How the healthcare industry can leverage data to fix a fragmented system

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The health sector is complex and fragmented, often with misaligned incentives or a lack of coordination that leads to inefficient allocation of resources. Fragmentation also negatively impacts patient outcomes, costs and quality of treatment.

At VentureBeat's Transform 2022 virtual conference, 30-year AI industry veteran Jana Eggers, CEO of Nara Logics, joined Sachin Joshi, SVP, Data and Analytics Engineering at Evernorth (a subsidiary of Cigna), to discuss what Cigna is doing to improve this fragmented care and reduce healthcare costs using data.

Cigna has created a platform that enables the company to automatically identify situations requiring clinical attention, implementing interventions tailored to a patient's clinical conditions and engagement preferences. The platform also provides 360 degree visibility into patient activity, resulting in the ultimate care coordination program.

Health System Complexities, Obstacles and Failures

According to the World Health Organization, the qualities of the delivery system in the health sector affect the speed, efficiency and appropriateness of medical care for patients. Patients often make a wise decision by choosing an outcomes-based model of care that secures clinical goals and connects a patient's touchpoints across the continuum of care.

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However, Eggers noted that many people have encountered complexity in the healthcare industry. Rather than looking at health issues from the patient's perspective, she asked Joshi to look at the view from inside the health care system. This fragmentation from the inside out, Joshi agreed, is the main problem.

"I know that as consumers, it feels like every day when we go for our tests, we go to our primary care physician...go get our prescriptions filled," Joshi said. "Imagine trying to bring this information together to create better outcomes for our patients so they don't have to navigate all these different channels without feeling like, one, they're being intentionally priced out and, two, [wondering if ] their whole health is taken care of with all these different channels. Joshi said the people inside see all of this and know that there is an ability to come together and come up with solutions.

Joshi explained that coordination management is one of the methods used to solve some of these problems. Evernorth's Health Connect 360 is designed to look at the total population from a patient management perspective, Joshi said. This provides a macro-level view to clients. "Then, at a micro level, we can look at a phased results approach that delivers a better patient o...