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To better target their members with customized messages, health plans are combining their claims data with non-health data, acquired through various third-party vendors.

The practice is helping health plans zero in on which patients need attention and helping health plans to address their healthcare needs, say industry experts. But some people think the practice is leaving a very tempting door open to discrimination and the violation of privacy.

Peter Eliason, director of analytics and data science at Revel Health, a company that partners with health plans and providers to run health action programs, says the data health plans typically purchase from third-party vendors includes information on members’ finances, shopping habits, leisure activities, family size, home purchases, moves and even community involvement. This data, purchased from companies like LexisNexis, Acxiom, Experian and PacificEast, is a resource for helping to predict health and wellness behaviors, health risks and the likelihood of being receptive to messages about healthcare.

Michael Millenson

Revel tests and refines the data over time, creating health action programs that use advanced analytics and AI to move people to do things that are good for them. “We’re not just making guesses,” Eliason says. “We are letting our machine learning models choose the right message for the right person.”

According to Eliason, in today’s risk-based payment model, data is the driving force that can make all the difference. He says he can sleep at night knowing the data is helping to save lives and improve quality of life.

Cameron Thompson, managing director of healthcare at Acxiom, says health plans have been using this kind of data for more than 15 years. Every other sector of the economy has used third-party data to target customers, for even longer.

A large portion of Acxiom’s clients are health plans, which have grown tired of relying on self-reported member surveys that are rarely accurate, according to Thompson. By contrast, digital data can always be refreshed and verified. “Acxiom is constantly putting in fresh information and taking out old information. We make no assumptions,” he says.

The data Acxiom provides is not covered under HIPAA, because it is not health information, but when it is combined with health plans’ billing information, it crosses into a gray area, he says. Acxiom is careful to follow the lead from health plans, who are very protective of the data.

“We’re experts in one thing—marketing use cases,” Thompson says. “We don’t house [payers’] claims data. We don’t know what the health side of it is for each person [we have collected data on].” Acxiom can also provide assistance to health plans in crunching the consumer non-health data with the health plan claims data.

Michael Millenson, president of Health Quality Advisors, says he only recently discovered the practice of health plans using third-party data, and he thinks many consumers are in the dark about it. In his concern, he did a literature search in the public record for studies on the effectiveness of the use of this data—and “found very little.” He would like to see some evidence. “You need to have some studies to show it works,” he warns health plans, should they need to defend the practice.

Deven McGraw, an attorney and former acting chief privacy officer at the Office of the National Coordinator for Health IT, recently expressed concern. “How do we make sure the uses of this are for the good, and who gets to decide that?” she said in the New England Journal of Medicine. “Is it enough to say that companies should do this internally?”

But despite the potential controversy, all evidence indicates the practice by health plans is not likely to go away anytime soon. With the cost of data storage down and AI speed up, along with increased interoperability, the environment is very favorable for growth in the use of third-party data, Cameron says. Further, many big health plans now have sophisticated in-house staff to handle their data analysis, and don’t need help. This higher level of expertise is pushing the envelope for third-party data companies like Acxiom, that feel they must up their game to compete, Thompson says.


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