The Business Health Care Group (BHCG), a coalition of employers located in Wisconsin covering 200,000 lives, has partnered with GNS Healthcare (GNS) to discover best practices of health care to improve outcomes and lower the cost of care.
In 2017, U.S. healthcare costs grew to 17.9 percent of the country’s GDP or $3.65-trillion. And yet despite spending more than other countries, health outcomes in the U.S. lag behind other countries across many categories. One of the primary drivers is variation in medical practice among providers that influences health outcomes and the total cost of care. Until now it has not been technically feasible to unravel the subtle and multi-factorial drivers of this variation.
BHCG and GNS are undertaking this study to answer two straightforward questions, “Which doctors return patients to their optimal health status as quickly and efficiently as they can and how do they achieve these results using the most appropriate resources possible?” To perform this analysis, GNS will leverage its artificial intelligence (AI) and simulation computer technology, REFS (Reverse Engineering & Forward Simulation) to evaluate the current health care provided to Wisconsin citizens. They then apply “what if?” changes to reveal the combination of patient care factors that drive health outcomes and costs.
The claims information for this evaluation will be provided by the Wisconsin Health Information Organization (WHIO) and includes 4 million insured individuals or 70 percent of Wisconsin’s population. The WHIO information (de-identified so that individual patients cannot be recognized) tracks an entire episode of care from start to finish and identifies the best results achieved by doctors across the state. This information can then be used to improve practice patterns and get patients to the most effective providers.
“These insights have the potential to dramatically improve health outcomes, identify care that does not improve patient’s lives and reduce health care spending on services that don’t improve a patient’s condition. Their technology will allow us to understand how and where the best care is delivered so that we can continue our mission of improving the value of health care provided in Wisconsin and beyond,” said Jeffrey Kluever, executive director of BHCG.
“We believe this initiative holds the potential to influence a substantial leap in the overall value of care that will benefit all health care stakeholders – employers, insurers, health systems, providers and, most importantly, employees, dependents and our communities,” Kluever added.
Colin Hill, chairman, CEO and co-founder of GNS said: “This is a natural extension of the work GNS has been doing to leverage machine learning across the health care ecosystem to slow disease progression, improve health outcomes and lower costs by matching the right treatment to the right person at the right time. By making this technology available to self-funded employers who pay for the bulk of health care costs and, in turn, to health care providers who deliver care, we are able to convey insights and value on a large scale. Having an innovative partner like BHCG means that those insights will be turned into real, productive change for the employers who are part of BHCG.”