Vital Signs: Examining Our Health Data

Vital Signs is our blog-in-a-blog on the Washington area's biotech and health care scene.

By Kendra Marr

Ever wonder who sorts through all the data that powers your all-knowing health insurance company?

Samuel A. McKinney did. McKinney was surprised to find a concerned letter from Blue Cross Blue Shield in his mailbox wondering why he had stopped taking his medication: Immediately consult a physician about your medication if it's too expensive or causing side effects, the insurer advised.

Trouble was, he had just filled the prescription.

So, he called and discovered that Resolution Health, a Columbia-based health analytics firm, was helping insurers keep closer tabs their members. Armed with a massive databases -- medical and pharmacy claims, lab reports, provider reports and other statistics -- Resolution analyzes personal health information. More than 1,000 computer algorithms dissect the data for millions of members, scanning for ways to cut costs, eliminate conflicting medications and avoid lapses in treatment.

When a problems are identified, letters, much like this one, are sent out to patients such as McKinney and their doctors.

As it turns out, Blue Cross wasn't informed that McKinney, a retiree who lives in Salem, Ohio, gets his drugs through a military pension program.

McKinney forgave the oversight.

"I think it's a great check and balance," he said. "I don't feel it's an invasion of privacy."

For its part, Resolution says it continues to refine its model. Last month, the company signed a consulting deal with Johns Hopkins Medicine. Experts in more than 20 clinical departments will review and sharpen Resolution's "clinical rules," or computer algorithms, that assess the quality and cost effectiveness of health care. Resolution expects these experts to expand the number of medical conditions and situations addressed by their computer models.

Constant upgrades such as these are key to Resolution's business. Over the years, the company has learned not all cases are as easily remedied. And not all patients are as pleasant as McKinney.

Resolution CEO Earl Steinberg

"We had one instance when the patient took the personal care note into her doctor and sort of bad mouthed it," said Earl Steinberg, Resolution's president and chief executive. "She said, 'Doc, look at what I'm getting from my insurance company. I don't know why they're doing this.' The doctor took a look it and the message said the patient had a history of diabetes and health failure and was not on a particular type of drug. And the doctor said, 'I thought you were on that drug.' "

Steinberg spent 12 years as a professor of medicine, health policy and management at Johns Hopkins University. There he founded the Program for Medical Technology and Practice Assessment, which evaluates the cost and safety of technologies, clinical problems and health care programs.

But in 1994, he left the university to explore other ways to deliver health care information.

"I was very struck by the success pharmaceutical industry had with direct to consumer marketing," Steinberg said. "In some studies, it found that if a pharmaceutical firm got a patient to ask his physician for a particular medication, there was a 75 percent chance he would walk out of the office with a prescription for that medication. I thought, 'why not do something analogous?' Extend more information to patients so they can talk to doctors about it."

Before coming to Resolution, he spent five years at Covance Health Economics and Outcomes Services, headquartered in Princeton, NJ, and four years on the Federal Physician Payment Review Commission.

When he finally landed in Columbia, he was put in charge of guiding the development of technologies to scrutinize medical data. He began by asking a lot of questions about what the data shows and doesn't show. For instance, can you track doctors who give their patients drug samples? How can you account for flu shots administered at drug stores?

He also had to figure out problems in interpreting data.

Once Resolution sent out a flurry of messages telling members to talk to their doctors about diabetes. None of them had the disease, but they had all recently visited a podiatrist. As it happened, since their insurer's health plan only covered these services for diabetes patients, podiatrists were recording that they all had the ailment.

"Claims data is not perfect," Steinberg said. "There's no question that you have to be savvy and clever in evaluating data and analyzing it. You have to take into account errors and missing data."

Resolution also hopes its work leads to new lines of business.

In April, the company was sold to Wellpoint, one of the country's top health benefits providers and a Resolution client, for an undisclosed amount. Wellpoint wants to work with Resolution to close the gap between recommended care and the care patients actually receive.

"Patients are really intimidated to question a doctor," said Kristin Binns, a spokeswoman for Wellpoint. "Doctors oftentimes, if they're not specialists, don't have the full patient history and they don't know what medications [patients] are on."

By Dan Beyers  |  October 10, 2008; 1:00 PM ET  | Category:  Vital Signs
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