LOS ANGELES—Health insurers have access to a bevy of valuable data, and the push toward interoperability made it easier for those data to be shared with providers.
The challenge now becomes making those data usable and useful for providers in a way that does not disrupt their workflows and interactions with patients. That's a key focus for the technology experts at Elevance Health, Ashok Chennuru, global chief data and insights officer at Elevance Health and the interim lead of Carelon Digital Platforms, told Fierce Healthcare in an interview at ViVE.
Elevance Health has access to both key claims data as well as clinical data that come in from its providers. The insurer is also able to track those data over a long time, as members can stay within its ecosystem even as they switch between different types of coverage.
The insurer synthesizes all of those data into a member profile, Chennuru said, along with other critical information like genomics, behavioral health data and even weather factors or social needs.
"One of the important, foundational investments we made was being able to accurately match all of this data to that person," he said.
Elevance's patient data matching algorithm operates with 99% accuracy, he said.
When these data are aggregated, Chennuru said, it can produce critical insights for clinicians, identifying gaps in care and measuring disease progression. These next-best actions can be populated for the clinician at the point of care, Chennuru said.
These alerts can also highlight potential risks, such as warning a physician that a drug they're looking to prescribe could have a negative interaction with a medication the patient is already taking, he said. Elevance can also share that information with the pharmacy the patient uses.
"The physician who's prescribing may not know that this drug would have a big impact," Chennuru said.
Embedding these kinds of insights directly in the provider's workflow makes it easier for them to address gaps in care and also makes it simpler for the insurer to track how well providers are performing. For example, if the Elevance team wants to check in about a gap in care that was missed, they have targeted data to bring to the provider and can also readily gather feedback on what's working with the alerts.
The provider could then respond that they did not understand why a certain action would be beneficial, feedback that can inform future insights, Chennuru said.
"All kinds of meaningful discussions have happened, because it's very data-driven," he said.
The insurer is applying similar thinking in determining which data are most valuable to surface to the member. Much of this information is offered through Sydney, Elevance Health's consumer-facing app.
Chennuru said that making data available in Sydney for now focuses largely on "administrative healthcare"—scheduling appointments or explaining benefits. The goal is to move beyond that and serve as more of a "companion" on the patient's care journey.
"We don't want to be the digital front door for everything, but what are we good at?" he said. "We are good at knowing everything about the member. Why? Because we collect all this data and we have the right insights."