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November 2012
How to Make BIG DATA Work for You!
By John Paul Galles

     Americans are among the most discriminating and demanding consumers. We know how and where to shop for what we want and what we’re willing to pay. We buy food, clothing, shelter, vacations, cars, jewelry, plastic surgery, technology, you name it. We buy in retail stores, in wholesale clubs, and online by computer or tablet or smartphone. We know how to find discount codes, obtain shipping for free, and even avoid paying sales taxes for nearly every purchase we make…that is, except health care!

     And I do mean health care. I am not talking about health insurance. I am talking about the services of doctor or other health professionals, services in hospitals or clinics or offices, testing and laboratory work, drugs and treatments, as well as extended care. Rarely, if ever, do we even know prices—let alone compare prices—for health care as long as we have had health insurance.

     When a doctor recommends lab work, a test, an x-ray, a CAT scan, or an MRI, we simply go where the doctor tells us to go and have the work done. It is only the increasing imposition by insurers of co-insurance and higher deductibles that has caused us to even ask if they are really necessary, but we will usually go and do it anyway.

     And if you are bold enough to ask about the cost? Well, good luck with that! In most cases, no one from the doctor on down seems to know the cost of anything beyond the consultation fee. They just provide the services themselves.

     Billing—the business side of health care—has the expertise in knowing how best to characterize the charges for services performed to obtain the maximum reimbursement from any given insurer, as well as the co-pay and deductible information to obtain payment from the individual, thereby maximizing the revenue stream for the health care provider. Yes, different rates may be applied to different insurance companies. It is incredibly complex.

     In this issue of Greater Charlotte Biz, we have focused on BIG DATA and BIG INSIGHTS. With the continuing expansion and application of information technology, we want you to learn about the impact of this information being collected and how to use it to your advantage.

     When purchasers of health care and payers of health care come together with their BIG data, they can begin to analyze the care, compare costs and quality to enable us to make better health care decisions. Large employers and large insurers are well-positioned to demand and analyze this information on behalf of their insureds. Individuals and small businesses are likely to gain this opportunity through the health insurance exchanges as they grow and develop. This data aggregation will support better and more cost-saving choices.

     Of note in this regard, is a company named Castlight Health, founded in 2008 to “enable employers and health plans to lower the cost of health care and provide individuals unbiased pricing and quality information to make smart health care purchase decisions. Named #1 on The Wall Street Journal list of “The Top 50 Venture-Backed Companies” for 2011, Castlight is building a search engine for health care prices, quality and coverage for large companies.

     Others providing health care cost comparisons include: New Choice Health, Healthcare Blue Book, ClearCost Health,, Change Healthcare, Aetna, Blue Cross Blue Shield, United Health, and Hospital Compare (HHS/Medicare).

     Imagine knowing in advance the range of costs for particular procedures. Imagine being able to compare doctors, find their locations, learn about their charges, and review their outcomes and satisfaction ratings. Imagine being able to do the same for hospitals. This information only becomes available and valuable when the inputs from hundreds and even thousands of discharge records are collected. Think how Big Data can positively impact your health care choices and your life!

     Moreover, consider how such data accumulation can lead to Big Insights impacting your health care and your life. The individual health experiences and records of thousands of others will be available for comparison to symptoms and courses of treatment, aiding in more accurate diagnoses and more appropriate health care options.

     Price transparency can significantly change the way health care is purchased in the United States. The lack of price information in health care has been a big driver of skyrocketing health care costs. Most patients never see the charges, employers are busy paying for coverage, and insurers are batted around by providers. As long as patients pay for health care with someone else’s credit card, they will ignore costs and seek all the care they can get.

     What is important is to seek quality care at reasonable prices. Lining up the incentives in the right direction will go a long ways to reduce costs and improve care in very BIG ways. We have BIG steps to take in managing our health care costs.


John Paul Galles is the publisher of Greater Charlotte Biz.
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