Startup Mojo from Rhode Island writes:
Hey there, maybe THCB readers can weigh in on this one. I work at a healthcare startup. Somebody I know who works in medical billing told me that several big name insurers they know of are using analytics to adjust reimbursement rates for medical billing codes on an almost daily and even hourly basis (a bit like the travel sites and airlines do to adjust for supply and demand) and encourage/discourage certain codes. If that’s true, its certainly fascinating and pretty predictable, I guess.
I’m not sure how I feel about this. It sounds draconian. On the other hand, it also sounds cool. Everybody else is doing the same sort of stuff with analytics: why not insurers? Information on this practice would obviously be useful for providers submitting claims, who might theoretically be able to game the system by timing when and how they submit. Is there any data out there on this?
Is this b.s. or not?
Filed Under: ACA Database, THCB
Tagged: ACA Database, analytics, Big Data, Billing Codes, Insurers, THCBist
Feb 24, 2014
Today, academic medicine and health policy research resemble the automobile industry of the early 20th century — a large number of small shops developing unique products at high cost with no one achieving significant economies of scale or scope.
Academics, medical centers, and innovators often work independently or in small groups, with unconnected health datasets that provide incomplete pictures of the health statuses and health care practices of Americans.
Health care data needs a “Henry Ford” moment to move from a realm of unconnected and unwieldy data to a world of connected and matched data with a common support for licensing, legal, and computing infrastructure. Physicians, researchers, and policymakers should be able to access linked databases of medical records, claims, vital statistics, surveys, and other demographic data.
To do this, the health care community must bring disparate health data together, maintaining the highest standards of security to protect confidential and sensitive data, and deal with the myriad legal issues associated with data acquisition, licensing, record matching, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Just as the Model-T revolutionized car production and, by extension, transit, the creation of smart health data enclaves will revolutionize care delivery, health policy, and health care research. We propose to facilitate these enclaves through a governance structure know as a digital rights manager (DRM).
The concept of a DRM is common in the entertainment (The American Society of Composers, Authors and Publishers or ASCAP would be an example) and legal industries. If successful, DRMs would be a vital component of a data-enhanced health care industry.
Giving birth to change. The data enhanced health care industry is coming, but it needs a midwife.There has been explosive growth in the use of electronic medical records, electronic prescribing, and digital imaging by health care providers. Outside the physician’s office, disease registries, medical associations, insurers, government agencies, and laboratories have also been gathering digital pieces of information on the health status, care regimes, and health care costs of Americans.
However, little to none of these data have been integrated, and most remain siloed within provider groups, health plans, or government offices.
Continue reading “Could Digital Rights Management Solve Healthcare’s Data Crisis?”
Filed Under: Tech, THCB
Tagged: Amanda Frost, Big Data, Carolina Herrera, data enclaves, David Newman, digital rights manager (DRM), EHRs, HIPAA, HIT, Stephen Parente
Jan 27, 2014
Thanks to the flood of new data expected to enter the health field from all angles–patient sensors, public health requirements in Meaningful Use, records on providers released by the US government, previously suppressed clinical research to be published by pharmaceutical companies–the health field faces a fork in the road, one direction headed toward chaos and the other toward order.
The road toward chaos is forged by the providers’ and insurers’ appetites for categorizing us, marketing to us, and controlling our use of the health care system, abetted by lax regulation. The alternative road is toward a healthy data order where privacy is protected, records contain more reliable information, and research is supported or even initiated by cooperating patients.
This was my main take-away from a day of meetings and a panel held recently by Patient Privacy Rights, a non-profit for whom I have volunteered during the past three years. The organization itself has evolved greatly during that time, tempering much of the negativity in which it began and producing a stream of productive proposals for improving the collection and reuse of health data. One recent contribution consists of measuring and grading how closely technology systems, websites, and applications meet patients’ expectations to control and understand personal health data flows.
With sponsorship by Microsoft at their Innovation and Policy Center in Washington, DC, PPR offered a public panel on privacy–which was attended by 25 guests, a very good turnout for something publicized very modestly–to capitalize on current public discussions about government data collection, and (without taking a stand on what the NSA does) to alert people to the many “little NSAs” trying to get their hands on our personal health data.
It was a privilege and an eye-opener to be part of Friday’s panel, which was moderated by noted privacy expert Daniel Weitzner and included Dr. Deborah Peel (founder of PPR), Dr. Adrian Gropper (CTO of PPR), Latanya Sweeney of Harvard and MIT, journalist Sydney Brownstone of Fast Company, and me. Although this article incorporates much that I heard from the participants, it consists largely of my own opinions and observations.
