Joe Pringle, Socrata director of health, is a FedScoop contributor.
The United States spends more than $3 trillion a year on health care. Governments at all levels, in partnership with the private sector, are working to improve the collection, use, management, dissemination and reporting of health data — a project in scope equal to the Apollo Space Program. The emergence of vast amounts of new health data, and improved tools for using it, is occurring in parallel to a tectonic shift in the demand for that data. The health care industry is transitioning from an opaque, fee-for-service model, where costs and transactions are based on the quantity of care delivered, to a more transparent and value-based model, where providers are compensated based on value and consumers are better able to compare providers in terms of cost and quality. These concurrent trends foster a rapid rise in the health data economy that will help transform health care and health policy.
Much of the attention on the current health data revolution is focused on both the use of big data within the enterprise and the increasing availability of personal health data to consumers. Providers, payers, insurers and other actors are rushing to build data warehouses and to implement a wide range of technologies to support enterprise data management, analytics, population health, decision-support and business intelligence goals. Traditional health care IT vendors are adding big data, analytics and BI capabilities to their offerings. Electronic data is now captured at the point of care, and providers access clinical decision support systems in real time as they interact with patients. Payers use data mining and analytics to improve fraud detection and risk management. Wearable devices track and store health data, while increased consumer awareness of personal health records and data give individuals greater ability to make informed choices. All told, vast amounts of health data across these activities are being captured, stored and accessed in new ways.
The emerging health data economy
A second trend driving equally important changes in health care is the emergence of a shared layer of health data all organizations and individuals can tap into. In some ways, health data is following the same path as open data in other sectors, where increasing amounts of raw and machine-readable data are being released into the public domain.
However, some of the most valuable health data is patient-level data, which is private and subject to severe restrictions in how it can be shared and used. For this reason, patient-level data is only being shared to approved entities. Both publicly available and privately shared health data will drive innovation in the form of reduced costs, higher quality and better public policy.
Public sector health organizations have published data for decades, but it has generally been difficult to find, access and use. Innovative efforts by the U.S. Department of Health and Human Services, the Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention vastly improve the quality and utility of available health data. These efforts lower the barriers for researchers, developers, and entrepreneurs to build upon this data.
The impact of data on health care and health policy
This emerging health data economy is driving a “learning health system” where prices are more transparent; consumers, payers and policy makers can compare quality and outcome. At the same time, research data is being shared in new and innovative ways. Both these changes impact health care and health policy in numerous ways.
First, we are seeing an increased understanding of the cost of care. As the biggest single payer for health care in the United States, the Centers for Medicare and Medicaid Services is playing a leading role in making the costs of health care more transparent and easier to compare across geographies and providers. CMS releases aggregated data on provider charges and makes claims-level data available to approved entities for research. A number of states are establishing all-payer-claims-database systems to provide comprehensive, multipayer data to allow consumers, purchasers and policy makers to understand the cost, quality and use of health care for their citizens. Innovative companies such as Pricing Health Care, Health Care Bluebook and others use these data sources to provide new tools for consumers and others. The media uses the data to shine a light on disparities in costs in different communities. All of this is driving providers to compete on price in a fundamentally new way.