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How Big Data is Transforming Health Insurance

Health care is an intensely complex and challenging process.  From collecting and identifying all of the relevant symptoms, developing the right diagnosis and to applying the most effective treatment plan, the health care process is filled with complications with the potential for error.  Not only are patients interacting with physicians, but they are also obtaining information and services from a host of secondary medical providers including nurses and pharmacists.

On top of the medical services, most patients must also navigate a byzantine administrative system that includes hospital administrators, clinical supervisors, government agencies and insurers.  While most of these administrative staff try to make the process of obtaining health care and paying for it as simple as possible, often the multitude of conversations and paperwork can be overwhelming—for you as well as the organizations involved.

In an effort to help simplify these systems, health care providers and insurers are turning to powerful tools like Big Data.  Big Data is a set of tools that help collect and analyze large amounts of information so that organizations can produce actionable conclusions.  If you consider that 2.5 billion gigabytes of data is produced daily, you understand that it is almost impossible for humans to sort through the growing mountains of accumulated information.

The Potential of Big Data

Health care providers and supporting organizations like insurers are eager to develop Big Data tools that can save time gathering information about patients and produce more accurate treatment responses. These powerful analytical tools would enable providers to see more patients, treat them more effectively and limit errors.

The Potential of Big Data

We are entering a new age of health care, one that offers real-time monitoring and medical intervention. The medical community has already taken steps to adopt digital tools that will more easily share information among primary care providers, medical specialists and secondary service providers.  The government has enacted a set of laws requiring medical providers to use electronic health records in an effort to make patient data more portable which could save lives in emergency situations.

Not only will the free flow of patient information provide invaluable insights in critical situations, the ability to draw on thousands of similar medical cases should help make doctors more prepared and effective. They can use the entire patient history, not merely the most salient details, to develop a comprehensive profile that will pinpoint key health issues.  Big Data should enable physicians to hone their medical investigative skills and identify the therapies that will provide the greatest likelihood of success for each patient.

How Big Data Will Change Insurance

If you are like most health insurance consumers, you probably don’t realize how critical insurers are to your health.  Insurers are constantly analyzing their pool of beneficiaries to determine how healthy they are and how to minimize the risks and costs to the entire pool of insured.  Because the health care costs are spread across the entire risk pool, it is important that insurers identify enrollees who may be extremely costly to insure.

Although the Affordable Care Act now prohibits insurers from denying coverage or raising premiums for sick enrollees, the health insurance industry is trying to improve the health of its customers in an attempt to keep costs low for everyone. One of the ways health insurers are using Big Data to help people healthier is by raising personal awareness.

Almost one third of health insurers now offer discounts or free services for enrollees who use health wearables like Fitbit or Apple Watch. These personal electronics help monitor the health of wearers and encourage them to adopt healthy habits like walking and stretching. Not only do these devices enhance the health of users, but they can transmit health information to providers allowing them to identify potential health issues.

How Big Data Will Change Insurance

Big Data analytics are integral to these programs, as they can monitor health information without human supervision.  They only require human intervention when an anomaly is detected and a medical professional must speak with a patient.

For insurers, these new tools are a godsend because they raise the health of the insured and lower the costs for all those in the insurance risk pool. Financial incentives are proving highly cost effective in keeping overall costs down, which is especially important in the low profit margin world of health insurance.

Big Data is also helping keep insurance costs down by identifying fraudulent claims.  Analytical tools match key details of medical claims against those of other fraudulent claims to see if there are any similarities.  If there are, investigators are alerted to take a closer look at the claim. Big Data has proven quite effective at recognizing fraud, even very sophisticated operations that might slip past well experienced insurance claims specialists.  By rooting out these false claims, insurers are able to apply financial resources only to authentic expenses and minimize costs for everyone.

The Limits of Big Data

Big Data has the potential to radically reshape the health care world, but there are many challenges to be overcome. Many consumers are hesitant to divulge so much of their personal health information to insurers out of fear that the information could be used against them. Of course, that is highly unlikely given the current legal system that makes it illegal to discriminate against unhealthy enrollees.

A much more legitimate concern is theft of this personal information by criminal groups. Consumers are right to be concerned about security issues given the number of data breaches within the health care sector. Cyber criminals will continue to pose a threat to patients, but more health care organizations are recognizing their vulnerabilities and are devoting more resources to reinforcing their security measures.

If you would like to learn more about how powerful Big Data solutions are helping to keep your health insurance costs low or health plans that can keep your family safe, please visit Boost Health Insurance and speak with one of our highly knowledgeable insurance brokers.

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