Continue reading “Chaos and Order: An Update From Patient Privacy Rights”
Filed Under: Uncategorized
Tagged: Adrian Gropper, Andy Oram, Big Data, HIEs, HIPAA, Hospitals, Meaningful Consent, Patient privacy, Patient Privacy Rights
Oct 16, 2013
In a world where big data plays an important role of monitoring individual health care and wellness, Health 2.0’s CEO and Co-Founder Indu Subaiya had an exclusive interview with Christine Robbins, CEO of BodyMedia on the future of health care in the marketplace as well as the role of big data. As we all know, BodyMedia was recently acquired by Jawbone – and we’re excited to have Christine joining us on the famous “3 CEOs” panel at the Health 2.0 Annual Fall Conference next week to tell us more about it.
Here’s a preview of what you should be looking forward to.
Indu Subaiya: We’re really excited for the Health 2.0 7th Annual Fall Conference and of course, I’ve been following news about you and BodyMedia over the last two months, which is really exciting. Congratulations on the acquisition.
Christine Robbins: Thank you. We’re on to the next chapter.
IS: That’s just amazing to me because BodyMedia in and of itself has had so many chapters and we’ve followed you almost from the very beginning. But what would be great is [if you could give] us an overview of the last year. When we saw you at Health 2.0 last — what you were beginning to present at the earliest stages, I believe, were data that BodyMedia had collected that could then be used in partnership with health plans and larger healthcare organizations.
Continue reading “Moving Beyond the Quantified Self”
Filed Under: Health 2.0, THCB
Tagged: Big Data, BodyMedia, Cigna, Jawbone, Quantified Self
Sep 25, 2013
Co-instructors Aman Bhandari and Dr. Tom Tsang of Merck’s Data Partnership Group will lead the next and final class in Health 2.0 EDU’s summer webseries, Big Data, Big Business, on How HITECH and the ACA Are Changing the Data Landscape, today, Tuesday, July 30th at 3pm PT/6pm ET.
Together Bhandari and Tsang bring decades of experience analyzing, predicting, and writing the legislation that most impacts the use of big data in health care. Join us to learn how the fine print in both the ACA and HITECH is creating both new opportunities and new challenges for using data. If you are a startup and have questions about either piece of legislation do NOT miss this class- Bhandari and Tsang will answer your queries live.
Sign up here and join us today.
Filed Under: Health 2.0
Tagged: Aman Bhandari, Big Data, Health 2.0, Health 2.0 EDU, HITECH, The ACA, Tom Tsang
Jul 30, 2013
NEHI recently convened a meeting on health care innovation policy at which the Harvard economist David Cutler noted that debate over innovation has shifted greatly in the last decade. Not that long-running debates about the FDA, regulatory approvals, and drug and medical device development have gone away: far from it.
But these concerns are now matched or overshadowed by demands for proven value, proven outcomes and, increasingly, the Triple Aim, health care’s analog to the “faster, better, cheaper” goal associated with Moore’s Law.
To paraphrase Cutler, the market is demanding that cost come out of the system, that patient outcomes be held harmless if not improved, and it is demanding innovation that will do all this at once. Innovation in U.S. health care is no longer just about meeting unmet medical need. It is about improving productivity and efficiency as well.
In this new environment it‘s the science-driven innovators (the pharma, biotech, and medtech people) who seem like the old school players, despite their immersion in truly revolutionary fields such as genomic medicine. It’s the tech-driven innovators (the healthcare IT, predictive analytics, process redesign, practice transformation and mobile health people) who are the cool kids grabbing the attention and a good deal of the new money.
To make matters worse for pharma, biotech and medtech, long-held assumptions about our national commitment to science-driven innovation seem to be dissolving. There’s little hope for reversing significant cuts to the National Institutes of Health. User fee revenues painstakingly negotiated with the FDA just last year have only barely escaped sequestration this year. Bold initiatives like the Human Genome Project seem a distant memory; indeed, President Obama’s recently announced brain mapping project seems to barely register with the public and Congress.
Continue reading “Science-Driven Innovation and Tech-Driven Innovation: A Marriage of Convenience or a Marriage Made in Heaven?”
Filed Under: Tech, THCB, The Business of Health Care
Tagged: Big Data, Biotech, clinical research, Innovation, Medical Devices, NEHI, Pharma, Tom Hubbard, Triple Aim
Jul 9, 2013
Last week I was in DC and I caught up with Bryan Sivak, a geek’s geek who has migrated from Silicon Valley (via London) to government service first in Maryland and now at HHS. He has a big job there to keep pounding out the open health data drumbeat Todd Park started. And he’ll have at least two big opportunities to do it this spring, first at Health 2.0′s developer conference Health:Refactored in Silicon Valley in May and then at the now 4th annual Health DataPalooza in DC in June.
Filed Under: Health 2.0, THCB
Tagged: Big Data, Bryan Sivak, HDI, Health Datapalooza, Helath:Refactored, HHS, Matthew Holt, Open Health Data
Mar 1, 2013
My father, Foster Hill, has stage III prostate cancer.
