Drilling into Health Care Data Sets to Improve Coverage and Outcomes

Dr. Nathan Gunn is a technology-focused health care executive who engaged in a turnaround position as Valence Health’s president of population health. He oversaw a consistent increase in client satisfaction and profitability by enabling scalable growth in Valence Health’s software division. Dr. Nathan Gunn was featured in a 2011 New Yorker article titled “The Hot Spotters - Can We Lower Medical Costs by Giving the Neediest Patients Better Care?”

The article featured his efforts with Verisk Health to drill into data sets for clients that manage employers’ health care benefits. Against a backdrop of sharply increasing coverage outlays, he identified the top 5 percent of spenders. Among more than 100,000 covered lives, these accounted for 60 percent of total medical spending. This brought to sharp relief those people who did not receive adequate care when they got sick, which Dr. Gunn called “the sweet spot for preventive care.”

Through looking at individual cases, he was able to find mismatches between conditions and steps taken to remedy them within the health care system. For example, one patient with chronic migraines would be prescribed medications that did not work and then make regular visits to the emergency room, where she would receive narcotic injections that eased the symptoms. The preferred treatment pathway would involve the physician guiding the patient in exploring the full range of prescription medications until one that actually worked was found. These individual inefficiencies often lead to the discovery of larger patterns that can be solved in ways that save money and improve health care outcomes.