Question

Suppose there is a Big Data platform called ‘Wise Mind’ that could trawl through all the EMRs of all the hospitals and learn from physicians’ diagnoses and outcomes (ignore regulatory issues for now, or assume that all the personal information has been redacted before the system trawls the hospital databases). How would insurance providers – the firms that pay the hospitals, physicians, and clinicians for their services – use this system? Provide one clearly illustrated example.

Answer 1

With the help of such system the insurance company's can quickly validate the claims authenticity and will be able to make the payment accordingly. If the system is capable of trawl through all the EMRs of all the hospitals then the patients history in terms of his previous illness and treatments undertaken will be readily available to the insurance companies and this will help insurance companies to make a better informed decision.

Let us take an example of cancer protection insurance a person has bought recently and while buying the insurance person had declared that as pre-existing condition he never had been diagnosed with any type of cancer. The pre-existing condition was not covered under the insurance plant unit 24 months has been passed since the inception of the insurance plan. With in 12 months the person sends a claim regarding the treatment of cancer, Now under such situation the company can check all the ERMs and can easily validate the fact that his person was not diagnosed with cancer earlier and this is the first time it has been diagnosed with. This will make a valid claim get scrutinized in quick time and the insurance comapny as well as the patient will be beneficiary of such system.