UnitedHealth Group is the owner of a mind-bending amount of information on the people it insures — some 28 petabytes of deidentified patient data, covering 160 million lives, is housed in its Optum Labs subsidiary alone.
Somewhere in UnitedHealth's databanks is information that shows how well Medtronic's insulin pumps for diabetes patients work over time. The data also include insights about what practices at the Mayo Clinic have led to the hospital system's reputation for world-class health care.
But how can that data be leveraged in a system where an insurer, a technology provider and a hospital may be accustomed to doing business in arm's length transactions that aim to maximize each one's own profit?
"No one is going to have, in isolation, all the data for everything. So you need to work with others," Medtronic CEO Omar Ishrak said Tuesday at AdvaMed 2016, the medical device conference happening at the Minneapolis Convention Center. "Using data to change outcomes is the way ... we've got to approach this."
The decade-old, traveling AdvaMed conference staged by the industry trade group of the same name set an attendance record Tuesday — more than 2,500 people gathered to see events like top leaders from Medtronic, Mayo and UnitedHealth Group talk about Big Data.
Dr. Richard Migliori, chief medical officer of UnitedHealth Group, said the nation's largest private health insurer formed its Optum Labs subsidiary in cooperation with Mayo several years ago to address the need to bring together disparate sets of data and see what insights emerge.
"When we started bringing pieces of data together, it changed the way we think dramatically," Migliori said.
UnitedHealth crunched the data and recognized that advanced features on a Medtronic insulin pump for diabetic patients seemed to decrease the number of middle-of-the-night hospitalizations for complications like hypoglycemia.
The real value of the pump, Migliori said, was linked to the value of avoiding preventable hospitalizations. Similarly, the value of a drug for a treatment for chronic myelogenous leukemia became evident when UnitedHealth analyzed how well it kept patients from progressing to the next phase of the disease.
"It caused us to stop looking at line-item cost figures and start looking at, what is the total value? Because we saw a total value, we then began to wonder, shouldn't we be (paying) on the basis of total value?" Migliori said.
Earlier this year, UnitedHealth announced an agreement that made Medtronic its preferred provider of insulin pumps for patients over age 18 in its commercial and community health plans. The move rankled diabetes patients who use different companies' devices, though UnitedHealth said the vast majority of its members who needed an insulin pump already used a Medtronic model.
Mayo CEO John Noseworthy said a lot has changed in the past five years in terms of collaboration among the traditional stakeholders in health care. All of them are working to solve the problem of curbing rising health care costs while also improving outcomes.
"This is all going to be about partnership, and trust, and transparency and working together to solve this," Noseworthy said.
One topic crying out for a Big Data approach — the use of implantable medical devices instead of addictive pills to treat chronic pain — was the topic of a session on Tuesday.
Several kinds of devices exist to treat pain. Some use electric stimulation to block or interfere with pain signals to the brain, while others inject very small doses of drugs directly into space near the spine. In general, such devices are tried only after pain pills and corrective surgery have failed.
"The question is, why are we continuing to put the most advanced treatments for pain at the very end of the treatment spectrum?" asked Dr. Lawrence Poree of the University of California, San Francisco.
The effectiveness of painkilling devices has improved in recent years, while the toll of prescription opioid painkillers continues to mount at a rate of 15,000 deaths per year. But on paper, one month of prescription pills is much cheaper than the upfront cost of several thousand dollars for an implanted device.
Dr. Allen Burton, medical director of "neuromodulation" devices at Little Canada-based St. Jude Medical, said the power to analyze data on long-term outcomes and costs may eventually win over insurers skeptical of covering medical devices for chronic pain.
"This health economics outcomes research is just getting sophisticated enough to mine these huge databases and get meaningful information," Burton said. "We're going to have that data to take to the third-party payers and have these kinds of collaborative discussions."