Blog: The hegemon will see you now

I spoke with Dr. David Brailer last week and have been mulling over something he said ever since.

“The fight over the control of data will be an epic struggle,” he said. “I think it's going to be the reining battle of this decade.”

Brailer rephrased his statement to “a very large struggle” so as not to imply the fight will be between Judy Faulkner’s Epic Systems and everyone else, although the EHR wars are shaping up that way.

But with patient data, payers have long boasted of their hegemony, attained by their ability to gather claims information over long stretches of a patient’s life and across multiple providers. In recent years, though, I’ve heard talk about payers and “data disintermediation,” that is, health insurers losing their dominance over the patient data stream.

What’s happening is this. Payers’ lower-grade claims data are being supplanted by more granular, higher-quality, more useful and therefore much more valuable clinical data being gathered and stored by providers on their electronic health records systems. More and more providers have EHRs, thanks to the federal incentive payment program under the American Recovery and Reinvestment Act of 2009.

Most people know that Brailer served as the first head of the Office of the National Coordinator for Health Information Technology at HHS, beginning in 2004. Before that, though, he ran a care management and data analytics firm called CareScience. So, I asked Brailer about disintermediation. He said it was “not a good term,” but conceded that “he who controls the patient’s data has a lot of suasion on the patient’s healthcare consumption,” and “by default” that control should fall to providers with the EHRs.

I covered in the magazine this week some of this in my analysis of the acquisition of the healthcare analytics firm Humedica by a unit of UnitedHealth Group. You can read about it here.

To Brailer’s take, I would concur. Providers can—and from my perspective as a patient—should have control of this vital healthcare commodity, patient data, at least for now. They will control it, too, unless, of course, they blow it—if their patrimony is wrested from them by guile subversion, or their own cupidity or indifference.

Anyone thinking about the patient-data battle ought to read “Carbon Democracy: Political Power in the Age of Oil,” by Timothy Mitchell and consider the parallels.

Providers, as they arm themselves with data-capturing technologies at the point of care, and bolt on data-analytics systems in the ramp up for Obamacare, are at roughly the same place as the oil rich nations of the Middle East, Asia and Latin America were in the 1970s.

Providers no longer have to rely on the supply of technology and expertise by “foreigners,” or put up with the exorbitant economic “rents” they seek, to benefit from a commodity that is naturally theirs. Providers can buy whatever technology they need, and either develop home-grown human expertise to operate it, or hire its operation out, without giving up control and the lion’s share of the benefits of the commodity they produce in abundance.

At this stage of their health IT development, it also seems clear to me that providers are like data-rich healthcare nations with latent, OPEC-like power, but without a corresponding data cartel like OPEC itself to assert that power—at least not yet.

The American Medical Group Association’s Anceta data pooling initiative has the potential to catalyze the formation of a healthcare data OPEC. But with only 25 of the AMGA’s 430-member groups having joined Anceta more than a decade after its founding, it’s obvious a lot of non-participating member groups simply don’t get it yet, or distrust their follow providers more than they can envision the benefits from data sharing and collaboration.

This, too, mirrors the tribalism and distrust of many of the oil states before and after the formation of OPEC.

And now, with Anceta’s data analytics partner, Humedica, being taken over by a “colonial power,” a giant insurance company, the control and segregation of Anceta’s data is hanging by what seems to me, under the circumstances and viewing the rocky history between providers and payers, the rather thin tread of a data-use agreement.

Ultimately, longitudinal patient data should belong to each patient, and, ideally and, I believe eventually, technology will take us to a place where patients will own and control their information, releasing it for treatment as needed and contributing it to research as they see fit.

Until then, I’d much rather have my medical information kept and cared for by providers. I just hope they’re smart enough and tough enough to win the battle for health data hegemony that’s already begun.



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