Managing risk requires finding and treating your costliest patients first

Reti-AlejandroStatistical analysis used by Billy Beane to mold the Oakland Athletics of the early 2000s into winners wasn’t new by any means. The Brooklyn Dodgers hired a statistician in 1947 who advocated using players adept at getting on base. It took Major League Baseball more than half a century to embrace the use of data analytics to build teams, a trend now known as “moneyball.”

Health care has a similar reliance on expert tribal knowledge, which can inspire resistance to new ideas and the use of data to drive change in general. But data is a powerful equalizer that can help ordinary people give their ideas power and authority — a key imperative for change. Today in sports, there are examples of non-coaching employees floating ideas — driven by data — that have been adopted by coaches and players to improve themselves. We see this in health care as well.

We recently worked with an IDN using OptumOne who noticed that outpatient pharmacy costs had risen substantially — due to improved adherence — as their population health initiatives gained steam. The story told by the data triggered a renewed focus on appropriate use of generics and treatment escalation protocols to blunt this trend. Conventional wisdom had previously held that the financial opportunities present in generics management had been played out; this wasn’t true in this case and the data helped leadership see that.

Such efforts are just the beginning. Beane understood his staff had to continually analyze player stats and make necessary modifications to maintain their winning ways. We have a parallel in health care here as well. Ongoing feedback to providers needs to be tied to patient-level examples where the provider could have done something differently. Data-savvy providers are creating a “replay reel” to have productive conversations about best practices and behavior change. At a recent AMGA meeting launching our Together To Goal diabetes performance improvement collaborative, we identified a physician in the audience who had the top 2 percent performance in A1c management across more than 15 systems and we gave him a chance to describe what he saw as the key ingredients for this success. Organizations with strong cultures regularly link these ”stars” with their laggards to discuss how to perform better — as a team.

For more information on how to use data analytics to manage value-based risk, download Optum’s Moneyball Analytics eBook by clicking here.

In our next post, we’ll discuss how health care organizations need to trust what data analytics tell them about population health and why it’s important to stick to a game plan for the long run.

About the Author:

Alejandro Reti, MD, MBA
Chief Medical Officer, Optum Analytics

With responsibility for the Office of the CMO, Alejandro is accountable for the clinical integrity and relevance of Optum Analytics’ provider solutions and contributes to thought leadership and clinical product innovation for the organization. Alejandro came to Optum from Premier, where he served as Vice President, Population Health Products with general management responsibility for Premier’s organically developed population health suite. Prior to Premier, Alejandro served as Senior Vice President, Clinical Informatics at Verisk Health, where he led development of a provider analytics solution that achieved top 4 in market share nationally. Previously, Alejandro held positions of increasing responsibility at Avalere Health and The Advisory Board Company. Alejandro received a bachelor’s degree in Psychology from Amherst College, magna cum laude and his MD and MBA degrees from Yale University.

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