At 69 years old, he is a quiet man who was often told in his younger days that he resembled Muhammad Ali. He immigrated in his twenties to Canada from the small Caribbean nation of Antigua to look for opportunities beyond sugar cane and the tourism trade.
My father became a chemical technician for well-known oil refineries, while staying true to his real passion in life – playing organ music. Every Sunday, as he has since I can first remember, he plays the largest church organ in Sarnia, near Lake Huron, where he lives with my mother.
Like many men of his generation, he has always been wary for the medical system. For decades he avoided the test, known as PSA, that screens for prostate cancer. In September of this year, driven by pain he could no longer ignore, he went to his doctor who discovered a rock-hard prostate gland. The diagnosis, stage III prostate cancer, means that the cancer has already begun to spread, but is still potentially treatable.
Now retired, his long hours practicing the organ are punctuated with doctor visits to receive Lupron hormone therapy. The good news? The therapy is working. For now.
We don’t know what lies ahead. The first round of Lupron therapy is often effective, but a significant number of patients later develop a resistance to the drug.
The battle against my father’s cancer has only just begun.
This is where Big Data in healthcare can become a true lifesaver. Typically, in medicine, we know only what works for the majority of patients, not what will work for an individual. However, with enough data from enough people – we are talking hundreds of thousands, and sometimes, even millions of patients – we can apply analytics to build predictive models to discover which interventions will work. For the last twelve years, it has been my job to make that happen.
As CEO and founder of GNS Healthcare, I oversee a team of mathematicians, biologists, and data scientists as they crunch and decode healthcare data to unlock the mysteries of what treatment will work for specific patients.
My father’s cancer has given these efforts a new urgency and has raised a new question: Can I use Big Data to save my father’s life?
Continue reading “Can Big Data Save My Dad From Cancer?”
Filed Under: THCB
Tagged: Big Data, Cancer, Colin Hill, Foundation Medicine, GNS Healthcare, Lupron therapy, Oncology, Personalized Medicine, Prostate Cancer
Dec 21, 2012
Obama’s most significant healthcare-related accomplishment this year may well have been his campaign’s demonstration of the effective use of analytics and behavioral insight – strategies that also offer exceptional promise for the delivery of care and the maintenance of health.
For starters, of course, there’s the widely-reported “big data” success of the Obama campaign. In unprecedented fashioned, they collected, mined, analyzed, and actioned information, microtargeting voters in a remarkably individualized fashion.
Imagine if healthcare interventions could be personalized as effectively (or pursued as passionately).
Another example: according to the NYT, the Obama campaign hired a “dream team” of behavioral psychologists to burnish their message and bring out the vote, using a range of techniques the field has developed over the years.
According to the article, the behavioral experts “said they knew of no such informal advisory committee on the Republican side.”
This idea of focusing intensively on behavior change is without question an idea whose time has come.
Earlier this year, for instance, a colleague (with similar training in medicine, molecular biology, and business) and I were surveying the biopharma landscape, and were struck by the extent to which classic biology hasn’t (yet) delivered the cures for which we had hoped; physiology turns out to be extremely complicated, and people, and communities, even more so.
We were also struck by the remarkably low adherence rates for many drugs, abysmal whether you look at this from the perspective of clinical care or commercial opportunity (imagine if Toyota lost half their cars on the way to the dealership).
Continue reading “The Mentalists”
Filed Under: Uncategorized
Tagged: behavior change, Big Data, David Shaywitz, Medication adherence, Translational medicine
Nov 13, 2012
My twitter stream is awash in math this morning, cheering Nate Silver’s exceptional forecasting (“Triumph of the Nerds: Nate Silver Wins In Fifty States”, Chris Taylor wrote), and celebrating the victory of math and big data over pompous punditry. Jeff Greenfield tweeted, “I, for one, welcome our new Algorithmic Overlord.”
At some level, I thrill to the ascendancy of math, and of math nerds – and I write this as a proud former math team captain (and math team T-shirt designer), and as someone whose very best summers as a teenager were spent in math (and writing) camp at Duke University. It’s also one of the reasons I love Silicon Valley so much – it’s where nerds rule, and where even emerging VCs promote themselves as “Geeks.”
However, before we turn all of life over to algorithms, as some are suggesting, it’s important to place the election prediction in context.
The accomplishment of Silver’s splendid forecasting was to intelligently aggregate existing data, to accurately summarize the current, expressed intentions of the national electorate. And we’ve learned that careful analysis is far more useful than blustery experts – something Philip Tetlock has been trying to tell us for years.
At the same time, all forecasting challenges are not created equal, and summarizing current public opinion is a much lower bar than predicting events far into the future – and Silver has been clear about this; it’s others who seem to be leaping ahead.
Continue reading “Nate Silver Is King, Long Live Nate Silver”
Filed Under: THCB
Tagged: 2012 Election, Algorithms, Big Data, David Shaywitz, expert predictions, Nate Silver
Nov 7, 2012