"It was the late '80s, going into the '90s, when indemnity plans were switching to HMOs and it was all about data," she says. "Bringing in disease management programs and looking at the cost of care was just starting to happen. The health plans were the ones with the computer systems and the power to do that."
But even with this technology, Makar faced an uphill battle. Nursing informatics was still an emerging field and didn't have a certification until 1995. She also had to struggle to use the data she collected to disprove common perceptions, such as the time involved in telling customers their benefits didn't cover certain treatments or other unpleasant news.
"When I was doing the studies about workflow, people would say, 'Oh no those calls take 20 minutes,' but when you track them, they might have been the most difficult calls but they didn't take that long," she says. "That's how influential perceptions are. When you show them the data and they believe in the data, you can show them what the solutions are."
Next, Makar furthered her experience in analyzing health data when she began working for an IPA, which was the physicians' answer to HMOs at the time, she says.
"I looked at trends and tracking and evidence to find drivers and improve customer service," she says.
In 2000 Makar transfered to a position with a large New York health plan as an on-call nurse answering patient questions over the phone. The program was a new initiative for the health plan and was created as a counter to an escalation in ER wait times due to non-emergent cases.
"I was on the phone using advanced computer software that today we would call decision-support software," she says.