How HealthCore Got Started: Part II


Claims data was the critical starting point for HealthCore.

As an ‘index’ of the individual’s exposure to the healthcare system, my cofounder Mark Cziraky and I learned early on that it was the key starting point of the platform for building a complete, detailed understanding of the patient within the healthcare system. With this, we would eventually enable decision makers (product innovators, policy makers, regulators) to develop relevant insight generated under real-world circumstances, and improve the quality of patient care and health outcomes. As valuable as claims data are to our understanding of ‘what’ is happening, it often comes up short in telling us ‘why’ it is happening. By and large it is missing key data on clinical outcomes (i.e. blood pressure; test results). Data from the health record (patient chart) and the voice of the patient (often gathered through survey) are just as essential to the richness required for drawing proper conclusions about health outcomes.

While HealthCore’s own robust database contains information on nearly 60 million individuals from multiple health plans across the U.S and over 175,000 physicians, 44 million private U.S. commercial lives with medical and pharmacy claims, lab results for 13 million lives integrated with claims data, clinical oncology data, and vision and dental claims data – it is merely our foundation for building deeper insights.

It is within data environments, such as the HealthCore Integrated Research Environment (HIRE), that we enrich claims data with clinical, enabling us to ask additional questions, and build a much better understanding of what is happening in the real world.

In all of this, we also recognize the importance of treating these data with great respect. Not only is it critical to protect the privacy of our patients or health plan members, but we must never forget that the systems that generate these data were not designed with research in mind. Thus, research is a ‘repurposing’ utility that must be done with care, great thought and the ability to go back into those source systems to assure we are interpreting it correctly. As the health outcomes research arm of Anthem, HealthCore has the ability to do so often providing us a unique understanding of its nuances. The ability to do this helps us maximize the accuracy of the research conducted on it; it is for this reason that we do not sell it.

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