WellPoint: Watson guarantees evidence-based care

When leaders from WellPoint saw Watson's Jeopardy performance, they knew that innovative technology could help them overcome barriers to evidenced-based care, according to participants on a panel discussion Wednesday at the AHIP Institute Data Analytics Forum in Seattle.

"We have an obligation as a health plan to make sure they're getting care that science supports," said Elizabeth Bigham (pictured), vice president of health IT strategy at WellPoint.

The Indianapolis-based insurer has been applying IBM's Watson technology to address issues that prevent providers from implementing proven, evidence-based medicine, such as providers' inability to keep up with new information and delayed health plan interactions for precertifications or preauthorizations.

WellPoint has utilized Watson--and its language processing, hypothesis generation and machine learning components--to make the insurer's "unheralded and unpopular" utilization management functions more efficient, effective and consistent.

In fact, Watson performs utilization management as a decision support tool for WellPoint staff on about 60 percent of outpatient procedures and between 12 percent and 14 percent of inpatient procedures.

Having proved successful at ensuring evidence-based care, Bigham said Watson can thoroughly understand the meaning of what the provider submitted as well as clinical policy. Watson compares the appropriate medical policies and clinical guidelines to the provider request, and then forms an opinion about whether criteria were met or if the insurer needs more information, she explained.

Moreover, it doesn't matter if the provider submits full charts, portions of charts, types free text paragraphs, or cuts and pastes from electronic medical records; Watson reads all of the information and knows what's going on with the patient.

As health insurers look to survive in the new data world, they must recognize that machine learning technologies will play a major role in getting patients the best care, Bigham said. And while payers have spent decades building up their infrastructure, the next five years will see the health insurance industry using all of the emerging data, tools and interoperable technology and devices to give consumers the power to access evidenced-base medicine themselves and manage their own risk and their own care in an active way, she added.

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