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Consumer data over clinical, next necessary revolution in the health industry

Most people spend far less than 1 percent of their lives in a clinical setting, but the relative use of data and information technology in healthcare has failed to address this conundrum.

More digital data is flowing within the healthcare industry than ever before, which is commonly and erroneously perceived as transformative in and of itself. While the healthcare industry becomes increasingly adept at applying clinical, claims and “omic” data to predict illness and improve the coordination and quality of care for sickness, it has largely ignored other data sources that provide the greatest opportunity to positively impact health status, outcomes and cost at scale. How can this be?

There is strong agreement among healthcare experts that medical care and genetics drive only about one-third of health status. So why is the healthcare system treating us as patients all the time? Because the healthcare system is a sick care system and the data model that feeds it is broken. The way to radically, but respectfully, fix the healthcare system is to apply consumer data to help all types of population health managers’ partner with people, not just as patients, but as consumers.

Patients and consumers

Imagine a simple device where healthcare data insights resulting from all this digital big data get dropped into an opening that branches into two tubes. Down one tube, the device translates the insight into a list-of-things that medical professionals should do to a person to fix what ails them. Down the other tube, the device translates the insights into actions that the person can take to achieve their highest health status in the context of their daily lives and in a way they can understand. We’ve spent decades working to perfect the first tube, but what about the second? Patients are not the same as consumers. Patients receive care. Consumers make choices. In reality, most people are consumers most of the time and some people are patients some of the time. In fact, most people spend far less than 1 percent of their lives in a clinical setting, but the relative use of data and information technology in healthcare has failed to address this conundrum.

Both government and private sectors have dedicated significant capital and energy to building electronic health record and claims systems to automate and record sick care transactions. This increased digitization supports consistent quality of care and payment accuracy, but this data is primarily retrospective – a story of what has been. How do we get to the story of what can or will be? This industry needs to rapidly build the pipes and the aptitude for amalgamating consumer data, which is a much stronger predictor of how a person will or won’t interact with available health resources, with medical and claims data. This creates immediately actionable information that population health managers, including health plans, large employers, health systems and even retail pharmacies, can put into play to change a health outcome.

To have any reasonable chance of changing the trajectory and value of the $2,3 trillion ballooning healthcare costs in the EU alone, it is imperative for consumers to become more active participants in their health. Every day we make decisions that impact our health, from food consumption to physical activity to management of known health conditions. Keep in mind that individuals who experience daily lifestyle and environmental factors are not closed-loop experiments. Adherence and compliance is the vocabulary of doctors to patients, not consumers. We all have variations in our relationships, finances, stress, locations, and emotions. Almost every healthcare clinical and administrative professional knows this intrinsically, and yet the healthcare system continues to operate primarily in a sick care vacuum.

If we go back to the simple, hypothetical device described above, a few actions by each of the many consumers emanating from the second tube are certainly more powerful than many actions being required of relatively scarce and overburdened medical professionals. And it is no stretch to consider that consumer incentives tied to consumer actions are a powerful ally to provider incentives that support value-based care delivery.

Consumer data is imperative and full of opportunity

Surprisingly little work has been done to date to understand the relationship between a consumer’s daily living with the impact on their health and how they interact with the healthcare system. Our company is in this way oriented to the future, we are trying to collect and analyze all possible data attributes via HRAs and other channels. These data is stripped of all sensitive information and used to comprehend the health situation on a larger scale.

Consumers’ data will be driving force of near future standards in health management inside companies. This information we can say for sure. AI, algorithms and data analysis can largely benefit companies in case of better understanding the risks and obstacles inside their workplaces and lay a solid ground for taking actions to contradict those.

Combining consumer and clinical data

While consumer data is imperative, it is not absolute. The combination of all available data – both consumer and clinical – create the most accurate predictive models. Said another way, the data generated by EMR/EHR systems and benefits administration systems remains vital. But, by adding data about consumers and consumer actions – which requires a complementary type of consumer activation system, and by applying machine learning to these consolidated data sets, it is now possible to coordinate provider and consumer efforts to drive behavior change and improve outcomes at scale.

Bottom line, the absence of consumer data in healthcare is equivalent to ignoring the most untapped change agents of healthcare– consumers – altogether. There’s empirical evidence that the combination of all data types is a powerful means for advancing targeting and consumer activation. Since population health is the summation of individual health, it would be irresponsible to discount consumer data and personalized consumer activation. Likewise, it would be irresponsible for traditional health organizations to assume they can readily and acquire and apply consumer data. (How many years has it taken for them to predictively apply the data they generate?) It takes years to amass and license the consumer data, train the machines and build the models. Partnerships are the optimal approach to consumer-data health endeavors rather than each organization expending the resources and time required to build the second tube.

Clinical data and expertise are vital, but the only way the healthcare industry will truly fix itself is to understand consumers at an individual level – by leveraging information about every aspect of their lives – to create personalized experiences that ultimately drive behavior change and improve outcomes.


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