California Healthcare Provider Wants Illness-Predicting Algorithm

alphadogg writes "The Heritage Provider Network wants to do for healthcare what technology in the film Minority Report did for police work. In other words, it wants to use technology to pre-emptively predict when illness is likely to strike and take measures to prevent costly hospitalizations. This week Heritage announced that it was offering a prize of $3 million for any developer who successfully created a 'breakthrough algorithm that uses available patient data, including health records and claims data, to predict and prevent unnecessary hospitalizations.'"

The Actual Problem in Pursuing this Prize

[sarbonn]

As a healthcare professional who does data analysis for a number of hospitals, this sounds like a great idea, but at the same time I also realize the limitations of conducting this algorithm process. To begin with, HIPAA compliance laws make it very difficult to share specific data about patients, which means someone trying to put together this type of information, or statistical based program process, is going to have to do it sans data, creating false data that isn't actually real case information. Which then means that even if you are capable of providing an algorithm that fulfills the functionality, the designers of the prize program are most likely going to stand up and say that it's not transferrable to real cases because you didn't account for the specific variables that are present in real world data (meaning you can't predict data that is actually already there due to the amount of errors in guesswork involved). If they made available the actual data they want extracted, this might be a possible process. But until they do, it is like guessing statistical outcomes of a presidential race without knowing anything about the people who might be actually running.

Re:Well with the stupid rules in place

[Isaac-1]

The real problem is cost of health care, about 6 months ago I fell and broke my back. I have decent if not great insurance, and the treatment for my break (single level split compression fracture if your interested) has been nothing more than a brace and monthly follow up x-rays (and one CT at 4 months)and doctor visits. I was transported to the hospital by ambulance on a back board (cost about $750, $300 out of pocket, kept in the hospital for 3 days base level observation, fall happened on a weekend and I could not be fitted for a $750 custom fitted plastic and foam brace until Monday, hospital bill about $15,000 for 35 hour stay, another $2,000 or so for the 2-3 hours in the ER before being admitted), plus about $515 per month for a couple of x-rays and spinal specialist visits. Total bill upwards of $25,000 so far, out of pocket around $4,000 .

Re:Well with the stupid rules in place

[Inda]

For comparison in the UK:

CT scan just cost my insurance £450 ($721.22) and the nurse told me that was cheap.

Wife just had gaul bladder removed. In and out of hospital within 24hrs. £4,750 ($7,612.83)

NB. Some of us in the UK get private health care through work.

Re:Predict and disqualify customers, you mean.

[NoSig]

That is exactly what insurance is about - distribute predictable risk at a cost. It is not about the low-risk subsidizing the high-risk. If you want the low-risk to sponsor the at-risk, then what you are talking about is government management of healthcare. Insurance is a red herring in the American health care debate - insurance simply is not about what Americans seem to think it should be about. It's about predicting your actual risk and charging you a fee that is proportional to that risk. So with insurance, many people will face unaffordable fees because their risk is unaffordable. That's what insurance is, it is not about the low-risk sponsoring the high-risk, it is about paying for the removal of whatever risk you actually have, and that price is going to be very high if your risk is very high. Don't blame the insurance companies for being insurance companies. If what you actually want is for the low-risk to sponsor the high-risk people, then you are not talking about insurance, so stop using the word insurance because insurance is not about that. Instead, realize that you are a supporter of government healthcare and go support what you actually believe in.