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Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association.
Population Health
InnovationLeo Barella
VP – Data Intelligence – BCBS of Michigan3/16/2015
2
Wallace Carothers
Pattern RecognitionTrial & Error Cause & Effect
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Pattern RecognitionTrial & Error Cause & Effect
Progression of Disease
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Symptoms
DiseaseWellness
HEALTHY SICK
How do we manage the health and wellness of the population before symptoms occur?
Progression of Health Care Cost
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$
HEALTHY SICK
$
Health Care Costs are the Leading Cause of Bankruptcy
http://www.nerdwallet.com/blog/health/2014/03/26/medical-bankruptcy/
PC
P
Clin
ic
Ho
spital
Progression of Health Care Data
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HEALTHY SICK
We Need to Focus Data and Analytics Towards Wellness to
Make an Impact on Health Care Cost Management
PC
P
Clin
ic
Ho
spital
?
Where Can We Collect Wellness Data?
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If We Can Measure the
Wellness of People we
Can More Effectively
Manage Their Health
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Exponential Technologies
EMPOWERING THE PATIENT
ENABLING THE PHYSICIAN
ENHANCING WELLNESS
CURING THE WELL…BEFORE THEY GET SICK
IT Evolution Compared Healthcare
Exponentially
FASTERSMALLERCHEAPER
BETTER
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Disruptive Products
Disruptive Products
Megatrends Impacting Entire Spectrum of Care
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A Modern Health Care System is on the Horizon, Demanding a Paradigm Shift
FROM TO
One Size Fits All
Fragmented, One Way
Provider Centric
Centralized, Hospital-based
Fragmented, Specialized
Procedure-based
Treating Sickness
Personalized Medicine
Integrated, Two Way
Patient Centric
Decentralized, Community-based
Collaborative, Share Information
Outcomes-based
Preventing Sickness (Wellness)
Connected Health Ecosystem
RemoteMonitoring
General Healthcare IT (CIS and Non-
CIS)
Telemedicine mHealth
• Video Diagnostic Consultation
• Remote Doctor/Specialist Services
• Distance Learning/Simulation
• Retail Telehealth• Teleimaging
• Electronic Health Records (EHR)
• Health Information Exchange (HIE)
• Patient Portals• Hosted Cloud Infrastructure
• Home and Disease Management Monitoring
• Activity Monitoring• Diabetes Management• Wellness Programs• Remote Cardiac ECG• PERS• Medication
Management
• Professional Apps• Wellness Apps• Fitness Apps• Texting Informational
Services
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Transaction
ProcessingAnalytics
Profit Opportunity $ $$$$
Current Investment $$$$ $$
Future Investment $ $$$$
Key Analytic Focuses
Innovative Payments
Risk Adjustment
CMS Star Ratings
Overcoming the Gaps
Leadership commitment to data as
a strategic asset
Long term commitment to drive
health care value
Alignment with enterprise priorities
Dedicated resources to infrastructure
and quality
Continuous improvement mindset
Strategic decisions consider data requirements
Operational decisions include data implications
What Prevents Insurers from Effectively Using
Data?
Inability to get to accurate, integrated data that can provide actionable
insights.
Lack of a clear strategy and roadmap
Budget and resources
Data fragmentation
System fragmentation
Poor data quality
Data silos across departments
Inadequate analytic tools and skill sets
Strategies
• Implement a data governance framework
• Engage providers
• Foster competition and transparency
• Bake analytics into training
• Provide for flexibility in information transference
• When possible, choose in-house solutions over
vendor-generated solutions
• Create simple, understandable tools such as
dashboards for clinicians on the front lines to
visualize incoming data.
• Don’t scale up, scale out
• Close the quality loop
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