Managed Care - September 2008 - (Page 19)

ular region, or employees of a particular comology or health care delivery system that we want pany — and we can conduct analyses that are taito represent in the model. The key word is high lored to that population. That’s very important quality: Everything is based on hard data. because without that capability, the tendency is MC: The model, then, is always growing? to look at a study that was done in one populaEDDY: Medical science, fortunately, does not stand tion and assume that the answers will apply still. We have to update the model in the same to your population, and that is just wrong. way that a clinician or an expert has to update his Archimedes can also be customized to particuor her own understanding of a disease and the eflar settings, by which I mean particular practice fects of treatments. We’re constantly watching for patterns that are used in different medical cennew information about the basic sciences, and ters or geographic regions. It’s clear that perwe’re constantly examining information about formance and compliance levels new treatments, tests, and intervencan vary widely from region to re- We have been in busitions. We’re also examining new ingion, medical center to medical ness a little over two formation when new trials are done. center, office practice to office years now, and we alIn that sense we’re no different from practice. Archimedes can be cus- ready have many very everyone else in medicine who has tomized to take those differences to keep up to date. large clients. Everyone MC: But in science, we don’t know into account. The effect of a drug in a setting where the level of care who has done one everything. So will Archimedes be project with us has is already very high might be very wrong about some things? different from the effect of the come back to do EDDY: Think of Archimedes as an exact same drug in a setting where multiple projects. intelligent physician with an infinite the level of care is very low. We can memory and an almost infinite abilalso customize the model to take into account ity to process data. It’s like Hippocrates meets different cost structures, such as the actual Einstein. We’re trying to build a representation amounts that each plan pays for different types of what a terribly, terribly smart doctor would of drugs or things like hospital admission. For know if he or she could remember everything he health plans that have good data, the Archimedes or she was taught about basic physiology, epimodel is very customizable. demiology, clinical trials, and so forth. Now, in the same way that a clinician’s understanding of MC: Where does all the information that makes reality can be wrong or can have gaps in it beArchimedes so customizable come from? cause the research just hasn’t been done, EDDY: The model was built up from what we know Archimedes can be wrong or will have gaps. about anatomy and physiology, and for that we Archimedes represents the medical knowledge as start with the basic science studies that physiolit is now understood. And if there are areas that ogists have been doing for decades. We also use are not yet understood, then Archimedes will not epidemiological studies to help us understand understand those areas. If there are areas where how diseases occur in populations and how varthe understanding is just plain wrong, if every exious factors, such as risk factors and aspects of a pert would get the wrong answer, Archimedes person’s past medical history, affect the occurprobably would get the wrong answer as well. rence and progression of diseases. We use clinical trials both to build and to validate the model. MC: Would it be easy to misuse Archimedes and The control group helps us understand the natARCHeS? Are there any dangers? ural history of the disease, and the treatment EDDY: Virtually anything can be misused either groups help us understand the effects of treatunintentionally or intentionally. The model is a ments. We also use surveys such as the National tool, like an ax, or Excel, or the English language. Health and Nutrition Survey and populationAll of those are very powerful and useful tools if based longitudinal studies. We use high-quality used correctly. But all of them can be misused. information from whatever source helps us adFor example, people might mistakenly type in dress a particular aspect of the disease or physithat the cost of a drug is $100 when in fact it’s SEPTEMBER 2008 / MANAGED CARE 19

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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