By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    improving patient experience
    6 Ways to Improve Patient Satisfaction Within Hospitals
    December 1, 2021
    degree for healthcare job
    What Are The Health Benefits Of Having A Degree?
    March 9, 2022
    custom software development is changing healthcare
    Digital Customer Journey Mapping and its Importance for Healthcare
    July 21, 2022
    Latest News
    Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
    May 16, 2025
    Learn how to Renew your Medical Card in West Virginia
    May 16, 2025
    Choosing the Right Supplement Manufacturer for Your Brand
    May 1, 2025
    Engineering Temporary Hospitals for Extreme Weather
    April 24, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Can Thinking Younger Make You Live Longer?
    April 20, 2011
    Image
    Obesity’s Outlook Unchanged
    June 13, 2011
    When It’s An Emergency Elderly Not Treated As Well in Hospitals
    July 16, 2011
    Latest News
    Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
    May 18, 2025
    The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims
    May 14, 2025
    The Backbone of Successful Trials: Clinical Data Management
    April 28, 2025
    Advancing Your Healthcare Career through Education and Specialization
    April 16, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Machine Learning: The Future for Health Plans
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Technology > Medical Devices > Machine Learning: The Future for Health Plans
DiagnosticsMedical DevicesPolicy & LawTechnology

Machine Learning: The Future for Health Plans

Flow Health
Last updated: March 4, 2016 9:31 pm
Flow Health
Share
6 Min Read
ball-1106910_1280
SHARE

By: Alex Meshkin

By: Alex Meshkin

Health plans are struggling to become more efficient and competitive in the marketplace. Beyond needing to be financially viable; they need to provide the best healthcare options for their customers. The future success of health plans, and for healthcare, will be the adoption of intelligent systems where automation and machine learning intersect. In order for health plans to flourish in this ever-changing environment — I believe that they must put machine learning at the core of every aspect of their business.

ball-1106910_1280At the recent Harvard Business School Healthcare Conference, Adam Koppel, Biogen’s vice president of corporate development and strategy, spoke about his company’s partnership with Verily (Google’s life sciences arm), in which they will use machine learning to understand how multiple sclerosis presents itself differently from patient to patient. Koppel shared his conclusions drawn from discussions and data sharing with Google.

More Read

Californians’ Attitudes and Experiences with Death and Dying
How Healthcare Is Changing to Combat the Next Deadly Pandemic
Five “Must Read” Articles on Radiology and Health IT
Why Not the Best? Or, at Least, Why Not the Same?
Corporate Social Responsibility in Healthcare

Koppel said Google recognizes that “current payers [are] using actuarial math — it’s like the 19th century.” Koppel went on to say, “They [Google] want to take over CMS…and they will say that to you.”

While there may be some hyperbole here, I do believe Google sees the tremendous opportunity of applying its world-class machine learning expertise to solving the country’s most important and challenging problem — delivering high-quality, cost-effective healthcare.

What is machine learning and why will it make a difference?

Machine learning algorithms continuously learn and are capable of making data-driven decisions. These algorithms discover breakthroughs in inference and understanding of cause-and-effect allowing payers to personalize decision-making (e.g. formulary). Consider a population of patients and everything that is known about them – including demographics, medical history, all the factors needed to understand a member’s risk through predictive analytics. Add in machine learning capabilities that incorporate intervention models and you have a system that allows you to select the best care pathway for each person based on their own unique history and health status. This is the holy grail of care management and utilization management.

The likely end result of machine-learning-guided care decision-making? Billions of dollars in savings achieved by driving effective and efficient interventions that will have the best outcomes.

Do we really need to wait for tech giants like Google to fix healthcare?

Health insurance startups like Clover Health and Oscar Health see this same huge opportunity, and are designing new health plans around the use of data to improve the care of members and reduce the cost of care. Oscar Health, like other ACA Commercial Exchange (HIX) health plans, has struggled to stay financially viable. Its success will be dependent on the creation of intelligent platforms that better manage complex cases, proactively engage members to reduce costs and more accurately identify the acuity of member risk to drive increased risk adjustment revenue.

All major health plan operations will be transformed by machine learning. Whether modernizing utilization management to determine the best course of treatment, expanding analysis of gaps in care beyond quality measurements (e.g. HEDIS) or moving from retrospective risk adjustment to predictive identification of undiagnosed conditions (e.g. HCC Optimization), payers will be one of the largest and most important groups of consumers of machine learning in health care. As the traditional lines between payers and providers are blurred, ACOs and other risk-bearing provider organizations will be among the payers using these tools.

Incumbent payers adopting machine learning will have the advantage over newcomers using machine learning. Incumbent payers have data stores that span decades, and in some cases billions of historical care events — the lifeblood of machine learning. With the right partners and the right strategy, incumbent payers can leverage this experience, this data, in order to improve the lives of all Americans.

Payers are at a crossroads where machine learning intersects with the status quo — those who fail to adopt data-driven intelligent systems will see their fate follow the same path as media companies diminished by Google and Facebook.

But we at Flow Health are optimistic. We are partnering with one of the largest payers in the nation to change the future of healthcare. Their leadership is squarely focused on transforming their business. At Flow Health, we are building the Operating System for Value-Based Care that leverages machine learning to help health plans and providers individualize care plans, automate workflows across the continuum of care and improve care coordination. The power of the operating system, coupled with the depth of our partners’ data stores, will drive this change.

Thank you for taking the time to learn about Flow Health . Flow Health is presenting at HIMSS 2016 Venture+ forum. We invite you to see all of our #HIMSS16 posts. If you would like to know more about Flow Health and how we can help your organization succeed, please contact us today at sales@flowhealth.com.

TAGGED:machine learning
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Clinical Expertise
Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
Health care
May 18, 2025
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Health
May 15, 2025
Learn how to Renew your Medical Card in West Virginia
Learn how to Renew your Medical Card in West Virginia
Health
May 15, 2025
Dr. Klaus Rentrop Shares Acute Myocardial Infarction heart treatment
Dr. Klaus Rentrop Shares Acute Myocardial Infarction
Cardiology
May 13, 2025

You Might also Like

online pharmacy
eHealthHealth care

How Online Pharmacies are Changing Healthcare

February 24, 2021

Bariatric Surgery Linked to Reduced Risk of Cardiovascular Death

January 7, 2012

Enhancing Medical Technologies in Developing Nations

July 18, 2016

What Causes Dementia? New Research Findings Point to Unexpected Factors

September 25, 2013
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?