While big data saw major hype in healthcare last year, it remained largely untapped in the health insurance sphere—but that may be about to change, suggests Munzoor Shaikh, director in West Monroe Partners’ healthcare practice, which works with health plans on driving organizational transformation via a strategic blend of business and technology.
“Primarily what we’ve seen is it’s still in the thought phase right now,” Shaikh says, because insurers have to figure out how to bring together data that are currently kept in siloed departments that separate medical management from member analytics.
There’s no way around that, he notes, because the nature of big data is the convergence of different data areas, and that’s what allows patient engagement centered around the member. “You have to engage with the patient based on their overall condition, you can’t do it in a siloed manner,” Shaikh says.
He sees four large categories of data that ideally need to come together for health management:
- Clinical;
- Administrative/claims;
- Socioeconomic; and
- Lifestyle (wearables data).
“Breaking down the silos is probably one of the biggest barriers when it comes to health plans doing big data, but I think they’re starting to make this a real thought,” he says.
That in itself is different from last year, Shaikh says. As for why now, it's due to a combination of factors that, while not specifically due to the Affordable Care Act, emerge from issues including the need to address spiraling health costs and seek better health outcomes in the fragmented system. Add to that the increased availability and affordability of technology as well as federal regulations supporting cost control and improved outcomes and the time is ripe to take advantage of what big data can offer.
Insurers are not big data early adopters
In terms of health plans, Shaikh says conversations are happening but he hasn’t seen any clients take big data very far yet -- though that doesn’t mean someone hasn’t. He ventures to guess several plans are working on it, and while he hasn’t worked with Kaiser, he suggests plans with similar models would be likely candidates. “I assume people like Kaiser have probably done something around this, or at least have started some work around it,” he says.
He adds interest in big data comes with a focus on customer centricity, and most health plans are still working on the transition from B2B to B2C.
As an example of easy but typically untapped data, Shaikh points to web analytics, real-time data on what customers look at and utilize online. Health plans don’t typically track or use such data though Shaikh says he did work with one ancillary health insurer, an early B2C adopter for insurers, on an e-commerce website with that type of digital tracking and intelligence.
Partner for data?
For those plans thinking about where to start in harnessing big data, Shaikh says there’s great opportunity in partnering with providers. He suggests that plans be willing to share claims data and find those providers willing to share EMR and lab data to bring together clinical and claims data. He adds if you can add socioeconomic data on top of that, either from medical management groups or the provider’s population health management system, “The trifecta of those is really, really powerful.”
On the IT end, the level of investment will depend on the plan; some will be able to do it in-house, some won’t. Shaikh says the challenge is two-fold:
- Aggregation, the big job, with a focus on which data to aggregate and the strategy of how to produce a ROI; and
- Analytics, the simpler second step.
Big data does not big money automatically make
He warns big data itself doesn’t translate into money; he says its champions sometimes forget data need to translate into tangible patient benefits in order to provide tangible financial returns. Shaikh says he sees a lot of hype from population health companies selling analytic products and solutions, but few that focus on producing outcomes.
Given that harnessing big data is a big job, Shaikh doesn’t recommend doing it for all patients. He says to start small and target value by partnering with provider groups in specialty areas that may be high cost and high in drug utilization such as oncology and rheumatology.
“We [at West Monroe Partners] have this perspective that is not big data but small data – you’ve got to start small,” Shaikh says. “I think if health plans could start in these specialty areas, that could have a real, provable ROI.”