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Monday, December 4, 2017

Should-Read: David Anderson : Aetna, CVS and data thoughts : "This is a risk adjustment data gold mine... ...Aetna has ... [feedly]

Should-Read: David Anderson : Aetna, CVS and data thoughts : "This is a risk adjustment data gold mine... ...Aetna has ...
http://www.bradford-delong.com/2017/12/should-read-david-anderson-aetna-cvs-and-data-thoughtshttpswwwballoon-juicecom20171204aetna-cvs-and-data-t.html

Should-Read: David AndersonAetna, CVS and data thoughts: "This is a risk adjustment data gold mine...

...Aetna has a kick-ass data team. They have huge and deep data sets that they control. It is quite likely that a significant chunk of their risk adjusted covered lives in 2018 have shown up in some point in their data bases in the past decade. An individual who is now insured by Aetna Medicare Advantage in Texas may have had an amputation claim from Aetna Medicaid in Pennsylvania that is dated in 2009. That is valuable information to build and curate a risk adjustment optimization list. However there are always serious holes in the Aetna list.... This is where CVS comes in. There is a good chance that CVS has filled some prescriptions for people who do not show up in Aetna's data banks....

The other side... is that Aetna will have far more granular level information on their markets. This will influence plan design, it will influence marketing materials, it will influence whether or not Aetna enters or leaves a market or bids for certain contracts.

Finally, the biggest data bonanza from my point of view is the CVS non-prescription data that is tied to the loyalty card that almost everyone carries on their keychain. This should give a massive predictive edge to the Aetna data geeks. Let me share way too much personal.... If an insurer could see the non-prescription purchases tied to the customer loyalty card, they had an excellent idea of when my wife and I started trying for Kid #2. If this was an insurer that sought to be socially productive and useful, we could expect to get mailings and outreach calls on pre-natal and perhaps pre-conception health enhancers. If the insurer was run by cynical bastards and the time of the year was right, they might try to be enough of a pain in the ass to get us to switch insurers so that someone else could pay for labor and delivery....

This merger offers an incredibly rich vein of data that can be mined and minted. This makes a lot of sense to me without even thinking about how the entire pharmacy benefit management function is a messed up situation.


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