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.'"

Comments

Predict and disqualify customers, you mean.

[mattcsn]

"New care plans and strategies" sounds like HMO-speak for "cut off people before they cost us more than we soak in from them".

Re:Predict and disqualify customers, you mean.

[NoSig]

That is exactly what insurance is about - distribute predictable risk at a cost. It is not about the low-risk subsidizing the high-risk. If you want the low-risk to sponsor the at-risk, then what you are talking about is government management of healthcare. Insurance is a red herring in the American health care debate - insurance simply is not about what Americans seem to think it should be about. It's about predicting your actual risk and charging you a fee that is proportional to that risk. So with insurance, many people will face unaffordable fees because their risk is unaffordable. That's what insurance is, it is not about the low-risk sponsoring the high-risk, it is about paying for the removal of whatever risk you actually have, and that price is going to be very high if your risk is very high. Don't blame the insurance companies for being insurance companies. If what you actually want is for the low-risk to sponsor the high-risk people, then you are not talking about insurance, so stop using the word insurance because insurance is not about that. Instead, realize that you are a supporter of government healthcare and go support what you actually believe in.

Re:Really?

[click2005]

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.

The Actual Problem in Pursuing this Prize

[sarbonn]

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.

Re:Likely to get sick: no healthcare for you!

[Chrisq]

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.

Re:Likely to get sick: no healthcare for you!

[mcelrath]

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.