You are on
notice...BIG BROTHER IS WATCHING...and you will pay! But ah....if you are over
using the system because of self destructive behavior (i.e. drug, drink, too
much food...) you should have to pay
more! Just saying!
Hospitals Spy on Your Purchases
to Spot Bad Habits
By Shannon Pettypiece and Jordan Robertson Jun 26,
2014 12:01 AM ET
You may soon get a call from your doctor if you’ve
let your gym membership lapse, made a habit of picking up candy bars at the
check-out counter or begin shopping at plus-sized stores.
That’s because some hospitals are starting to use
detailed consumer data to create profiles on current and potential patients to
identify those most likely to get sick, so the hospitals can intervene before
they do.
Information compiled by data brokers from public
records and credit card transactions can reveal where a person shops, the food
they buy, and whether they smoke. The largest hospital chain in the Carolinas
is plugging data for 2 million people into algorithms designed to identify
high-risk patients, while Pennsylvania’s
biggest system uses household and demographic data. Patients and their
advocates, meanwhile, say they’re concerned that big data’s expansion into
medical care will hurt the doctor-patient relationship and threaten privacy.
“It is one thing to have a number I can call if I
have a problem or question, it is another thing to get unsolicited phone calls.
I don’t like that,” said Jorjanne Murry, an accountant in Charlotte, North
Carolina, who has Type 1 diabetes. “I think it is intrusive.”
Acxiom Corp. (ACXM) and LexisNexis are two
of the largest data brokers who collect such information on individuals. They
say their data are supposed to be used only for marketing, not for medical
purposes or to be included in medical records.
While both sell to health insurers, they said it’s
to help those companies offer better services to members.
Bigger Picture
Much of the information on consumer
spending may seem irrelevant for a hospital or doctor, but it
can provide a bigger picture beyond the brief glimpse that doctors get during
an office visit or through lab results, said Michael Dulin, director of research and
evidence-based medicine at Carolinas HealthCare System.
Carolinas HealthCare System operates the largest
group of medical centers in North Carolina and South Carolina, with
more than 900 care centers, including hospitals, nursing homes, doctors’
offices and surgical centers. The health system is placing its data, which
include purchases a patient has made using a credit card or store loyalty card,
into predictive models that give a risk score to patients.
Within the next two years, Dulin plans for that
score to be regularly passed to doctors and nurses who can reach out to
high-risk patients to suggest interventions before patients fall ill.
Buying Cigarettes
For a patient with asthma, the hospital would be
able to score how likely they are to arrive at the emergency room by looking at
whether they’ve refilled their asthma medication at the pharmacy, been buying
cigarettes at the grocery store and live in an area with a high pollen count,
Dulin said.
The system may also score the probability of
someone having a heart attack by considering factors such as the type of foods
they buy and if they have a gym membership, he said.
“What we are looking to find are people before they
end up in trouble,” said Dulin, who is also a practicing physician. “The idea
is to use big data and predictive models to think about population health and
drill down to the individual levels to find someone running into trouble that
we can reach out to and try to help out.”
While the hospital can share a patient’s risk
assessment with their doctor, they aren’t allowed to disclose details of the
data, such as specific transactions by an individual, under the hospital’s
contract with its data provider. Dulin declined to name the data provider.
Greater Detail
If the early steps are successful, though, Dulin
said he would like to renegotiate to get the data provider to share more
specific details on patient spending with doctors.
“The data is already used to market to people to
get them to do things that might not always be in the best interest of the
consumer, we are looking to apply this for something good,” Dulin said.
While all information would be bound by
doctor-patient confidentiality, he said he’s aware some people may be
uncomfortable with data going to doctors and hospitals. For these people, the
system is considering an opt-out mechanism that will keep their data private,
Dulin said.
‘Feels Creepy’
“You have to have a relationship, it just can’t be
a phone call from someone saying ‘do this’ or it just feels creepy,” he said.
“The data itself doesn’t tell you the story of the person, you have to use it
to find a way to connect with that person.”
Murry, the diabetes patient from Charlotte, said she
already gets calls from her health insurer to try to discuss her daily habits.
She usually ignores them, she said. She doesn’t see what her doctors can learn
from her spending practices that they can’t find out from her quarterly visits.
“Most of these things you can find out just by
looking at the patient and seeing if they are overweight or asking them if they
exercise and discussing that with them,” Murry said. “I think it is a waste of
time.”
While the patients may gain from the strategy,
hospitals also have a growing financial stake in knowing more about the people
they care for.
Under the Patient
Protection and Affordable Care Act, known as Obamacare, hospital
pay is becoming increasingly linked to quality metrics rather than the
traditional fee-for-service model where hospitals were paid based on their
numbers of tests or procedures.
Hospital Fines
As a result, the U.S. has begun levying fines
against hospitals that have too many patients readmitted within a month, and
rewarding hospitals that do well on a benchmark of clinical outcomes and
patient surveys.
University of Pittsburgh Medical Center,
which operates more than 20 hospitals in Pennsylvania and a health insurance
plan, is using demographic and household information to try to improve
patients’ health. It says it doesn’t have spending details or information from
credit card transactions on individuals.
The UPMC Insurance Services Division, the health
system’s insurance provider, has acquired demographic and household data, such
as whether someone owns a car and how many people live in their home, on more
than 2 million of its members to make predictions about which individuals are
most likely to use the emergency room or an urgent care center, said Pamela Peele,
the system’s chief analytics officer.
Emergency Rooms
Studies show that people with no children in the
home who make less than $50,000 a year are more likely to use the emergency
room, rather than a private doctor, Peele said.
UPMC wants to make sure those patients have access
to a primary care physician or nurse practitioner they can contact before
heading to the ER, Peele said. UPMC may also be interested in patients who
don’t own a car, which could indicate they’ll have trouble getting routine, preventable
care, she said.
Being able to predict which patients are likely to
get sick or end up at the emergency room has become particularly valuable for
hospitals that also insure their patients, a new phenomenon that’s growing in
popularity. UPMC, which offers this option, would be able to save money by
keeping patients out of the emergency room.
Obamacare prevents insurers from denying coverage
because of pre-existing conditions or charging patients more based on their
health status, meaning the data can’t be used to raise rates or drop policies.
New Model
“The traditional rating and underwriting has gone
away with health-care reform,” said Robert Booz, an analyst at the technology
research and consulting firm Gartner Inc. (IT) “What they are trying to
do is proactive care management where we know you are a patient at risk for
diabetes so even before the symptoms show up we are going to try to intervene.”
Hospitals and insurers need to be mindful about
crossing the “creepiness line” on how much to pry into their patients’ lives
with big data, he said. It could also interfere with the doctor-patient
relationship.
The strategy “is very paternalistic toward
individuals, inclined to see human beings as simply the sum of data points
about them,” Irina Raicu, director of the Internet
ethics program at the Markkula Center for Applied Ethics at Santa Clara
University, said in a telephone interview.
