The buzz around the phrase “Big Data” is loud and getting louder. As technology’s capacity to capture, store and analyze this data expands, it will affect the way companies treat their employees. What is fascinating to those in charge of managing business enterprises of all sizes is the predictive nature of this Big Data.
More and more large companies, with many employees, are relying on the big medical data supplied by so-called “predictive analytics” companies to reduce the cost of healthcare for their employees. This may be good business, but is it good medicine?
Two experts – one executive who works on the business side of the practice and one spine surgeon – at Texas Back Institute were asked to share their professional opinions on the efficacy of predictive analytics in saving companies money on healthcare for their employees.
The Rise of Predictive Analytics in Healthcare
According to a recent Wall Street Journal article on this subject, “Trying to stem rising health-care costs, some companies, including retailer Wal-Mart Stores Inc., are paying (predictive analytics) firms like Castlight Healthcare Inc. to collect and crunch employee data to identify, for example, which workers are at risk for diabetes, and target them with personalized messages nudging them toward a doctor or services such as weight-loss programs.”
The companies say the goal is to get employees to improve their own health as a way to cut corporate health-care bills. The employees are sometimes surprised by the fact that their personal medical data is being used to save their companies money, and the privacy advocates are often skeptical that this action meets the rigorous privacy guidelines of the Health Insurance Portability and Accountability (HIPAA)
The chief development officer and the patient privacy expert of Texas Back Institute, Cheryl Zapata explains what guidelines a company must follow to be compliant with HIPAA laws on privacy?
“A company can use the patient’s information if they have authorization to do so,” Cheryl noted. “However, more and more companies are using patient data without getting authorization from the patient. They are using what’s known as ‘de-identified’ information. This means the medical information about the patient can be analyzed, so long as the patient is not specifically identified. For example, the names, date-of-birth and other patient identifiers are taken off these records.”
Insurance companies are retaining the services of these predictive analytics groups in order to save money for their clients (the companies) and themselves. Is there any research which suggests that this leads to good medical outcomes, or is it strictly a cost-savings action?
“With regard to research, I can’t really point to anything specific,” she said. “I would say that it is a little bit of both – medical can be a cost-savings measure and that’s pretty much what every company is looking for. And, it could also lead to better medical outcomes. For example, if patients needed more conservative care, they could be required to go through more conservative measures before having surgical intervention.”
“On the downside, it also interferes with the medical decision-making of a physician because there are so many requirements that have to be met before going to surgery. Unfortunately, there are times when the patient needs to go straight to surgery. In that case, it creates a barrier.”
Things You Do Which Can “Predict” Your Health
What are some actions which might predict an employee’s future expenses for healthcare? The WSJ article noted a wide range of activities. Here are a few:
- Where an employee shops and eats will predict a healthy lifestyle.
- Someone who spends money at a bike shop instead of buying video games is more likely to be healthy in the future.
- Credit scores can predict if a person is likely to be readmitted to the hospital after a procedure. How? Those with lower credit scores are less likely to fill prescriptions and show up for follow-up appointments.
- Even voting is a predictor. Those who vote in mid-term elections are engaged and mobile and they tend to be healthier, costing the company less money.
Predictive analytics companies, which mine this type of data, can legally obtain this information as long as the employee opts-in to their company’s wellness program and then re-sell it to their customers.
Other Ways Companies Can Save Money on Healthcare
Chronic back pain is one of the most expensive conditions companies have to deal with. It accounts for literally millions of lost work days and billions of dollars in lost productivity and healthcare expenses. One of the senior surgeons at Texas Back Institute, Dr. Scott Blumenthal, sees this every day in his examining room. He suggested several other ways companies might save money on healthcare and specifically on the treatment for back pain and injuries.
“At Texas Back Institute, all of our treatment is individualized,” Dr. Blumenthal said. “So, if the patient is most appropriate for a conservative care, non-surgical doctor, they will be able to go straight to that doctor instead of a surgeon. This process helps us get our patients to the most appropriate doctor from the start, which can lower the need for additional appointments and in turn lower the cost healthcare.”
“Regarding chronic back pain and other chronic conditions, most of the time we are going to take a conservative approach,” he said. “Surgery is the last resort under those circumstances. However, that does not apply to all spine care. If a patient has an acute situation, sometimes the conservative care approach can be the more costly approach because it’s more time-consuming. It’s all about individualizing treatment options for each patient.”
What does Dr. Blumenthal think about getting a second opinion for expensive procedures such as spine surgery?
“That’s where it comes down to data,” he said. “Right now there are very good outcomes-based data on what works and what doesn’t work. The fact of the matter is, for any elective procedure, I can’t see why anybody would not seek a second opinion. There are many ways to approach treatment for spine conditions and seeking out a second opinion is always in the patient’s best interest.”
“We encourage second opinions. We do second opinions. If indeed surgery is needed, sometime we can find a less invasive option to get the patient back on their feet, back to work and feeling better more quickly. All of this is based on evidence-based medicine, in other words data.”
If your company is trying to find ways to control healthcare costs, start with a provider organization which understands the importance of using data to conservatively treat your employees with the best spine care in the world. Contact us for more information.