Invest in “Precision Health” to Better Care for High-Need, High-Cost Patients, AJMC® Study Says

Any discussion involving “precision” in healthcare typically revolves around the use of precision medicine based on a patient’s genetic profile. However, in a commentary in the September issue of The American Journal of Managed Care^®, authors Dhruv Khullar, MD, MPP, and Rainu Kaushal, MD, MPH, say there’s a different way that precision can be employed to better care for high-need, high-cost (HNHC) patients. This can only happen if significant investments are made in new comprehensive data networks that connect and integrate clinical factors, social determinants of health, and genomic information from multiple health systems.

The authors, both from Weill Cornell Medical College, say the need is critical as a disproportionate share of healthcare spending is concentrated on HNHC patients. They note that 1 percent of the US population accounts for 21 percent of healthcare spending, and more than half of all health spending comes from 5 percent of the population.

They write that current efforts to collect and analyze data about these patients are limited due to a number of factors, including:

• Limited information sharing across multiple hospitals and health systems, particularly in urban settings
• Analyses that are limited by payer type
• Relying on claims data, which may underestimate the prevalence and severity of chronic disease and mental illness

The authors use the examples of patients with heart failure, lung cancer, or Parkinson disease to illustrate how integrating claims, clinical, and social data might work.

The paper also mentions several recent efforts creating these models in New York, Texas, and Colorado:

• In New York, the New York City Clinical Data Research Network joins 22 institutions to share data, develop common tools, and collaborate on research. The network, funded by the Patient-Centered Outcomes Research Institute, includes comprehensive longitudinal data on millions of patients and uses open-source code to develop high-utilizer “phenotypes” and focus interventions.

• In Texas, Parkland Health and Hospital System developed a risk model to predict the likelihood of readmission for patients with heart failure based on 29 clinical, social, behavioral, and utilization factors. The program has resulted in a 26 percent relative reduction in the odds of readmission.

• In Colorado, Denver Health, a vertically integrated health system, developed a predictive algorithm to divide patients into four tiers and personalize care based on their medical and social needs.

To move forward, greater public investment in data-sharing infrastructure is required, and there are other challenges, including the creation of a new multidisciplinary informatics workforce and the adjustment of payment models, the authors wrote. Data privacy and security questions would also need to be addressed.

“It is also not clear who should ‘control’ such data networks and how competitors should share potential costs or savings,” the authors noted. “Finally, the extent to which care models based on integrated data networks can improve health outcomes will require rigorous and prolonged study.”

Khullar is a physician at New York-Presbyterian Hospital and an assistant professor in the Weill Cornell Medical College Department of Healthcare Policy and Research. Kaushal, a pediatrician, is the chair of Healthcare Policy and Research at Weill Cornell Medical College.

Hear more about this issue in an AJMC® interview with Dhruv Khullar, MD, in Managed Care Cast, a podcast about managed care. The podcast is also available on iTunes, TuneIn, and Stitcher.

About  The American Journal of Managed Care^®:

The American Journal of Managed Care^® (AJMC^®) is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. AJMC.com is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC^® family include The American Journal of Accountable Care^®, and two evidence-based series, Evidence-Based Oncology and Evidence-Based Diabetes Management^™. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC^® publications, please contact Gil Hernandez at 609-716-7777, ext. 139.

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