Population-based versus Individual Healthcare: MN’s Expensive Big Data Collection Efforts Miss The Mark
Monday, May 25th, 2015
Minnesota health care providers are now required to report “quality measures” to the Minnesota Department of Health http://www.health.state.mn.us/healthreform/measurement/adoptedrule/
Many Minnesota and US government policymakers are entranced by managed care practices justified by collecting and then drilling down on Big Data being which is now by law collected from Minnesota health care providers. Governments increasingly rely on vendor companies such as UnitedHealth’s Optum https://www.optum.com/ to do IT and data crunching.
So, MPPA is discussing government mandated health care “quality” data collection and evidence-based medicine. David Sackett, the putative “Father of Evidence Based Medicine” (who at age 80 recently passed away) steered medicine towards scientific evidence in justifying medical practices. He’d agree that it’s both unscientific and illegitimate to apply probability theory to Big Data sets in which the events (or things) studied are neither truly homogeneous nor repeatable a very large number of times.
How does this relate to true scientifically-based medicine? The answer requires a look at probability theory. Probability theory is a branch of mathematics frequently used in statistical analysis. Richard von Mises posed the following simple but revealing question in his great work Probability, Statistics, and Truth:
What does it actually mean to say that the probability of a die coming up as a two-spot is one-sixth?
What the probability fraction actually means is this: if the die is not loaded, and if it is thrown a very large number of times, it will tend asymptotically (See http://en.wikipedia.org/wiki/Asymptotic_analysis) to come up as a two one-sixth of the time. The only way one can really make sure that the die is not loaded, i.e., that the two-spot will come up one-sixth of the time, is to make a large number of throws in order to do an asymptotic statistical analysis.
The rationale for requiring all Minnesota “health care providers” (physicians and other licensed professionals) to submit clinical information to the Minnesota Department of Health transactions is: Only by capturing large numbers of events or numbers (at great cost to society, providers and patients) can government, health plans, employers, and consumers (patients and families) tell which “providers” are doing “quality” practice. And, therefore, which health care procedures, hospital confinements, and medications will be eligible to receive third party dollars.
It is false to say that the “probability of Hillary Clinton (even after the Democratic Party nomination) will be elected President in 2016 is (name the number — 1/2, 1/4, 1/20.. or whatever) because US Presidential elections are not homogeneous events and are not are repeated often enough to do a asymptotic analysis. Likewise, It is false to proclaim that all patients should receive drug X or treatment Y because of the probability of success (good outcome) as deduced from Big Data (even if the IBM Watson computer or United HealthCare Optum does it).
Here is the point: A good deal of “mathematicalizing” [a new word] in social science and health care policy inappropriately applies probability theory to studying individual medical care treatment options, decisions, and patient choices. This is truly false science. And Minnesota policymakers need to become very skeptical of reliance on health care clinical care “quality” collection.
Instead, scientific studies comparing the costs and outcomes of Direct Pay (cash) practices vs. managed care clinics which use provider pay-for performance formulas based on population-based clinical care “quality” data must match a sample of doctors and patients who are free to make make medical care decisions with a similar sample from government-directed managed care. Such studies are not possible using the “quality” data currently being collected by the Minnesota Department of Health. De-centralizing medical care decision-making should be encouraged by Minnesota policymakers and insurance companies. Hopefully state and federal policy will empower consumers (patients and families) financially and encourage them to find and engage doctors and other health care professionals of their choice. This is where Minnesota and the Nation need to go.