One of the biggest problems health plans face is dirty data, says Jordan Bazinsky, executive vice president and administrative officer at Atlanta-based Cotiviti.
The healthcare solutions and analytics company reports having “several hundred” health insurance companies among its clientele, including 24 of the top 25 plans, he says.
“Dirty data is one of the key problems that blocks health plans from finding insights from data,” Bazinsky says. “You might be able to push data real-time, but if you can’t trust the underlying kernel of data—all the other things can’t be trusted.”
According to Bazinsky, Cotiviti uses data analytics to help payers achieve financial health through payment accuracy that is appropriate to the care delivered. The company also works on risk adjustment for managed care plans and quality and performance analytics. In addition to its health plan clients, Cotiviti also serves employers and consultants.
Bazinsky says data can be classified into “buckets” that include descriptive, predictive, prescriptive, cognitive and artificial intelligence-based data. He predicts that highest growth to come will be in the predictive through AI buckets. Bazinsky expects a 45 percent growth in the predictive and prescriptive data category in coming years, while the descriptive bucket of data will dwindle.
When it comes to AI, it’s not anywhere near fruition. “AI is clearly a technology being used, but it’s still early in the maturity cycle,” Bazinsky says. “Its day will come.”
With Cotiviti’s impact reaching 125 million lives—or half of the country’s insured population, Bazinsky was asked to share more of his thoughts on what ails, eludes and encourages health plans in today’s market.
What interests the payer sector right now?
Bazinsky: In working with all of our clients, we often find ourselves in conversations related to the regulatory and structural trends impacting innovation. Everyone knows we need to innovate, but what that looks like and what is causing it to be easier or more difficult to do, is a question of great discussion and debate.
In a world of scarcity—where dollars and talent are short—there is an increasing sense of pressure to get resources for patients. And on top of it all, the majority of the healthcare system is being run on an old technology architecture. The question then becomes, “How do we leverage this business intelligence to get as much as we can out of what we’ve got?”
How have recent policy changes affected efforts toward a value-based care model?
Bazinsky: Recent changes to value-based care payment policies have pressured health plans and providers to shift from a tentative approach to a fairly direct and committed approach to value-based care. In the previous administration, it was mainly a carrot-and-stick approach. But now we have moved from the pilots to the risk-based models that have become a reality and are increasingly becoming the MO (modus operandi). The new Medicare Shared Savings Program (MSSP) rules have recently been changed to two years from six years for risk, and this has caused a tipping point toward adoption. We are seeing a true shift—after talking about value-based care for the past 15 years—we’re starting to get there.
What other trends are you seeing in healthcare, aside from those that are impacting payers?
Bazinsky: Providers are waking up. It’s a real fight over capturing as much market share as possible to negotiate leverage. It’s a land grab, if you will. And topping it off, health plans are left having to contend with the increase in provider consolidations.
Disruptive innovation is also an obvious trend for consumers in non-traditional provider settings—as healthcare tries to keep pace with the retail world.
What are your predictions for healthcare’s future?
Bazinsky: Over the next 10 years, I really expect to see some exciting healthcare opportunities coming out of the electric car revolution. Cars will be capable of weighing passengers, testing their breath, and checking coordination and response time. Cars could monitor for health.
I also predict that healthcare will continue to see strong competition from non-traditional players like Amazon and Google, and payers will see an erosion in their traditional markets. Already they are beginning to ask what the future will look like for them.
