How Payers Transform Volumes of Data into Actionable Information

August 08, 2019 - Payers want to know how to drive a personalized care management plan, how to excel at member engagement, and how to improve outcomes, all ultimately to cut costs. But when a payer attempts to answer these questions with data, it’s easy for payers to get lost in the information.

With the volume of information payers have and the limitless challenges in healthcare, how can payers effectively leverage data? Payer organizations should assemble dedicated provider teams to sift through the data, according to Leanne Metcalfe, PhD, Executive Director of Data Science at Blue Cross Blue Shield of Texas, who recently led a HealthPayerIntelligence.com webcast.

From there, data analytics teams can identify key trends in specific patient populations, determine the key resources the plan has to manage that population, and design a response plan.

By walking her audience through three case studies, Metcalfe underscored the keys to success in data analytics and implementation.

Case study: CKD and COPD population

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Before looking to isolate problem areas within a set of data, first the team had to set aside any preconceived notions about population health. Regardless of what was in the headlines or what a colleague had told them, the data team had to prioritize the data to honestly assess the core health issues Texans faced.

Then, the researchers used the Blue Cross Blue Shield Health Index to identify areas of Texas that had a high prevalence of one disease as well as areas with a high rate of healthcare spending on a given condition.

In addition to tools such as the Blue Cross Blue Shield Health Index, Metcalfe discussed using data from pharmaceutical companies.

Knowing when or if the member is refilling her prescriptions can help fill in details about how the member is pursuing treatment outside of the clinical setting. It can help identify non-adherence to a medication regimen, conflicting or overlapping medications, and level of illness.

Drilling down, the team found that chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) were rising from year to year, in contrast to other states where the numbers were stable.

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With the data clearly pointing them to a specific problem that could be fixed, the team consulted providers to develop the optimal intervention plan.

BCBS Texas’s interventions on behalf of CKD and COPD members resulted in a six to one return on investment. It also decreased outpatient visits, decreased hospital admissions, and increased provider visits for individuals whose costs were under $100,000.

For patients who had been spending over $100,000 on CKD or COPD treatments, the results were less positive. The overall healthcare spending was higher and there was only a slight decrease in hospital admissions. Nonetheless, the provider visits for these members still increased and BCBS Texas hopes to see these numbers change in the second year of their intervention.

Case study: Hurricane Harvey survivors

BCBS used this same strategy to address healthcare needs for individuals hit by Hurricane Harvey in 2017.

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After setting aside preconceptions, the team tracked how the members affected by the hurricane were doing now, revealing two different clinical challenges. They identified both a spike in post-traumatic stress disorder (PTSD) in the two years following the disaster as well as a 150 percent increase in infections and parasitic diseases.

BCBS leaders were left to determine which issue they should target first. In the immediate future, BCBS recognized the need to reach out to members who may still be suffering from PTSD or other health effects up to a couple years after the hurricane. Other data points will prove helpful for future natural disasters interventions.

When determining what problems to prioritize, Metcalfe recommended sticking to what can be addressed with the resources at hand.

“You look at your numbers, you look at your trends, you look at your identified populations, your clusters of populations, you take in your operations team, figure out what's possible today,” Metcalfe said.

“You still want to keep in the back of your mind, ‘how do we solve these other things that are unsolvable today,’ and you keep that list, but you prioritize the ones that you know that you can solve today, either by operations or from a clinical intervention.”

BCBS will use the information collected after Hurricane Harvey and share it with other organizations in order to better address similar future events.

Case study: Victims of violence

Lastly, Metcalfe described how BCBS explored the response to a member suffering violence.

Looking at the data, the data team realized that far more minors are victims of violence in Texas than in most states. Overall, 20 percent of violence victims classified as minors in other states, while in Texas the percentage was 27. This enabled them to localize their interventions.

Interventions will vary based on the issue but collaborating with providers is key, Metcalfe explained.

BCBS uses a “health risk score” or “opportunity score” which they send to providers to help them understand the claims data for the BCBS members they serve. In the past, BCBS has also partnered with providers to send text messages to members once a month and communicate about treatment with the members based on their score.

Metcalfe emphasized that having a team of providers on hand is critical to understanding the underlying factors and the true meaning of data results. Without the expert knowledge of clinical partners, it is easy to misinterpret and poorly employ the analytics.

Advice to Small Companies

Metcalfe also offered advice to smaller payer organizations who are looking to use data effectively, emphasizing that they start small and know what problems they are capable of fixing.

“Definitely focus on some of those things we talked about earlier in the presentation,” she also recommended. “Do you trust the source of data that you have bringing in? Do you have the right people at the table? Do you have someone that you can outreach to if you don't have that talent in house? Is there a provider? Is there some other operational specialist that can consult on what you're working on so that you can get good insights?”

She also advised smaller payers go to conferences where it is possible to learn and borrow from successful organizations.

“Some things are easier in a small company, because you have the flexibility to move around and change things quickly,” she encouraged. “So it actually might be good that you're in a smaller company with less resources, because you can probably move things faster and do things faster.”