Cambia Health Solutions

As the saying goes – everyone is a patient, thus everyone is invested in health care. However, as individuals we are all more than just our medical histories, our diagnoses and treatments. Health care needs to look at people in a more personalized and holistic way to truly influence outcomes.

When we do the math, over 80% of health care spending goes into the acute care system, which only impacts 15-20% of an individual’s health outcomes. By the time a person has embarked on the ‘patient’s journey’ – they usually have missed their chance to address the other variables which affect a greater percentage of their health, including: behavior, lifestyle, economics and genetics.

"As innovators and leaders, it’s up to us to drive transformation in our industry and respond to consumer demand for simplicity and efficiency in health care"

The integration of technology – to bridge the gaps and provide navigation through an infamously fragmented health care system – offers the potential to accelerate the shift to person-centricity.

My goal as Cambia Health Solutions’ CIO is to bring a platform of integrated solutions to consumers that will make their experience and perception of their health journey more seamless and personalized. The industry needs to look at the total equation to truly impact a person’s health and well-being instead of jumping in at the end – where at age 65 you could still be facing 60 percent of your lifetime health care costs.

Historically, IT systems in health care resemble a data swamp. What we have is a wealth of Big Data but no clear way of separating the signal from the noise. Admittedly, some of the barriers are deliberate or regulatory requirements in order to protect the privacy of patients and maintain data security. But this approach makes it difficult for health professionals to actually use these data to deliver insights and make personalized health and clinical recommendations to help prevent more serious conditions.

The health care industry often has fragmented views of their data –it’s hard to aggregate and even more difficult to consume in an actionable way. One way we are changing that is employing predictive models that use historical data to help forecast emerging illnesses and deploy resources. Our data scientists created over 30 models, running daily with over 1,500 data elements against our regional health plans’ two million members to help us predict where and when proactive health and clinical interventions should be made.

A new service, Nurse Insights, was launched by Cambia last year as a tool to aggregate a patient’s history in a single-screen dashboard. It is a data-driven clinical solution that allows people to receive personalized care from Cambia nurses and care advocates. It provides the care management team with a 360-degree view of the patient by combining demographics, eligibility, information on possible gaps in care, future clinical and utilization predictions, and pharmacy, medical and dental claims in an easily digestible way. For example, using advanced analytics, Nurse Insights can inform the care management team if their patient with diabetes is at lower risk for high blood pressure but at higher risk for coronary artery disease, the interaction can then be better personalized as they interact in real-time.

Another effort to match patients with the appropriate medical interventions led us to GNS Healthcare’s causal machine-learning technology. The analytics evaluate multiple, large-scale data sources that include the patient’s genomic and longitudinal health records. Partnering with GNS, we launched a program that identifies Medicare members with serious illnesses or chronic conditions who may benefit from the support of a care manager to manage their conditions. With this insight, we can proactively engage with people to understand their palliative care needs and provide them with the information and support they require to make informed decisions about their care. Machine learning enabled a new level of insights and helped us determine the root causes of disease so that we can work to prevent them in the future as well as help our members better manage chronic illnesses and complex care.

As innovators and leaders, it’s up to us to drive transformation in our industry and respond to consumer demand for simplicity and efficiency in health care. Today’s consumer sare expecting health care to offer the same seamless experiences that they have in retail. People are used to comparison shopping for goods such as TVs and tablets, taking it upon themselves to learn about individual features, technical specifications, limitations and costs. But this magnitude of details is not as readily available when it comes to medications, therapies and health services and we’re working to answer the people’s call for greater transparency.

For example, HealthSparq, designed to make health care easier for people, is a first-of-its-kind platform that enables consumers to comparison shop for health services online. HealthSparq offers the most relevant and personalized data to help give people the context they need to better understand costs and quality. Developed with real-world, claims-based data, HealthSparq increases decision making ability by empowering people to understand costs of entire episodes(pre-surgery, surgery, post-surgery) and quality as they make health care decisions. The data is based on the individual member’s plan and benefits, offering pricing based on the member’s deductible, co-pays, and out-of-pocket maximums.

Another solution, MedSavvy, empowers people to understand their medication options and gain more control over their treatments. The service increases transparency by assigning evidence-based letter grades –A, B, C, D, F and I (Incomplete) –to medications’ efficacy for easier side-by-side comparison. Grades are based on objective criteria developed from best practices in evidence-based medicine, and assigned by a team of pharmacists who have specialized training in clinical evidence review and evaluation. MedSavvy simplifies critical information for people and helps them have more informed conversations with their physicians. The service can also be integrated directly with a health plan’s portal for greater and more convenient access.

At the heart of each of these capabilities is to make good on our promise to improve the health care experience for people and their families. With data science and augmented intelligence, we can learn from and empower our consumers, streamlining their health care journey by offering tailored recommendations on health care options, costs and savings. Creating the right tools to unlock data and optimize a person’s health journey in real-time is one way in which we can impact outcomes.

To transform health care, the industry needs to commit to comprehensive care and creating an environment where individuals have freedom of choice, power in knowledge and can solve for any existing pain points they’re experiencing. The health care experience should be a two-way conversation and data is the bridge that will serve as astrategic solution in creating a more relevant, seamlessand personalized experience people have come to expect. At Cambia, we are always investigating ways technology can elevate us into the future of health care and with a focus on creating the experience each of us, as individuals, deserve.

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