In this era of big data, managed care companies have comprehensive data sets from which to extrapolate and report precise and meaningful findings about health services. With pay-for-performance models championed by the Affordable Care Act and pursued by the Centers for Medicare and Medicaid Services, the value and relevance of these data in improving health is likely greater than ever. That is why we agree that managed care companies have an imperative to participate in quality improvement initiatives, conduct rigorous, transparent research with our data, and widely share and disseminate those findings so that others may learn from and build on our experiences. Managed care companies should publish findings on real-word effectiveness in their large beneficiary populations to quantify the benefits to individuals of specific population health initiatives.
Data sources are myriad. They include claims from providers along with pharmaceutical and medical device purveyors that yield direct insights into patients’ use of products, services, and levels of care. Managed care companies also collect data from participants using web-based programs or mobile phone applications that motivate healthy behavior. Partnerships with provider groups also generate substantial clinical data from medical records. Companies already routinely use these data sources to assess quality improvement initiatives in an effort to achieve the triple aim of improved health outcomes, better patient experience, and lower costs, and to comply with reporting requirements of regulatory agencies such as the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set measures.
One might suspect that managed care companies with voluminous data and in-house analytic expertise would lead the way in contributing to state-of-the-art publications and presentations in a number of health-related fields: general medicine, medical specialties, public health, epidemiology, managed care practice, health economics, and quality improvement, to name a few. Although publications of managed care exist (albeit originating from academia), they are far less common than we believe they should be.
Why the dearth of scholarly output? Fiduciary responsibility to focus on short-term, quarterly accountability and value to beneficiaries and stakeholders among publicly traded companies may inhibit longer-term investments in writing and publishing that may not have an easily calculable, immediate return on investment, and that therefore seem less essential to the business mission. Additionally, there may exist concerns that disseminating any insights would benefit competitors more than those who initially invest the extra time and resources to publish their findings.
Managed care companies must focus on the business of selling insurance and benefit administration services: collecting premiums and fees and paying or administering claims, and more recently, designing products to help keep populations healthier in the first place. Publishing scientific insights gleaned from their big data sets has historically not been relevant to this business model. However, we believe managed care sales teams could emulate their colleagues in the pharmaceutical industry whose marketing materials frequently include references to peer-reviewed studies that were designed and written to objectively assess effectiveness using the scientific method. Big pharma and medical technology companies have realized that the peer-review process adds credibility and evidential transparency to discourse about their products in both business and research contexts.
In contrast to pharmaceutical or device manufacturers whose bottom lines depend on the existence of illness, managed care companies do better financially by promoting health and well-being. At this point, newer health care delivery models enable managed care companies to share both risk and rewards with provider groups or to join with employers in designing incentives for healthy behavior among employees. We believe that when a managed care company assesses whether a product enhances health in real-world populations, it should disseminate that finding through journal articles and conference presentations, not just in marketing materials. Ultimately, an innovative insurance or health care benefit product (be it a health plan, a wellness program, or a mobile phone application) that leads to a healthier insured population can result in reduced premiums that enable companies to price their products more competitively, particularly when claims of those products’ value have been vetted by a community of peer reviewers and journal editors.
Accordingly, Cigna is currently shifting our corporate culture such that publishing findings from analyses on health services use and delivery becomes the norm. We have therefore launched a pilot publication effort that provides the support of a professional medical writer for projects worthy of dissemination. This form of assistance, along with staff analytic expertise, can help to overcome the relatively high “activation energy” required of our medical professionals to find time to prepare data for publication. Thanks to this mechanism, within less than a year, we have had several manuscripts accepted by journals. Topics include the effectiveness of medication-assisted treatment for opioid addiction (publication in press), the disutility of spinal fusion surgery in reducing analgesic use and improving outcomes, an intervention to prevent the worsening of chronic kidney disease to end-stage renal disease (publication in press), and a risk stratification model to improve management of various cancers. We have also, through our employee training mechanism, developed an hour-long online tutorial that reviews for potential authors the requisite steps of the peer-review publication process. Those at Cigna involved in publishing have reported that it is professionally very meaningful. With professional talent at a premium, the ability to recruit and retain highly skilled clinicians and statisticians by facilitating or even incentivizing this scholarly activity will also serve companies well.
We also believe that any competitive disadvantage due to other companies replicating our findings by copying our programs would be more than outweighed not only by our contribution to improving health care in general, but by our clients’ appreciation of our being the first to bring new innovations to the marketplace. In fact, we hope other companies will replicate our effort to disseminate real-world effectiveness data. In this way, managed care companies can together make meaningful contributions to health services delivery and to the health of the populations we serve.
Publishing insights from decades of funding health services will bring greater credibility to policy debates, increase our industry’s relevance to partnering provider groups, and broadcast a more compelling message of health and well-being for clients and customers. Time has arrived for all managed care companies to claim a rightful seat at the table as experts in health services delivery by contributing in a scholarly domain.
We gratefully acknowledge Paula Nevins, Tania Graves, Stephen Cassell, and Lisa Bacus from Cigna’s marketing organization for their support of this pilot project, and Doug Nemecek for his helpful comments on the manuscript.