Talk by Madhav Sitaraman, Co-Founder, Enlightiks at The Hive Big Data Think Tank Meetup - Healthcare 2.0 hosted at the EMC India.

1. The US Healthcare System
Madhav Sitaraman – Co‐Founder, Enlightiks

3. US Healthcare
7% 17.2 %
1970 2012
Share of wallet
Value Good Health
Gross Domestic Product (GDP)

4. US Healthcare spending
Americans Payer Providers Patients
Fee for Service
Hospital Care $ 882.3 Billion
Physician & Clinical $ 565.0 Billion
Professional Service $ 76.4 Billion
Dental $ 110.9 Billion
Personal Care $ 138.2 Billion
Home Health Care $ 77.8 Billion
Nursing Facilities $ 151.5 Billion
Prescription Drugs $ 263.3 Billion
Medical Equipment $ 95.0 Billion

5. The problem
Some facts:
 Healthcare spend will crowd out
all spending other than defence
 If city’s and towns were to report
their financials for healthcare
commitments, most would be
BANKRUPT!!!
Millions of uninsured (~48 million Americans)
Increasing premium amounts
Sick people are being excluded / health care cost was capped
Patients with pre-existing conditions were denied insurance or had to pay heft
premiums
Payments revolved around ‘Fee for Service’ and performance is not tracked
Healthcare is
TERMINALLY ILL!!!!

6. Patient Protection and Affordable Care Act
(Obamacare)
Health coverage for larger population
Continues long term care with no cap
Patients with pre-existing conditions get insurance
at the same premium
Medicaid Expansion with in states to accommodate
lower income groups
Healthcare Exchange for buying insurance
Individual Mandates requiring everyone to get
insurance
Medicare Shared Saving Program to improve care
coordination and performance
Obamacare bill is
20,000 pages long
Would be over 7 feet
tall if we stacked them

7. Accountable Care Organization (ACO)
Population Health Management
Patients
ACO must define processes to promote evidence‐based medicine and patient
engagement, monitor and evaluate quality and cost measures, meet patient‐
centeredness criteria and coordinate care.

8. Querent Overview
Readmission
Management
Risk
Prediction
Cost &
Resource
Compliance
Patient
Similarity
Profiling
Outcomes
Optimization
Clinical
Pathway
Future state
Of Health
Disease
Progression
Preventive
Healthcare

9. Solution ‐ Querent
Models
Hospital
Systems
Pattern
Recognition
Big Data
Domain
Expertise
Machine
Learning
External
Sources
Claims &
Insurance
Data

10. Areas for innovation
Care Coordination Care Delivery
Security Innovations
Education Social Media

11. Healthcare Security & Privacy
HIPAA HITECH MU
94%
Data Breach
48%
Billing & Insurance
records
20%
Prescription
Details
24%
Payment details
13%
Monthly
statements
48%
Medical Files
2769
Avg no. of
records stolen

12. Q & A