WellPoint, which bills itself as the country's largest health benefits company, recognized that the Watson Deep Q/A initiative could be used to automate utilization management. That's the manual, often complicated and time-consuming insurance-approval process physicians are required to go through before treating patients, says Ashok Chennuru, director of technology.
"We know according to guidelines and policies we have for cancer treatment options that [patients] need certain drugs and procedures" that are given or performed in concert for maximum benefit. However, right now the company doesn't have a streamlined approach for doctors' offices to submit multiple pre-op authorization requests together, says Chennuru. "Sometimes not enough documentation is submitted and we have to go back and forth and it can be frustrating."
Those claims about being able to improve medicine . . . have to be looked at carefully. The question is: What do people do with the information from these systems? Dr. Harlan Krumholz, Professor of Medicine, Yale University
The company started using IBM's Content and Predictive Analytics (ICPA) decision support engine last fall to automate the submissions process between the physician and payer, he says. If everything is clearly documented from the doctor's office, it is sent to WellPoint's version of Watson, which determines if the submission meets all criteria and quickly gives a yes or no answer or requests more information, he says.
WellPoint is conducting a pilot in one region on a limited basis to ensure that the tool is working well, Chennuru says. By the end of the year, the company is hoping to deploy it in all 14 states where WellPoint has facilities.
Eventually, once oncology is covered , WellPoint foresees being able to use the tool for other medical issues such as respiratory distress, diabetes and cardiac and kidney diseases. Using Watson, WellPoint says it envisions being able to look at massive amounts of medical literature, population health data and a patient's health record to answer "profoundly complex questions."
The company believes it will eventually be able to develop new applications to allow physicians to load patient medical histories, recent test results, recommended treatment protocols and the latest research findings into Watson. The goal is to be able to discuss the most effective courses of treatment with their patients.
"It's about leveraging the power of the computer rather than oncologists having to keep up with this [new information] they receive on a daily basis,'' says Chennuru.
Preventing hospital readmissions