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Berwick on Analytics: Technology Is Ready, but Doctors Need Help

Scott Mace, for HealthLeaders Media, May 15, 2012

HealthLeaders Media: Why was Oak Ridge doing this? I don't think of them usually in this space.

Berwick: Oak Ridge is not just a Department of Energy supplier. They work with other government agencies that want to contract with them to do essentially analytics and data mining. The one place I saw analytics working was in our early work on predictive analytics for fraud. The Affordable Care Act suite of efforts to reduce fraud involves the traditional what they call pay-and-chase, which is enforcement. You find something wrong and you prosecute. We were working with the Department of Justice and the FBI and local law enforcement to catch criminals. That's traditional and effective. You need to do it. But it's, after all, after the horse has left the barn.

So upstream from that, there's prevention. Make sure that the people that want to offer home healthcare or durable medical equipment, that they're qualified to do so, they don't have a history that makes you suspicious, and since there's a very high concentration of fraud in certain parts of Medicare payment, one's able to target prequalification as an area. But I thought the most promising was predictive analytics, which was take the data and turn loose the ability to go through it looking for weird patterns. The technology was ready.

Along about this time, I took a vacation with my wife in Turkey. I got online to buy a ticket for an internal flight in Turkey from Istanbul to an interior village, and I'd say a minute or two later, my cell phone rang, and it was American Express saying, "Just checking—a purchase was made in Turkey. Is this you?" Well it's the same thing, where we can get not just retrospective but almost real-time signals. I remember the first run of predictive analytics, the volume of insights and ideas and hot spots that were spotted, it was really something.

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