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Insurance companies: An unexpected ally in preventative healthcare

Scientists at UCLA have determined that medical insurance company records can be used to make accurate predictions about future health issues in their members. These predictions lead to better outcomes by enabling proactive treatments for future illness, rather than falling back on reactive treatments for each new health crisis.

In recent years, computers have used "big data" analysis to identify faces in photos, predict shopping tendencies, and recognize driving habits. However, predictive technology has made far less progress in improving medical outcomes. The newly published study illustrates that scientists can predict which patients are likely to be hospitalized or require specialized medicine. The highest-risk patients can then be brought in, proactively, for specialized preventative treatment.

"These findings are exciting because they show the potential of big data in the healthcare setting," stated Dr. Welmoed van Deen, assistant professor of clinical medicine at USC and co-author of the study. "We [showed] it is possible to use the data to create meaningful insights."

Unlike many new technologies that are too expensive to implement, this model will actually save insurance money by predicting high-cost events before they occur. Preventative treatment for at-risk patients is less expensive than preserving the status quo, which inevitably incurs expensive hospitalizations. "This is a good example of how insurance companies, clinicians, and researchers’ interests can come together to improve patient care and save money," stated Dr. Jamie Feusner, a Professor in Residence in UCLA’s Department of Psychiatry.

Dr. Don Vaughn, the lead author and a computational neuroscientist at UCLA, points out that the consensus about the benefits of prevention is not new: "The problem has been in getting useful data." Medical data is fragmented between different labs, hospitals, and doctors. By contrast, insurance companies—like Anthem—have a comprehensive view and keep great records, giving these often-maligned companies "the potential to be heroes."

The program is expected to garner enthusiasm for implementation because it offers something for everyone: easier treatment decisions for overworked doctors, better outcomes for patients, and lower costs for insurers. The results illustrate what’s possible from a cross-disciplinary team of clinical doctors, mathematicians, and neuroscientists.

"Predictive medicine like this has the potential to improve medical outcomes," noted Dr. David Eagleman, neuroscientist and NYT best-selling author. "Additionally, it could reduce healthcare costs and help overworked physicians. It’s a no-brainer."

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