The healthcare exceptionalism
As a matter of fact, others fields/domains are highly regulated: nuclear industry, civil transportation, building construction. What is unique in the healthcare business is the segmentation of the 3 central movements of the cycle in 3 distinct actors: the one who benefits, the one who pays and the one who prescribes. In many other businesses, these 3 entities are one decision maker. In healthcare, the decision is always a matter of negotiation. Traditionally, the caregivers represent the ones who “know”, and among them, there is the omnipotent figure of the medical practitioner. This is not as true as it used to be. Multiple specialists now join forces to take care of a single pathology. Medical knowledge is both more complex and more distributed among experts.
In other areas, it is often the one who is at the center of the information flow that dominates. Google is the most glaring example of it. They dominate the advertisement on the web as they gathered data from their search activity. They are in a unique position to sell targeted advertisement
In healthcare, one might think the “patient” owns the data because it is “his/her data”. But in reality the patient does not have all the data; he has neither the full ability to interpret it nor to understand it. On the other side, the practitioner only controls data for a moment when he must make a decision; he understands data but does not centralize it.
The only one who has the capacity of centralizing and valorizing data is a third player: the insurer.
The insurer can no longer be the only payer
It calls for a transformation of the insurer role moving from a passive payer role (with unidirectional data flow) to an active data driven partner role (with reciprocal data exchange). In this data intensive relation, by analyzing the multitude of therapeutic paths, machine learning may feed each individual’s decision with quantified evidence. The contextualization of personal information opens the opportunity of choosing the best treatment for each patient at the right time. This helps to accelerate the health pathway (recreating data drive relationship). The payer has a unique opportunity to use the data he collects to act in order to “prevent”, in addition to reimbursing.
The 21st century insurer: Soli-Data-Rity
In the near future, insurers will be called to revolve around two levels of solidarity: the classic one is the financial risk pooling; the new one catalyzes the principles of solidarity by data. As the caregiver should constantly put the patient at the center of its decisions, the insurer will have to serve the user through data sharing. The insurer must no longer be prisoner of its financial role. It must escape from it and sign a new deal with its users. It is no more about using data to improve its models and pricing which is contrary to the principle of Solidarity. Soli-data-rity is about creating trust that using data will solely impact interfaces and tools provided to the end-user and never what he pays. This shift of paradigm and vision is needed for the benefit of all.
Pierre-Antoine Gourraud is an associate professor in the University of California at San Francisco (USA) in the department of Neurology and Professor in the School of Medicine at the University of Nantes (France). He has published over 100 peer-reviewed articles in biomedical journals.
Jean-Charles Samuelian, is a 2011 graduate from École des Ponts ParisTech, founder of Expliseat a company manufacturing lighter economy class “titanium” seat for the aircraft industry. He is currently the CEO of Alan.
Charles Gorintin is a 2011 graduate from École des Ponts ParisTech too. From 2012 to 2016 he was a Silicon Valley data scientist for Facebook Instagram and Twitter. He is currently the CTO of Alan.
This article has also been published on Huffington Post