline was even greater as the recession, job losses and rising costs that forced some small employers to ditch employee group insurance altogether were all contributing factors.

Meanwhile, the American workforce has been changing, too. For example, 20 percent to 30 percent of workers in Fortune 100 organizations today are freelancers or “contingent workers.” By 2020, the number is expected to rise to 50 percent [3], and the number of people covered under employer-sponsored health insurance will become a smaller percentage of the overall population. More people will have to pay for insurance on their own – from the exchange marketplaces or otherwise. For many who will not have to pay their total insurance bill, the cost sharing will be higher or the coverage will be less or even inadequate. Those that can afford it might have to supplement their insurance with personal policies.

Where is the Analytics?

As part of the Affordable Care Act widely known as Obamacare, the U.S. government is trying to drive performance efficiencies and improved quality of care through providers and in the delivery system using programs such as value-based purchasing, readmission penalties and meaningful use of electronic health record systems. In response to these initiatives, providers are adopting information digitization and healthcare analytics, mostly in the form of descriptive business intelligence tools that make fancy post-mortem charts. Predictive analytics is still far-fetched.

Health Leaders Media recently identified the top three strategic drivers for providers in 2014, which includes clinical decision support and clinical performance tracking. Both require heavy use of analytics. Payers are taking on more risks to increase their medical-loss-ratio using analytics that can identify patient cohorts with higher risk exposures. But where is the consumer in this change? Are we not supposed to “drive” better, more efficient healthcare for us?

Today, that drive is limited to asking for provider cost transparencies or insurance plan shopping. Apart from the quantified selfers, most of us are happy with our annual physical check ups that cost our health system $8 billion a year according to a 2012 study analysis [4], but that does nothing to address serious and expensive illnesses or premature mortality. Few, if any, individuals use analytic insights to proactively know what our current or future risk exposure is or what behavior we should abandon to prevent higher downstream medical costs. Needless to say, we are not sophisticated enough to analyze our now forbidden (by FDA) 23andMe genetic test report to know our genetic predisposition toward future medical expenses.

A Future of Empowered Consumer Patients

For the latter, we are yet to have predictive analytics, which can take our individual physiological measures and a myriad of other factors and inform us what we need to do to avoid out-of-pocket medical costs three to five years downstream that won’t be covered by our insurance plan. This brings up an interesting idea of fusing our health insurance information with our physiological data and genetics – not under the watchful eyes of insurance providers but for us and only for us. Think of it as our personal financial risk dashboard using the powers of predictive analytics! It will be even better if we are able to tweak our behavior data and then see the impact in our risk dashboard. That will be real empowerment for us as consumers.


Rajib Ghosh (rghosh@hotmail.com) 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. Follow Ghosh on twitter @ghosh_r.

Notes and References

  1. Avik Roy, 2010, “Obama Officials In 2010: 93 Million Americans Will Be Unable To Keep Their Health Plans Under Obamacare,” Forbes.
  2. Income, Poverty and Health Insurance Coverage in the United States,” 2011, government publication.
  3. Thomas Fisher, 2012, “The Contingent Workforce and Public Decision Making.”
  4. Sharon Begley, 2013, “Think preventive medicine will save money? Think again,” Reuters.

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