Healthcare Data Analysis to Improve the Cost and Quality of Our Care

Healthcare Data Analysis to Improve the Cost and Quality of Our Care

Editor’s note: Connected health devices, both in the home and at healthcare facilities, will generate an enormous amount of data to add to that already being created regarding patients and conditions.
To help you – and us – understand how health data will be used and what it can mean to the health and care of our senior loved ones, we asked our in-house data scientist, Matthew Birkett, to write some articles for us over time. This is his first.
You can learn more about Matthew at his own site, A World of Data.

As a family caregiver, you likely realize healthcare is continually changing right in front of your eyes. You have probably seen firsthand that physician’s offices, hospitals, emergency rooms and urgent care offices – not to mention pharmacies – are having overwhelming numbers of patients, with numbers that continue to rise.

Doctors, healthcare workers, and perhaps, the administration at many hospitals are wondering what the future holds for them in terms of staffing, reimbursement and meeting everyone’s needs safely without mishap.

Because my interests are data driven, this situation gives raises questions for me about healthcare, questions that are likely shared by healthcare leaders and data experts. In order to learn from the data generated by the millions of healthcare encounters, we need to know what questions to ask to begin conducting helpful data analysis.

Once we determine which questions to ask and what answers are most helpful, we can begin to create solutions to the difficulties faced by providers and patients in the future.

Healthcare Industry Statistics of Interest

The Health Care Cost Institute prepared the 2013 Health Care Cost and Utilization Report, which was presented October 2014. The Institute tracks healthcare spending and utilization of adults privately insured in the US.

They found:

  • spending per privately insured person grew 3.9% in 2013 because falling utilization offset rising prices, that is fewer hospitalizations but at higher average prices
  • healthcare spending averaged $4,864 per enrollee in 2013, up $183 from the year before
  • consumers spent an average of $800 per person out-of-pocket which was a 4% increase over 2012
  • out-of-pocket spending for young women ages 19-25 remained the same
  • use of brand prescription drugs, inpatient admissions, and outpatient services declined in 2013. Average prices increased for all three categories at higher rates than in 2012
  • antidepressants dominated generic prescription drug use and were more than 10% of all generic drugs used in 2013

They collated data from several billion insurance claims (with identities removed) and the prices paid for each claim.

The Healthcare Imperative: Lowering Costs and Improving Outcomes found that of the trillions spent on healthcare in the US, there were many billions wasted on healthcare in the form of unnecessary services ($210 billion), fraud ($75 billion), excessive administrative costs ($190 billion), inefficiently delivered services ($130 billion), prices that are too high ($105 billion), and missed prevention opportunities ($55 billion).

They estimate that we can save $463 billion in the next 10 years by preventing avoidable hospital admissions, streamlining services, preventing fraud and abuse, decreasing costs of episodes of care, improved hospital efficiency, preventing medical errors and improved targeting of costly services.

What Patients Want to Know

Many patients hope for improvements in the way their healthcare is delivered and also in the direct cost of that healthcare. They may want to be sure their physician and healthcare team are providing the safest and most up-to-date care that will fix their medical problems quickly and help them be healthier.

They probably also hope that research will cure what ails them including major diseases like diabetes, dementia and cancer.

Here are some examples of questions that many people ask about their healthcare that could be answered using data.

  1. “How do I make sure I’m spending money effectively or is there another healthcare process or model that would be more cost effective?”
  2. “Is this the best facility and staff where I will be treated correctly and safely?”
  3. “Is it possible to know in advance what treatment or procedure will work best?”

The first question is very important because trillions of dollars are spent in the US on healthcare every year, which puts a great burden on the government, businesses, and the patients themselves.

The unfortunate part is that billions were spent on treatments that did not improve health conditions — and some that actually worsened the condition.

Lack of Information Driving Additional Testing

According to information from Aetna, a healthcare provider with a stake in the subject, studies indicate that people are spending more on additional testing and being over-treated, which did not result in an improvement to their health.

What they found is that if patients’ doctors do not know the full medical history or genetics of their patients, they may not know what would be the best and most effective treatment. The less information doctors have about the patients, the more testing they may order to learn more. This process causes inefficiency and higher cost for the whole healthcare system.

These issues are a call to action to bring improvements in effectiveness to the current healthcare system and make it more sustainable for the economy overall.

As a person who works as a database developer, I believe that one solution to resolving the issues we are facing concerning the healthcare system is improved usage of the data that is being generated.

Utilizing Data That Already Exists

Over recent decades, information such as clinical studies, insurance data, and hospital records were collected and kept confidentially in data files. Therefore, the industry is filled and in truth, overwhelmed by a variety of data including biological (DNA) and clinical data (think of drug trials where many people with a variety of genetics volunteered to provide the data).

This wealth of data can be used to help solve some of our medical mysteries and improve the delivery of healthcare and improve outcomes.

Fortunately, we have witnessed an advancement in technologies which allow us to work with massive data sets consisting of electronic health records and medical claims. We are also able to combine the data collected with clinical trials and direct observations by practicing physicians to understand the effectiveness of a treatment.

Now we can begin to answer the questions mentioned earlier.

Data’s Benefits to Our Healthcare

Analysis of available data is already providing valuable answers, such as how effective a specific drug or treatment is against diseases. For example, in the past doctors prescribed a certain drug as a treatment for a diagnosis, such as breast cancer, based on results from clinical trial studies, believing they would successfully improve the condition. The trial showed an effectiveness of 60% in the general population.

The doctor then prescribes the new drug even though he maybe unsure if it would work as expected for a specific patient. What if this patient is allergic to this drug but it is the only one available for the particular diagnosis? Not only could the patient suffer further harm, but the doctor could be held liable if the patient’s condition takes a turn for the worse instead of delivering on the promised benefits.

The results of data could provide more information to help the doctor determine if the drug would be most effective for each patient based on the specific individual characteristics rather than relying just on the results from the study group as a whole.

Using data to answer these questions will result in better health outcomes while saving costs associated with healthcare delivery. With newly developed methods to use the warehouse of data we are collecting, we can help recipients of healthcare by ensuring providers use the right drugs and the most appropriate treatments while avoiding the cost and lost time of overlapping services.

I believe analysis of data already available will help us choose the safest and most appropriate doctors and hospitals for our needs and help those healthcare providers utilize the most efficient processes.

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