The University of Pittsburgh Medical Center’s health plan reportedly has developed prediction models that use such data as patient claims, prescriptions and census records to determine those members who are most likely to require emergency and urgent care, which tends to cost more. Interestingly, how people shop could place them in the higher-risk “baskets.”
Use of data for predictive analytics has been common for years, as even credit card issuers often use analytics of consumers’ buying habits and financial status when determining to whom to market their best products. But the health insurer has added new elements to its predictive analytics, including members’ household incomes, marital status, education levels, race, number of children living at home and other factors, reports the New York Times.
And instead of using the data simply to pitch a new payment tool to individuals, health insurers potentially could use such information to determine methods, and locations, of care.
The Affordable Care Act motivates health care providers to seek out was to control costs. And that has many health plans similarly using analytics to bolster their own efficiency.
Marketing-analytics company Axciom is one of the sources the University of Pittsburgh Medical Center’s health plan uses to collect both public and private consumer data (Wells Fargo also is a client). Using the household details it collects, the insurer has found some unusual correlations, such as the fact that mail-order shoppers and Internet users tend to be more likely than some other members to use emergency services.
Though the direct correlation may not be apparent, use of mail-order shopping could signal the buyer is elderly or unable to visit a store to shop for health reasons. “It brings me another layer of vision, of view, that helps me figure out better prediction models and allocate our clinical resources,” Pamela Peele, M.D., told the Times in an interview. “If you are going to decrease the costs and improve the quality of care, you have to do something different.”
According to the Times report, the medical center has yet to act on the correlations found in the household data. But it does use the information to help steer members segmented into different “market baskets” so primary care physicians or specialist can provide better coordinated care that is less costly that periodic emergency department visits.
Use of such information, however, can run into ethics issues, such as the potential for provisioning health care service unequally. “This intensive, intrusive kind of data analytics that leads to different treatment of customers, even if we are find with it in the business context, needs to be disclosed in the medical context,” Frank Pasquale, a health care regulation professor at the Seton Hall University School of Law,” told the Times.