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The health sector is complex and fragmented, often with misaligned incentives or a lack of coordination that leads to inefficient allocation of resources. Fragmentation also has a negative impact on patient outcomes, costs and quality of treatment.
Joining Sachin Joshi, SVP, Data and Analytics Engineering at Evernorth (a subsidiary of Cigna), to discuss what Cigna is doing to improve this fragmented care and reduce healthcare costs by using data.
Cigna has created a platform that enables the company to automatically identify situations requiring clinical attention, implementing interventions tailored to a patient’s clinical conditions and engagement preferences. The platform also provides 360 degree visibility into patient activity, resulting in the ultimate care coordination program.
Health System Complexities, Obstacles and Failures
According to the World Health Organization, the qualities of the delivery system in the health sector affect the speed, efficiency and appropriateness of medical care for patients. Patients often make the right decision choosing an outcomes-based model of care that secures clinical goals and connects a patient’s points of contact across the continuum of care.
However, Eggers noted that many people have encountered complexity in the healthcare industry. Rather than looking at health issues from the patient’s perspective, she asked Joshi to look at the view from inside the health care system. This fragmentation from the inside out, Joshi agreed, is the main problem.
“I know that we as consumers think that every day when we go to do our labs, go to our primary care doctor…go get our prescriptions filled,” Joshi said. “Imagine trying to pull this information together to create better outcomes for our patients so they don’t have to navigate all of these different channels without feeling like, one, their price is being intentionally abused and, two, [wondering if] all of their health is accounted for with all of these different channels. Joshi said those on the inside see all of this and know there is an ability to come together and come up with solutions.
Joshi explained that coordination management is one of the methods used to solve some of these problems. Evernorth’s Health Connect 360 is designed to look at the total population from a patient management perspective, Joshi said. This provides a macro-level view to clients. “Then, at a micro level, we can look at a stepwise approach that delivers better patient outcomes from a health perspective by reducing costs.”
The challenge with Health Connect 360, from a data perspective, is being able to provide predictive modeling that allows Evernorth to target and improve those patient outcomes.
Joshi added that the important thing in this situation is to be able to offer each patient a personalized treatment plan. He suggests a tailored strategy for clients that allows them to collaborate with the company, assess the level of investment and costs incurred to serve their patients, and then compare it to the results they were seeing before.
Joshi uses diabetes as an example: “It’s something common in the population, but perhaps more common in some segments of employers than others. So what we can do from a total population perspective is analyze this medical pharmaceutical data, third-party data, claims data, which is our own. By integrating this data with third parties as well as digital devices, Evernorth is able to generate data at a macro level.
“Are we seeing that they are filing fewer pharmaceutical applications? [prescription] claim and buy less? Because we have this information, we are able to discriminate in this population, to do education which then intervenes to ensure that medication adherence or [that] prescriber guidelines are properly executed to create a sort of preventative use case where we are raising awareness around blood glucose monitoring.
He added that if someone is at risk for prediabetes or diabetes, based on predictive modeling and machine learning concepts, the company is able to contact directly or through providers so they can intervene before someone ends up in the emergency room, which has far greater consequences. This, according to Joshi, improves patient outcomes and also reduces long-term costs for their clients.
“Huge amounts of data have been the biggest challenge for the tech audience, because it’s so fragmented, it doesn’t line up well together,” Eggers noted. “Audiences are working through their own challenges of how to feed that data. I know there’s power there, but I’m stuck in analysis or something.
However, reiterating what Joshi suggested to fix this problem, Eggers said the tech audience should “go to an MVP you know [and] make sure you stay focused on the experience. Next, make sure your team feels that experience you’re trying to drive. Make sure they know they’re vulnerable and they’re trying things out and it’s okay to choose that middle ground because you won’t always achieve perfection.
Don’t miss the full discussion on harnessing the power of data to repair fragmented care and reduce healthcare costs.
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