Will winning algorithm be used as rationale to boot patients?

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JCE01's image
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Joined 8 Nov '11
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I'm brand new here and haven't seen all the posts so forgive me if I am probing into an area already covered. It seems like a truly good algorithm could be used to pre-emptively identify patients that may have future problems and try to help them before a problem becomes acute. Alternatively, a nasty scrooge type could use the information to identify potentially costly patients to boot from the health care program. I'm not saying this would be a problem for me, since I don't have much in the way of a conscience and there is very little chance that I will come up with anything worthwhile anyway. But for those that do have a conscience, has there been any pronouncement, legally binding or otherwise, to the effect that the resulting winning algorithm will not be used as an input in the decision to terminate a policy.

 
Sali Mali's image
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Joined 22 Jun '10
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I was fortunate to go to a seminar yesterday where I met someone who was involved in selling software to build these predictive models for the US healthcare industry. He explained that in the US if a patient is re-admitted to hospital within 30 days of being let out, the hospital won't get any money from medicare for the second stay - the hospital has to foot the bill themselves. Hence if they have a model to predict who is going to be re-admitted, they can take action, such as sending a nurse around to their house to make sure they take their medicine. He also mentioned one of the biggest drivers of the re-admittance model was patients on anti-depressants.
I know this is a bit different in that we are predicting for next year, but the idea is probably the same.

 
CasaDelRay's image
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Joined 25 Oct '11
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Sali Mali: Changes to payment policies are driving the lion's share of health care industry interest in predictive modeling. The re-admission rules aren't for all conditions, but are for a subset of conditions where the U.S. Center for Medicare and Medicaid Services (CMMS) has decided that re-admissions have a lot to do with what the hospital does or doesn't do when the patient is admitted in the first place.

There's another set of investigations happening on the payer (insurance side) because legislation says that after a certain date, you can't reject a patient because of a pre-existing condition. So now the focus shifts to intervening to keep people with existing conditions from getting sicker (and more expensive).

 

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