Hospitals Mining Credit Card Data to Predict and Control Patient Behavior

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July 11, 2014

Copyright 2014 Questex Media Group LLC All Rights Reserved

Say hello to new risk scores. Yes, credit behavior is taking on a whole new meaning. Credit behavior is no longer only predicting your risk as a borrower, but additionally your risk as a health liability on society and to health providers.

Hospitals are beginning to assign risk scores that predict how your personal spending habits will affect your health—and their profits—by mining credit card purchases and loyalty program transactions. If you're smart you'll start buying everything you consume from cocktails at happy hour and prescription refills to food at the grocery store in cash only and without using a loyalty card.

Like all big data projects, there is both good and bad in this effort. It may be helpful to patients to find an alert on their phone that says "Wait! Don't buy that grapefruit. If you eat that, it will negatively interact with your medicine." Such a warning could be life-saving. And yes, it may be beneficial for society to delve into why you aren't getting your medicines refilled regularly. If it's a money issue due to a recent layoff, for example, it would be cheaper to society to help you get those refills now than to foot the bill for your major health crisis later. And yes, it will be helpful to your doctor to be able to say "your diet is missing XYZ. Buy more of these things to improve your condition." Or, for him to ask "I see you are regularly purchasing over-the-counter sleep aids. How long have you been fighting insomnia?"

But this scenario also includes a number of privacy nightmares. Do you like to hang out with your buddies on Friday nights or buy drinks for your colleagues at conferences? Watch your alcohol score and risk for alcoholism rise. Future employers won't like that and neither will health, auto and life insurers. Never mind that you were the designated driver or you only had one drink but bought a round for your friends or your clients, all those drinks are now on your score.

Maybe you have asthma but your job moved you to an area with a high pollen count. Not ideal, but hey, you need that job. Expect your doctor, hospitals and insurers to jump your case about the move. And don't expect much sympathy for the fact that you need that job to pay for your asthma meds.

Whatever your health issue, payers and providers will soon start pointing to you as the ultimate cause and that will then be their way out of covering your healthcare costs. It won't be long before some employers and insurers figure out that they can save billions by offering employee health plans that they rarely have to pay anything out on. That way they have met regulations by providing the insurance benefit but still manage to cut costs by finding a way around actually paying for anything.

Yes, the tactic of deliberately finding ways not to pay for covered expenses is an old one that has been practiced in various ways by insurers for decades. But now with the advent of big data, this tactic will be seriously ramped up.

The great irony here is that providers and insurers may even argue that policing patient and potential patient behaviors is actually required under the new healthcare law, since the mandate is to ensure patient outcomes rather than focus on billable treatment delivery. The onus will shift from provider to patient, in other words.

More than likely the U.S. government will eventually resolve this by moving to a single payer plan thereby taking the for-profit players out of the process. But even under a single payer plan, pressure on individuals to change their behaviors will continue as the government seeks to lower healthcare costs, too.

"Health advocates and privacy experts worry that relying more on data analysis also will erode doctor-patient relationships," writes Shannon Pettypiece and Jordan Robertson in a Bloomberg Businessweek post. "'If the physician already has the information, the relationship changes from an exchange of information to a potential inquisition about behavior,' says Ryan Holmes, assistant director of health care ethics at the Markkula Center for Applied Ethics at Santa Clara University."

Even if you make the switch to cash-only purchases now, in an effort to extradite yourself from this unfriendly mess and stress, it's likely too late. Much of your personal purchasing data has already been gathered, stored and analyzed by several different big data players. Perhaps the better tactic is to seek regulation forbidding the use of personal purchasing data by healthcare providers and insurance companies.

For now, this case can give an idea of what's happening with the data:

"While Carolinas HealthCare can share patients' risk assessments with their doctors under the hospital's contract with its data provider, the healthcare chain isn't allowed to disclose details, such as specific transactions by an individual, says Michael Dulin, chief clinical officer for analytics and outcomes research at Carolinas HealthCare, who declined to name the data provider," the Bloomberg Businessweek post quotes.

"If the early steps are successful, though, Dulin says he'd like to renegotiate to get the data provider to share more specific details with the company's doctors on their patients' spending habits," the post continues. "'The data is already used to market to people to get them to do things that might not always be in the best interest of the consumer,' he says. 'We are looking to apply this for something good.'"

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