Data Analytics and the New Health-Care Frontier

Excellus BlueCross BlueShields' Mark Pitts explains what insurers and providers can learn from Amazon, Netflix, and Great Clips.

According to Mark Pitts, senior vice president and the new chief analytics and data officer at Excellus BlueCross BlueShield (BCBS), health care is well behind other industries when it comes to leveraging data analytics. When Amazon and Netflix can provide “upsell” recommendations and Visa can send automatic fraud alerts, he believes it’s time for health care to receive an upgrade. “Traditional CIOs are excellent at focusing on infrastructure to run and support the business. But more progressive companies, like Excellus BCBS, recognize the value of relying separately on chief data officers who have the skills to create, enhance, and leverage data as a strategic asset,” Pitts says. “It’s an approach that opens an entirely new set of opportunities for addressing costs and clinical challenges.”

While all health-care companies are eager to use data to conquer “the triple aim” (reduce cost of care, promote quality care, and improve patient experiences), they face a number of unique challenges.

Aside from the massive volume of data that patient assessment and treatment creates, privacy regulations make it difficult to aggregate the information and harvest meaningful insights that can improve business and clinical systems. Second, data is scattered across numerous siloed sources: hospitals, private physicians, insurers, and more. In this instance, something simple like identifying a patient can be extraordinarily challenging when each source may have a different identifier for the same individual. Third, after useful results have been generated, they need to reach clinicians and other decision makers in a timely fashion and in useful formats.

For example, if predictive models can identify patients most likely to be readmitted to the hospital due to medication noncompliance , care providers need to know at discharge so they can get prescriptions into patients’ hands. “It doesn’t do any good if we learn about the risk when it’s too late to make a difference. Getting the information to the point of care at the right time is the hard part,” he explains.

Pitts knows that innovation can be disruptive and that many people may be resistant even to beneficial changes. That’s why he takes a practical approach to winning over supporters. While working at another company, he created a pilot program to identify patients most likely to complain about their care to the Centers for Medicare & Medicaid Services, potentially impacting the company’s rating and reimbursement levels.

“Everyone wants to innovate until the time comes for them to change. But because the results of the pilot were very visible, practical, and impactful, everyone loved it,” Pitts says. “It increased excitement, motivated buy-in, and convinced more people to try new approaches to address their own business challenges. That’s how you accomplish real transformation. It becomes viral.”

At Excellus BCBS, Pitts is in the early stages of making sure the right tools and platforms are in place to produce the desired results. “I know senior leadership was expecting immediate improvements to reporting processes, but you have to solve the right problems in the right order to get where you ultimately want to be,” he admits. “You have to build a good foundation.”

Once the basics have been addressed, he expects to be able to show concrete results, such as improving risk adjustment and other meaningful quality measures. As these types of initiatives begin to move forward, he believes Excellus BCBS can take advantage of several factors to help make them successful. This includes the State Health Information Network of New York, which will help facilitate data sharing and excellent relationships with providers who are enthusiastic about partnering to improve clinical outcomes and overall efficiencies.

While Pitts appreciates the value of better understanding specific factors such as medical cost trends, he has more comprehensive ideas about how analytics can improve health care. Rather than simply identifying individuals with the highest claims costs and attempting to manage their care, for example, he believes it’s important to investigate the progression of those patients over the previous five- or ten-year period in order to identify and better manage risk factors, disease progression, and introduce preventive measures for people who might otherwise become ill in the future.

He is also keen on creating what he calls the “Great Clips approach” to health care. When he’s ready to get his haircut, the company’s application remembers his preferences, recognizes his location and the closest shops, and puts him on the waiting list before he arrives. He wants to provide patients with the same ease of use and convenience. “I want analytics to be embedded in every business process so we have the highest quality care for the lowest cost and a patient experience that’s the envy of the rest of the country,” he says. “That’s my vision for health care.”