Harnessing the power of data

The term “big data” is prevalent in many fields today, but it is an especially critical concept in healthcare. The massive amount of data produced within the healthcare system presents a vast opportunity for those who can harness that information and use it to make healthcare easier, improve outcomes and ultimately help to save people’s lives.

Humana collects, analyzes and applies healthcare data in ways that have tangible positive benefits for people’s health. As one of the nation’s largest providers of Medicare coverage, in addition to the other types of coverage we extend to millions more, we have access to a significant amount of claims data and other patient information. We estimate that we manage 1.5 petabytes of data in our analytics environment—150 times the information stored in the digitized version of all of the print collections of the Library of Congress.

We have not only the ability but also the responsibility to use that information to improve the healthcare provided to all patients—all the while maintaining the security and privacy of confidential patient information.

Impacting the “moment of influence”

Collecting healthcare data has relatively little use unless the information can be applied toward improving the delivery of care. That’s why Humana focuses on “moments of influence”—the points during the care of a patient at which a healthcare provider can have the most positive impact on the patient’s health.

Humana has demonstrated the power of using data to reach these moments with the help of our proprietary data analytics tool called Transcend Insights™. By integrating and assessing a variety of information from medical claims and other sources, this engine identifies and predicts evidence-based gaps in care for a particular patient. The alerts the engine generates could indicate that a diabetic patient is at particular risk of disease progression, or that a particular drug would be contraindicated by another medication that the patient is on, or that a patient is due for a needed health screening.

Humana then uses a sophisticated clinical infrastructure we call “CareHub” to transform these analytic insights rapidly into actionable intelligence at the moment of influence. CareHub optimizes the frequency of the clinical messaging that care providers and members receive, as well as the channels used to deliver those messages. In this way, care providers and members receive comprehensive views of patients’ medical profiles with crucial information that they can act on, without being inundated with messages that are not useful for improving care or changing behavior. Throughout the process of analyzing data and providing clinical intelligence, Humana utilizes stringent safeguards to ensure the privacy of confidential patient information, in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as well as all other federal and state laws and regulations.

This type of real-time, data-driven clinical decision support, delivered to doctors at the point of care, directly supports them and their efforts to help patients achieve their best health. In addition, it helps strengthen the doctor-patient relationship, and it identifies the patients who are in need of greater clinical resources. In the first eight months of 2014 alone, Humana was able to use its data insights to close 2.4 million gaps in care, with initiatives like sending more than 1.5 million alerts about medication adherence or screening reminders, as well as more than 400,000 drug safety messages, resulting in the discontinuation of potentially harmful prescriptions, according to a 2014 Humana study.

The right care, in the right setting, at the right time

The potential of harnessing patient data is not just relevant to the best treatment of one particular patient at a particular time. The concept also has immense promise for ensuring better outcomes across the population.

Using and applying predictive data analytics across its Medicare population, Humana quickly identifies members who are at high risk for chronic disease or the worsening of existing chronic conditions soon after enrollment in our plans (a point where claims data alone would not be sufficient to predict chronic condition risk). Using this information, Humana is able to then refer these members to special clinical programs that invest significant resources toward managing chronic illnesses. As a result of this rapid identification and referral, the number of new Humana members who enrolled in special clinical programs increased from 32,000 in 2012 to more than 120,000 in 2015.

By compiling and analyzing large amounts of patient outcomes information, Humana is among the healthcare companies offering the greatest assistance in detecting health conditions earlier, projecting the progression of disease and predicting healthcare utilization patterns. Delivering those insights to the patient—in an in-home setting or during a clinic visit with a physician—improves health outcomes, while significantly reducing healthcare costs, by working to ensure that each patient receives the right care, in the right setting, at the right time.

This transformation has very real value to patients and the entire healthcare system. In 2011, the McKinsey Global Institute noted, “in about 10 years, there is an opportunity to capture more than $300 billion annually in new value” created by big data, with about two-thirds of that figure coming in the form of reduced national healthcare spending.

Harnessing clinical analytics to create actionable health intelligence is a key to improving population healthcare management, and Humana has the tools and the commitment to accomplish that goal.