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Thanks for coming on here and giving some insight. Not always easy to do as HN comments can sometimes get a bit brutal. I agree there needs to be better health

by qwrusz 10y ago

Thanks for coming on here and giving some insight. Not always easy to do as HN comments can sometimes get a bit brutal. I agree there needs to be better health care data science going on towards improving wellness and health care (assuming data is collected, stored and analyzed honestly and appropriately - whatever that means these days is whole other debate). But I think it would be helpful to everyone if there was a bit more transparency and clarity from health care related startups about their plans and what they are doing. For example: It sounds like a couple very separate things are going on here: 1) You are a health insurance company 2) You are an organization doing medical patient data collection and data analyses and pushing real-world actions based on this analyses to try to improve wellness and prevent/reduce expensive medical problems. The first is relatively straightforward, the insurance business is really just a math equation with a marketing department. Health insurance and Medicare are a bit of a special case because the government has said health insurance companies must pay out most of the premiums to medical care costs or give the money back. Though this government contract component creates a numbers game with a single digit profit % built in once you scale (you can also do a decent back of the envelope valuation just discount your member growth as other inputs and comps are ~standardized). The second thing, medical data science is where it gets complicated. This is serious work that needs to involve doctors and medical research professionals and studies before anything major can happen. I think it's great if an insurance company wants to take some of its revenue and put it towards data science focused on researching better wellness and health care. (Let's ignore for a moment that the incentives from a business model and profit potential are not clearly aligned by doing this, eg you don't get to keep medical care cost savings, you give it back). More of an issue is the ambiguity around stuff like the "promise of using technology to solve such a large and socially significant problem as health care is one of Clover’s most powerful recruiting tools" and then goes on to say a guy from Yammer and engineers from FB and Google are mining health data to "suggest ways to prevent them before they happen." What is that suggesting process and who is involved? Recommendations of brown rice and gym memberships to a couple of octogenerians is funny and relatively mild (and kinda pathetic tbh). But it's a risky slippery slope when potentially unqualified and premature medical data analyses conclusions start to be implemented in the real world, it could be even dangerous to people's health, the opposite effect, even with the best of intentions. The example from the article could go bad: have you studied a potential rise in injuries when you recommend gym memberships to 83 year olds? If this has been properly studied and implemented make it public.

ubernostrum 10y ago
I think it's interesting you assumed there must be zero credentialed medical professionals involved in the company or the things we're trying, or that random engineers are making care decisions. So allow me to immediately disabuse you of that notion. We are not a tech-led company: we're a company that makes tech -- in the form of tools, data science, etc. -- available in service to our clinical, operations, and insurance staff. My project right now involves building out a social-work assessment app, for example; I don't decide what goes in it or what actions to take based on the responses entered. No engineer does. The LCSW who's in charge of the assessment tells us what goes in it and what the workflow rules for it are and how data from it should propagate into our systems and be used. My job is to bring technology to bear to make it A) easier for the social workers to use than their current paper forms, B) easier to process the data so that they can use data-science frameworks on top of it to inform their decisions about how to care for someone.
- qwrusz 10y ago
  I didn't assume zero credentialed medical professionals are involved in the company. The article clearly states you have 12 nurse practitioners serving your 19,000 members. I looked at your website too and saw some of the other clinical operations roles. I also didn't assume random engineers are making care decisions. I said this is ambiguous and I asked a question: What is that suggesting process and who is involved? The article says you are "developing software to organize the trove of data coming from workers on the ground in New Jersey, mine it for likely health problems and suggest ways to prevent them before they happen." Your website says "we’re also partners in care, using patient-centered analytics and a dedicated care management team to identify potential risks and directly provide preventive care." Well nurses generally don't know much about data science software and data scientists generally don't know much about practicing medicine or preventive care. And of course you are not a tech-led company. You are a marketing company and government contracted middle man connecting health care services to patients and handling some of their paperwork and payments. Still this is an industry entirely living off regulatory capture. I'm not accusing you of denying someone's valid insurance claims because they didn't take your eat brown rice suggestion. But you yourself claim to be an insurer "trying to change the statistics". I get the preventive care and data science shtick looks good when marketing to potential members and to potential investors. But it's not clear how you are taking on the "change the statistics" part you claim to be, which is the most interesting and important part of all this to the extent it is real as improving peoples' health and wellness, and preventing serious health problems would be amazing! So I asked a question about how the process works and who is involved as getting data and actionable data analyses to and from health care professionals in the field is not straightforward, nor is it trivial, nor is it explained anywhere.

by qwrusz 10y ago

ubernostrum 10y ago

I think it's interesting you assumed there must be zero credentialed medical professionals involved in the company or the things we're trying, or that random engineers are making care decisions. So allow me to immediately disabuse you of that notion. We are not a tech-led company: we're a company that makes tech -- in the form of tools, data science, etc. -- available in service to our clinical, operations, and insurance staff. My project right now involves building out a social-work assessment app, for example; I don't decide what goes in it or what actions to take based on the responses entered. No engineer does. The LCSW who's in charge of the assessment tells us what goes in it and what the workflow rules for it are and how data from it should propagate into our systems and be used. My job is to bring technology to bear to make it A) easier for the social workers to use than their current paper forms, B) easier to process the data so that they can use data-science frameworks on top of it to inform their decisions about how to care for someone.

qwrusz 10y ago
I didn't assume zero credentialed medical professionals are involved in the company. The article clearly states you have 12 nurse practitioners serving your 19,000 members. I looked at your website too and saw some of the other clinical operations roles. I also didn't assume random engineers are making care decisions. I said this is ambiguous and I asked a question: What is that suggesting process and who is involved? The article says you are "developing software to organize the trove of data coming from workers on the ground in New Jersey, mine it for likely health problems and suggest ways to prevent them before they happen." Your website says "we’re also partners in care, using patient-centered analytics and a dedicated care management team to identify potential risks and directly provide preventive care." Well nurses generally don't know much about data science software and data scientists generally don't know much about practicing medicine or preventive care. And of course you are not a tech-led company. You are a marketing company and government contracted middle man connecting health care services to patients and handling some of their paperwork and payments. Still this is an industry entirely living off regulatory capture. I'm not accusing you of denying someone's valid insurance claims because they didn't take your eat brown rice suggestion. But you yourself claim to be an insurer "trying to change the statistics". I get the preventive care and data science shtick looks good when marketing to potential members and to potential investors. But it's not clear how you are taking on the "change the statistics" part you claim to be, which is the most interesting and important part of all this to the extent it is real as improving peoples' health and wellness, and preventing serious health problems would be amazing! So I asked a question about how the process works and who is involved as getting data and actionable data analyses to and from health care professionals in the field is not straightforward, nor is it trivial, nor is it explained anywhere.