Sunday, February 12, 2012

Big Data, Big Doctoring, Big Savings?

It’s a revolution. We’re just getting underway. But the march of quantification, made possible by enormous new sources of data, will sweep through academia, business, and government. There is no area that is going to be untouched.

Gary King, director of Harvard University’s Institute for Quantitative Social Science, “The Age of Big Data,” New York Times Sunday Review, February 12, 2012

Big Doctoring is what the generalist does: doctoring that embraces the whole person that values comprehensiveness. that welcomes the richness and the complexity of the complete human being.

Fitzhugh Mullan, MD, Big Doctoring in America: Profiles in Primary Care, University of California Press, 2002

February 13, 2012 - The Big Question for the day is: Will Big Data and Big Doctoring save Big Money?

It is not an idle question, nor is it theoretical.

Let me explain.

Big Government and Big Data

Big Government is banking on Big Data to save Medicare, Medicaid, and other entitlement programs. The Affordable Care Act is counting on Big Data to save Medicare by making care more affordable and better. For these purposes, CMS has created an agency called PCORI (Patient-Centered Outcomes Research Institute)to save the government money as part of the Affordable Care Act.

PCORI. its advocates proclaim, will deploy rigorous and transparent data analysis to help people make informed health care decisions to improve care and outcomes while saving money.

The initial budget for the pilot PCORI project is $50 million. This is peanuts by federal standards. The budget will surely grow to meet its good intentions and expectations. Whether it will save money is questionable. No doubt it will require more federal employees.

Big Insurers and Big Data

Big Health Plans, like UnitedHealthcare, are counting on Big Data. America’s biggest insurer is changing how it pays hospitals and doctors based on Big Data. By 2015, United plans to roll out a data-geared plan eventually covering 50% to 70% of the 5500 hospitals and 550,000 doctors in its network.

“This “says Sam Ho, MD, United’s chief clinical officer, “is not just an exercise or pilot.” United is planning Big. Ho says Big Data will save from $1.35 to $3.27 per member per month. It will earn twice as much as it costs.

Savings for hospital will be tied to Big Data on readmissions, mortality for certain diseases, hospital-acquired infections, and patient satisfaction.

For doctors, data will be collected and analyzed for hospital admissions, ER use, total cost of care, and number of patients receiving immunizations and preventive screening.

The Big Assumption, I assume, it that hospitals and doctors can control these Big Variables, and doctors should be rewarded or punished on that basis.

Big Doctoring and Big Data

This Big Data gathering, analyzing, and mongering will be linked to Big Doctoring – more primary care practitioners directing and controlling care in Accountable Care Organizations, more bonuses and incentives for generalists for improving data-based outcomes and practicing in patient-centered medical homes offering preventive, coordinated, and continuous care with fewer duplications of care. If only primary care doctors play a bigger roll, the reasoning goes, care will improve and so will efficiency and outcomes.

Tweet: CMS & insurers plan data-based payments to hospitals and physicians to change clinical behavior,save money,and yield better outcomes.


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