October 16, 2012

Pop quiz: Which signature piece of legislation proposed by President Barack Obama led to the greatest shakeup in the health insurance information technology environment? Ask Brian LeClaire, chief information and service officer of Louisville, Ky.-based health and well-being company Humana ($36 billion in revenue 2011), and the answer might not be what you expect.

When it comes to the Patient Protection and Affordable Care Act (PPACA), "We have a lot of existing solutions that are relevant to the job at hand," LeClaire tells Insurance & Technology. "It means a lot to us as a company, but from a technology perspective it hasn't yet required as much heavy lifting."

According to LeClaire, it actually was the American Recovery and Reinvestment Act -- more commonly known as the economic stimulus -- that spurred the great majority of the recent IT innovation during his tenure at Humana. "The way this legislation has been constructed is to encourage all elements of the care delivery system to invest in technology," he says. "The vision is one of many systems that are connected via standards-based health information exchanges."

These systems break down into four major categories, LeClaire explains: workflow capabilities, information storage, information exchange and clinical decision support. He adds that Humana has used a mix of custom development, partnerships and acquisitions to build an integrated infrastructure that attempts to solve the inefficiencies in healthcare delivery.

The custom-developed components of the four-pronged approach are the workflow capabilities and information storage -- better known as electronic health records. For the information exchange component, Humana partnered with several other insurers -- Health Care Services Corp. (Chicago), parent to four Blue Cross and Blue Shield insurers and Dearborn National; Florida Blue (Jacksonville, Fla.); and Blue Cross and Blue Shield of Minnesota (Eagan, Minn.) -- to develop a solution. The final product, Availity, is the third-largest information exchange of its kind in the country, LeClaire reports.

Healthcare's Version of Big Data

But it's the clinical decision support that LeClaire says brings the most value to the entire endeavor. "When you start ramping this up on a major scale, the amount of clinical information and exhaust data generated is massive, which becomes healthcare's version of big data," he comments. "You need to then provide automated clinical decision support so you have a scalable mechanism to work through all that big data and inform the clinician who is delivering care, when and where it is most impactful. That's really where the secret sauce lies."

Humana initially attempted to find a vendor with a packaged solution to deliver this link in the chain, LeClaire relates. Unsatisfied with the commercial options available, however, the company changed direction and decided to develop its proprietary CareHub solution, pairing custom-developed clinical workflow capabilities with San Diego-based Anvita's Insight Engine, a state-of-the-art clinical analytics engine that Humana acquired in 2011.

"[Anvita] take lots of data and looks through it for patterns of care that they see in the data and they put together algorithms that are repeatable," LeClaire explains. "Using CareHub and Anvita, we can take a member's clinical information, apply those algorithms and it will tell us things like, 'This member has a contraindication with a medication,' or that they might need a mammography, or that they should have their blood levels checked because the lab values suggest that something might be going on."

The large amount of potential data sources in healthcare, as well as government- and market-based incentives to deliver on the promise of that data, makes health insurers a vital component of a big data crucible, LeClaire suggests. The term isn't just a buzzword in the insurance industry, he says, explaining that in the healthcare context, leveraging big data means understanding three major elements: volume, velocity and variation.

"Volume, simply enough, is just the sheer magnitude of the information that's being generated every day now," according to LeClaire. "If you look at the amount of information that's being generated daily, since the 1980s that amount of data is doubling every 40 months. And that's true in the care delivery system."