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California Healthcare Provider Wants Illness-Predicting Algorithm
alphadogg writes "The Heritage Provider Network wants to do for healthcare what technology in the film Minority Report did for police work. In other words, it wants to use technology to pre-emptively predict when illness is likely to strike and take measures to prevent costly hospitalizations. This week Heritage announced that it was offering a prize of $3 million for any developer who successfully created a 'breakthrough algorithm that uses available patient data, including health records and claims data, to predict and prevent unnecessary hospitalizations.'"
"New care plans and strategies" sounds like HMO-speak for "cut off people before they cost us more than we soak in from them".
or...
"Statistically you're likely to get so your premiums are going up by 588%"
or...
"There is a 22% likelihood that one of your kidneys will fail within 5 years, 44% for leukaemia blah blah.. how about one of our body scans??"
or..
Patient: Can I see a doctor?
HCP: Doctor? We dont need doctors.
Patient: But I'm sick. I think my kidneys are failing.
HCP: I dont think thats very likely. According to our software you only have a 2% chance of kidney failure. Its probably just gas.
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As a healthcare professional who does data analysis for a number of hospitals, this sounds like a great idea, but at the same time I also realize the limitations of conducting this algorithm process. To begin with, HIPAA compliance laws make it very difficult to share specific data about patients, which means someone trying to put together this type of information, or statistical based program process, is going to have to do it sans data, creating false data that isn't actually real case information. Which then means that even if you are capable of providing an algorithm that fulfills the functionality, the designers of the prize program are most likely going to stand up and say that it's not transferrable to real cases because you didn't account for the specific variables that are present in real world data (meaning you can't predict data that is actually already there due to the amount of errors in guesswork involved). If they made available the actual data they want extracted, this might be a possible process. But until they do, it is like guessing statistical outcomes of a presidential race without knowing anything about the people who might be actually running.
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So there I was, walking down the street minding my own business... when a van screeches to halt in front of me. Five (5!) scantily clad nurses throw me to the ground and give me the kiss of life. Who knew I was about to be run over?
The whole idea of a healthcare insurance is to spread the risk between people... therefore it's pretty much necessary that healthy and unhealthy people pay the same. If you have a cheap healthcare for all healthy people, and then an unaffordable one for those more likely to get ill, the system crashes, doesn't it?
An insurance is a protection against future problems. Healthy people also must invest in their own unavoidable loss of health.
You are assuming that the aim of healthcare insurance is to provide healthcare to people efficiently rather than to maximise profit for the providers.
The real problem is cost of health care, about 6 months ago I fell and broke my back. I have decent if not great insurance, and the treatment for my break (single level split compression fracture if your interested) has been nothing more than a brace and monthly follow up x-rays (and one CT at 4 months)and doctor visits. I was transported to the hospital by ambulance on a back board (cost about $750, $300 out of pocket, kept in the hospital for 3 days base level observation, fall happened on a weekend and I could not be fitted for a $750 custom fitted plastic and foam brace until Monday, hospital bill about $15,000 for 35 hour stay, another $2,000 or so for the 2-3 hours in the ER before being admitted), plus about $515 per month for a couple of x-rays and spinal specialist visits. Total bill upwards of $25,000 so far, out of pocket around $4,000 .
The question is, is this preventive medicine or preventive insurance?
With single-payer health care, this distinction doesn't exist.
"So, why would health insurance be different?"
Ultimately it is different because without car insurance you walk, without health insurance you die [1]. Maybe you are fine with the concept of the poor and people who don't live the way you feel they should just dieing of treatable illness, but that fundamental difference between car insurance and health insurance remains.
[1] Earlier than necessary due to treatable illness you can't afford.
And that, in a nutshell is what's wrong with for-profit insurance providers: the profit motive of the company is directly opposed to the health motive of the customer.
Because of that very fundamental fact, the only medical insurance scheme that makes any sense is a socialized one.
1^2=1; (-1)^2=1; 1^2=(-1)^2; 1=-1; 1=0.
You seem to be arguing from the following premise:
"costly treatments make people take more care of their health"
Until you bring forth Extraoridnary Evidence (tm) for this Extraordinary Claim (tm), please forgive us for ignoring your random speculations, and for frowning upon your attempt at presenting those ramblings as fact.
You might be surprised to learn that there are many other countries besides the US, employing many different models of health care funding. A first stab at checking your assumtions (don't knock it 'till you've tried it) would be to compare some industrialised countries in terms of public health, healtcare spending, and typical cost to patients.
Seriously - would you or anyone you know actually think "I never really considered getting a serious helath problem, but it the treatment is free, why the hell not?", or is it just "those other people" you collectively accuse of this insanity?
sudo ergo sum
Incorrect. If an insurance company has the opportunity to remove unprofitable members from the rolls, they will take it. If they have the opportunity to refuse treatment, they will take it. If they can select which new customers they will take and which ones they won't, they will use that. If they can write long obtuse contracts outlining things they won't pay for, and have their army of lawyers enforce it, they will do it.
It is a general fact about any kind of insurance that the interests of the insurer are misaligned with the interests of the insuree. They're predatory industries who rely upon promising more than they will deliver and tricking their customers wherever possible.
Only in the circumstance that the insurer is required to insure everyone does the profit motive go in the direction of the patient's interests (in the form of preventative care). Preventative care is a long term investment that wall street doesn't see.
1^2=1; (-1)^2=1; 1^2=(-1)^2; 1=-1; 1=0.