These details are all available in claims data, if you know how to dig them out, which BridgeHealth does. And when they add a few other patient risk factors to the predictive model, a fairly accurate determination of the likelihood that this individual will require surgery can be determined.
Armed with this information, health plans and employers can devise an early-intervention wellness plan of sorts to help their members adhere to non-surgical treatment options. "Ultimately, this should result in a higher quality and lower costs," says BridgeHealth CEO Vic Lazzaro, who likes to point out a study from The Rand Corporation and Dartmouth University that indicates up to 30% of surgical procedures are medically unnecessary.
Perhaps this may be viewed as one more effort by big brother health plan to question physician judgment. I would hope not, however, if it in fact achieves its goal of medical cost reduction.
After all, if it does lead to healthier patients and fewer surgeries—or other procedures and tests which similar companies are trying to effect—maybe it will help alleviate the strain on qualified clinicians that's expected to increase exponentially when millions of new lives enter the healthcare system under reform.