The role for big data in health care’s triple aim

Improving care, improving health and reducing costs with analytics

By Carolina Wallenius, Senior Health Care Advisor

Health care policies and practices differ tremendously around the world, but three objectives are common regardless of the health care system. They are referred to, in the industry, as health care’s triple aim:

  1. Improving the patient experience (including quality and satisfaction).
  2. Improving overall population health.
  3. Reducing the per capita cost of health care.

It might seem counterintuitive that you could accomplish all three at once, but there are changes afoot in many aspects of the industry that are enabling a simultaneous shift in all three areas. In this article, I will focus on three areas in particular that are driving change and increasing the use of analytics in health care. They are:

  1. The promise of value-based health care.
  2. The ability to track more aspects of health care.
  3. The trend toward engaging patients as more active consumers.

Each of these areas alone has the potential to contribute highly to a positive development of how health care is practised and paid for, and together, they have the potential to significantly improve the triple aim.

Value-based health care puts high demands on the ability to record and monitor data regarding specific conditions and symptoms, procedures and resulting quality.


The promise of value-based health care

Since traditional methods have proven insufficient to manage health care, and modern technology has created the means to analyze large quantities of information, the timing is right to move toward a value-based perspective in health care.

What is value-based health care? It is an approach that focuses on health outcome per dollar spent. The value-based system pays providers based on their contributions to desired outcomes. Traditional fee-for-service or pay-for-volume methodologies have proven over time to discourage achieving the triple aim. With a value-based approach, quality and satisfaction increase, and innovation is encouraged.

Let’s consider payment for hip replacements. The traditional method provides payment according to the number of procedures performed and – in some systems – leads to a fixed number of procedures. Payers who define and reimburse according to patients’ desired functions or results have more incentive to achieve patient value.

The push toward a value-based emphasis will require new systems for managing and analyzing health care data, including new efforts for standardization, measuring outcomes and understanding quality measures in health care. Ultimately, the efforts will lead to a number of benefits. Value-based health care increases pressure for innovations, which could make operations easier and will discourage unnecessary operations. Processes that focus on quality and increased health outcome per dollar spent will increase the efficiency of health care.

Furthermore, a successful introduction of value-based health care can have positive effects far beyond medical care domains. Clinical researchers, as well as industries like pharmaceuticals and medical technologies, have everything to gain from a value-based approach in the health care industry.

The ability to track more aspects of care

Value-based health care puts high demands on the ability to record and monitor data regarding specific information and achieved quality. Typically, a risk-based adjustment is applied to compare fairly. This Value-based health care puts high demands on the ability to record and monitor data regarding specific conditions and symptoms, procedures and resulting quality. adjustment accounts for different results depending on the age and health of the patient, among other factors.

One way of approaching these information needs is to establish registries that focus on health care outcomes. Sweden provides a good example of how a long tradition of disease registries can contribute to platforms for data management and analysis in health care. Sweden has nearly 90 government-supported disease registries (also known as national guidelines), many of them established by the medical societies of the relevant specialty. These registries contain historical data related to patients with a specific diagnosis or condition.

Sweden’s registries cover conditions representing more than 25 percent of total national health expenditures and provide a solid base for Swedish health care to benchmark and assess performance on various aspects of the health care system. The registries enable in-depth analysis of performance variations. Best practices can be identified and continuously improved over time by evaluating registry data. There are several examples from Swedish health care where improvements are focused on quality but also led to cost control and reductions.

Finally, the aggregate data in the registries is made available to the public, which leads to demonstrated clinical improvements as well as the ability to understand comparative effectiveness. Since citizens can access the information, it provides a competitive incentive for even better results. For example, a recent study of Sweden’s National Registry for Acute Coronary Care showed hospitals that followed absolute adherence to standards were numerically higher in all five value-based indicators studied.

Engaging patients as consumers

With more and more health care data becoming available, patients are taking an active interest in their health care choices. For starters, patients have become more eager to evaluate services using information from the Web and other channels. This underlines the importance of using analytics for risk adjustment to provide the consumer with the right information to make informed and fact-based decisions.

As patients become more informed, they not only demand the most modern health care, but they also tend to take a role in collecting and sharing their own health care data with providers. This can increase patient adherence to physician instructions, which is a critical factor in adverse events or post-discharge gaps in appropriate care.

The Swedish Rheumatoid Arthritis Registry is another example of an opportunity to continuously monitor patients’ conditions and treatment outcomes.

With rheumatoid arthritis, it is essential for patients to be engaged in their own treatments. Doctors therefore provide the patient with access to a Web interface or even an app where she has to answer a number of questions and evaluate her own health status. The patient assesses her ability to perform daily activities, such as vacuuming, taking a bath and cutting meat. The patient indicates the degree of pain and self-registered swelling and tenderness. In this way, the doctor gets access to the current state of the patient’s health. The physician can analyze the patient’s health status over time and also compare data from the disease registry. Based on this proactive analysis, the treatment can be adjusted and potential problems prevented.

Big data and the triple aim

Gathering large amounts of data in health care has previously been time consuming for clinical staff. New technologies such as high-performance analytics are making it easier to turn large amounts of data into critical and relevant insights that can be used to provide better care. Analytics can even be used to predict negative reactions and intervene before they become a problem.

For example, unstructured data can be captured via text mining from patient records for use in disease registries. This means information can be gathered without causing additional work for clinicians. With a large information base, analytics can answer questions such as how and why outcomes differ between hospitals, clinics and even between doctors performing the same care. Transparent, highly available information can thus improve quality and encourage innovation.

As information becomes increasingly available, transparent and comparable, patients will also be empowered and more involved in their own treatment via online health applications, which can integrate patient information with their health records and make it available to clinicians. A large amount of data gathered from different sources provides the best practices for today, and will help health care providers identify trends so they can achieve the triple aim.


Carolina Wallenius

Carolina Wallenius is a senior advisor who specializes in applying modern technology and new ways of working to improve health care efficiency. She also focuses on e-health diagnostics, primarily for malaria. Wallenius has held leading positions within the Swedish health care industry for more than 10 years, including head of health care reimbursement within Stockholm County Council.

Doctor views health data on ipad

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