Anthem, Chief Data and Analytics Officer: Data Interoperability and Integration are Key Challenges in Day-to-Day Patient Care

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Apr 11, 2022, 6:28 pm

(US and Canada) Neel Butala, Co-founder, HiLabs, talks with Ashok Chennuru, Chief Data and Analytics Officer, Anthem, about using machine learning for improving claims processing and patient care.

Chennuru shares that Anthem has invested in machine learning for claims processing, speeding up claims and improving accuracy. This was done by specifically creating their own data and data science platform capabilities. He shares that Anthem also plans to expand this platform to include more data across the enterprise to drive more value from their existing machine learning models and develop new high-value ones. This is an opportunity to leverage claims payment accuracy through pattern recognition and anomaly detection.

It's critical for health plans to pay providers accurately and pay as fast as possible. This streamlines Anthem’s operations and provides satisfaction to health care plan members, providers, and stakeholders.

Chennuru shares that gaining timely insights from plans is a key pain point for the providers. Often providers don't have a complete picture. The needed insights and history typically take weeks or months to reach providers, which is often too late to meaningfully use that information to positively impact patients.

Speeding up the delivery of that critical health information to providers and providing insights from their vast data analytics capabilities can help providers and patient care, he emphasizes. He shares that Anthem has done epic collaboration, particularly with HiLabs, Chennuru notes. It should help Anthem deliver better insights to providers in a timely fashion, he notes, adding that Anthem is looking forward to collaborating and scaling this approach across the country. Furthermore, regarding this payer-provider collaboration, Chennuru maintains there are two big domains — data interoperability and integration — that are key challenges in day-to-day patient care.

Doctors are probably one of the few professions still relying on fax machines for sending information today. Chennuru says that it would be great if doctors could have a complete history of each patient they see, but complete medical records don't always come through. They essentially work with patients to do their best, bringing medical histories together to make the best decisions possible. everything together, and make the best decisions possible.

With the limited information doctors have, a health plan with a full view of a patient's history can impact patient care. A health plan provider has the scale and the resources to integrate these data sets and ensure they're of high quality, and then actually deliver it all in an easily consumable fashion to clinicians at the point of care.

Leveraging interoperability and integration across providers to enhance clinical knowledge or advancement of knowledge overall is a challenge, especially in academic medicine, Chennuru points out. So, providers need vast high-quality data to generate real-world evidence to know which treatments work and which treatments don't work for patients.