If you’re a customer of WellPoint, Inc., your employees’ records soon will come under the guidance of a computer. Granted, a very smart computer, but a computer nonetheless.

 Last week, IBM, the creator of supercomputer Watson, and the insurance company announced a collaboration to create the first commercial applications of the Watson technology. Under the agreement, WellPoint will develop and launch Watson-based solutions to help improve patient care through the delivery of up-to-date, evidence-based health care. IBM will develop the base Watson health care technology on which WellPoint's solution will run.

 This comes under criticism from some who say WellPoint could use the intelligence to target plan members who rack up high costs to the insurer. However, there is also opportunity for great development, especially in surveying entire population differences.

“All those socioeconomic differences matter, plus an enormous amount of information on health care comes out every day,” says Cyndy Nayer, president and CEO of the Center for Health Value Innovation, which focuses on helping employees pinpoint health risks. “You could see how it could become overwhelming for the patient and clinician. By using Watson, they’ll be able to identify the nuances — where people might trip up — and try to catch it before.”

Watson's ability to analyze the meaning and context of human language, and quickly process vast amounts of information to suggest options targeted to a patient's circumstances, can assist decision makers, such as physicians and nurses, in identifying the most likely diagnosis and treatment options for their patients.

Nayer concedes there are potential ethical questions to address, including the possibility that WellPoint could use the system to boot a member from the plan.

“I would hope that that’s not the future of where we’re going. My understanding of the Affordable Care Act is that people will be not denied coverage because of a condition, but I also understand that there is threat to the law. I want to believe that that’s not the intention,” Nayer says. She also notes the issue of health records security is a possible danger. “We’re hearing that there has been hacking and we need to get a better handle on that.”

Watson can sift through an equivalent of about 1 million books or roughly 200 million pages of data, and analyze this information and provide precise responses in less than three seconds. Using this capability, WellPoint is expected to enable Watson to allow physicians to easily coordinate medical data programmed into Watson with specified patient factors, to help identify the most likely diagnosis and treatment options in complex cases.

"There are breathtaking advances in medical science and clinical knowledge, however; this clinical information is not always used in the care of patients. Imagine having the ability to take in all the information around a patient's medical care —symptoms, findings, patient interviews and diagnostic studies,” says Sam Nussbaum, M.D., WellPoint's chief medical officer. “Then, imagine using Watson analytic capabilities to consider all of the prior cases, the state-of-the-art clinical knowledge in the medical literature and clinical best practices to help a physician advance a diagnosis and guide a course of treatment."

Medical conditions such as cancer, diabetes, chronic heart or kidney disease are incredibly intricate. New solutions incorporating Watson are being developed to have the ability to look at massive amounts of medical literature, population health data, and even a patient's health record, in compliance with applicable privacy and security laws, to answer complex questions.

"With medical information doubling every five years and health care costs increasing, Watson has tremendous potential for applications that improve the efficiency of care and reduce wait times for diagnosis and treatment by enabling clinicians with access to the best clinical data the moment they need it," says Manoj Saxena, general manager, Watson Solutions, IBM Software Group.

Depending on the progress of the development efforts, WellPoint anticipates employing Watson technology in early 2012, working with select physician groups in clinical pilots.

“It’s not that health decisions are being made by a computer, but health priorities are being made by the computer,” Nayer says. “The decisions still lie with the clinician.”

Register or login for access to this item and much more

All Employee Benefit News content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access