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HL20: Richard Merkin, MD—Competing to Convert Care Dollars Into Cure Dollars

 |  By smace@healthleadersmedia.com  
   January 03, 2013

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Richard Merkin, MD.

This profile was published in the December, 2012 issue of HealthLeaders magazine.

 "We noticed that when we identify high-risk patients, we could intercede and prevent a lot of unnecessary care... and hopefully reallocate some of those healthcare care dollars into cure dollars."

If you're trying to solve complex problems in medicine today, it doesn't seem like the thing to do would be to assemble a community of math whizzes who've never met each other, and ask them to team up, compete with each other, and outguess the medical community. But that's just what Richard Merkin, MD, CEO of the Heritage Health Prize is doing.

Start with cash: The $3 million Heritage Health Prize, a data-mining, predictive-modeling competition to reduce avoidable hospital visits, launched in April of last year. Add a tech-powered online community that, this past September included more than 1,500 participants assembled into 1,300 teams that had submitted more than 22,000 entries.

"We noticed that when we identify high-risk patients, we could intercede and prevent a lot of unnecessary care," Merkin says. "It became obvious that if we could identify with greater specificity and sensitivity, then we could really transform healthcare in the world, particularly starting in the United States, and hopefully reallocate some of those healthcare care dollars into cure dollars."

Using historical claims data, competitors predict which patients will be admitted to a hospital within the next year. They can tweak their algorithms once a day, and accuracy rankings are displayed on the leaderboard at www.heritagehealthprize.com.

Unnecessary care, like beauty, is sometimes in the eye of the beholder. To Merkin, telltale signs include patients who skip medications, or those living alone, who might end up going to an emergency room on the weekend, where the ED physicians might not have those patients' medical history, and if overly cautious, might run extra tests and admit patients for overnight observation.

The more such inefficient care can be found, healthcare providers can reallocate resources to call those patients on a daily or weekly basis and preclude some of that unnecessary care.

"Sometimes we have what we call high-risk physicians, who might only have 100 or 150 patients in their practice," Merkin says. "These would be all either complicated medically, socially, or suffering from mental illness." Such physicians could reach out to the patients, even giving patients their home number or a cell phone and saying to call any time. "It's almost like a concierge type of medicine, and just by having access to a doctor more often, and the doctor being more part of that person's life, we've noticed that hospitalizations, which is the most expensive portion of healthcare today in America, have come down considerably."

Insurance companies have tried to figure out how to predict readmissions for years, but "they haven't necessarily included mathematicians and sophisticated data miners," Merkin says. "They may be able to identify a very small percentage of high-risk patients."

Even with the expansion of the care team to include social workers and dietitians, the patterns that predict readmission continue to elude caregivers, Merkin says. With the Heritage Health Prize, "the same kind of people that put us on the moon, the same kind of people that put Curiosity's rover on Mars, those are the kinds of people that are now working on these kinds of problems."

The history of prize-based scientific breakthrough stretches long back in time before the prize Charles Lindbergh won by flying nonstop between New York and Paris in 1927. In many cases, the winners of such prizes are building new industries, Merkin says.

Every six months, to encourage contestants, Heritage Health Prize awards some intermediate progress prize money. This also serves as a way of introducing contestants to each other and helping build the healthcare problem-solver community, Merkin says.

One of the perils of big data is the potential that data, having had its personally identifying elements stripped away, can be analyzed such that it becomes again attributable to individuals, threatening their privacy. With HIPAA concerns in mind, Merkin contacted experts who had helped Netflix overcome such concerns during its own data-mining competition. "Our No. 1 issue was keeping the privacy concern at the forefront," he says.

Any science or technology has potentially good and bad uses. When the final prize is awarded in April 2013, the science developed in its service will be made available to research institutions. "We want to make sure that people do not use it for any adverse purposes, so we were concerned initially that anyone could use it not for the betterment of mankind."

This won't be the last time Merkin takes the plunge into such initiatives. He brainstorms with agencies such as the National Institutes of Health and visionaries such as Craig Ventner on new challenges. One puzzle: How to store the genomic data of all 7 billion human beings on the planet. "I think that's equivalent to 25% of all the data that's ever been stored, so now they need new storage devices," he says.

Merkin's even talking to the Centers for Medicare & Medicaid Services, the Food and Drug Administration, and National Institutes of Health about additional opportunities that would help the agencies and regulatory processes perform more efficiently.

Merkin's interests may extend beyond healthcare, but they still train on the tough challenges. Sitting on the Jet Propulsion committee of CalTech's Jet Propulsion Lab, he was one of those experts who signed off on the sky-hook scheme that safely landed Curiosity on Mars. "A lot of the experts said that would never work."

Merkin delights in proving the experts wrong.

"Who would have thought that two bicycle mechanics would have flown over Kitty Hawk?" he says. "There's so much talent out there, and particularly now with technology and the Internet, there's going to be a billion people that didn't have access to education that are going to be able to solve problems and change the world."

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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