Use Data and Analytics to Know What Works in 2018

Amidst the plethora of year-end Top 10 lists and trends for the coming year, there’s one “trend” in particular that is mission-critical for healthcare executives to pay attention to in 2018.

In 2011 the McKinsey Global Institute published a report stating that “If US healthcare were to use big data creatively and effectively to drive efficiency and quality, the sector could create more than $300 billion in value every year.” The next year big data debuted for the first time at spot #6 on the Healthcare Executive Group’s annual list of top 10 key issues and concerns facing healthcare organizations.

Fast forward to 2018 and data and analytics is the #1 key issue on HCEG’s 2018 list of top concerns and trends for healthcare executives.

Amidst the swirl of geopolitical fear, political uncertainty and macroeconomic doubt, how did data and analytics manage to usurp such important topics as cybersecurity and healthcare reform? And now that we are here, what should healthcare executives do about data and analytics in 2018 and beyond?

“Surprisingly few companies know where and how analytics can create value.” –  Jit Kee Chin, McKinsey Analytics

How we got here

Despite seeing the powerful potential of data and analytics, in 2011 the computing power, algorithms and data volumes necessary to run advanced analysis were not widely available at a price or usability that made powerful insight generation a reality at scale. But a small group of engineers within Google changed that in 2012.

At around the same time that data and analytics first showed up on the HCEG list and McKinsey forecast massive value creation from data and analytics, a small research team within Google led by Andrew Ng used machine learning to analyze 10 million Youtube videos over the course of three days, taking advantage of newly available computer processing power that is now widely available and inexpensive. The algorithm learned to accurately recognize and categorize images of cats and human faces without being told to do so. The now famous “Cat Paper” research team proved that it was possible for small teams of scientists to quickly analyze enormous data sets to read medical images with high accuracy, quickly detect fraud and effectively segment members.

Just one year after the Cat Paper was published another team of researchers analyzed an order of magnitude more data using affordable, off-the-shelf computing equipment anyone could buy. Since then advances in graphical processing units and data architecture have enabled the use of big data, analytics and artificial intelligence such that delivering radical cost savings at scale is a very real opportunity for healthcare in 2018.

In other words, all the necessary data, tools and algorithms exist in 2018 to know what works to reduce costs at scale.

In 2018 it is possible to affordably analyze millions of data points in near-real time to produce highly accurate predictions and insights that can fundamentally impact business and healthcare outcomes.  

In other words, all the necessary data, tools and algorithms exist in 2018 to know what works to reduce costs at scale.

Why data and analytics are a critical 2018 agenda item for healthcare executives

  1. Data and analytics enable you to know what works. With so many consumer engagement programs running and so many competing priorities for investment dollars it’s critical to build the capability to prove what is worthy of investment and what is not. Data and analytics has the power to show you what works and what’s wasted this year. NextHealth clients routinely use NextInsight to discard poor-performing campaigns and invest in those that drive proven cost savings.
  2. Data and analytics are under your control. You can identity an important use case, kickoff a project and generate outcomes within the span of this fiscal yearOne NextHealth client reduced ER overuse-related costs 39% in six months in a medicaid population. Other trends such as healthcare reform are more complex with more moving parts outside of your control in 2018.
  3. You already have the data you need to generate results. The algorithms, data, and cheap computing power to analyze that data are in place to deliver meaningful impact on ROI and patient care this yearWe have seen clients move from data ingestion to realization of $6, $24 and even $42 PMPM cost savings in less than nine months.
  4. Data scientists are scarce but machine learning algorithms are plentiful. There is a well documented shortage of qualified data scientists and AI experts for hire so staffing your way to better insights is not realistic. Google, Facebook and Alibaba have likely hired most of them already. Yet the expertise you need to generate results exists in machine learning and Deep Learning algorithms that your current team can access and deploy this year. One NextHealth client’s analytics team deployed the NextHealth modified Welch’s T-test on top of their data in a few months to deliver results in less than a year.
  5. Data and analytics will fuel success in many of the other key issues you face. A key part of solving the affordability issue and reducing costs is knowing what programs work and which ones don’t. Healthcare payers spend millions of dollars on intervention programs in hopes of reducing costs without knowing precisely which ones work and which ones are a waste of time and money. NextHealth clients will use big data and prescriptive analytics to pinpoint which programs work and which ones don’t this year in order to realize proven medical cost reduction.


What to do in 2018

Here are three ways to use data and analytics in 2018 to generate powerful insights and outcomes.

Create a test and learn culture

Data and analytics thrive in an environment of experimentation. It all starts with a question or hypothesis that drives outcomes. Which population segments are most at risk of opioid overuse? Which one of those segments can we actually impact? How can we reduce opioid overuse across our members and reduce medical costs at the same time? Data and analytics are only as good as the insights and outcomes they produce and insights come from testing, experimenting and learning.


Measure and optimize

In 2012 when data and analytics first appeared on the HCEG Top Ten list it showed up as “Big data, warehousing and capability expansion.” In 2018 getting big data is no longer the problem. Getting meaningful and actionable insights from the data is now the challenge. The NextHealth platform ingests enormous amounts of member and third-party data to generate insights that allow healthcare payers to optimize their investment only in what works. Here is an illustrative version of a client campaign optimized for impact:

Data: Millions of member utilization and demographic data points identified 100,000 members at risk of overusing the ER

Analysis and Insight: Only 1,000 of the 100,000 segmented high risk members are predicted to change their behavior in a way that reduces costs.

Optimize: Instead of trying to engage all 100,000 high risk members, targeted outreach was delivered to only the 1,000 members who are predicted to change behavior to a lower cost alternative

Outcome: 90% (900) of the 1,000 members used alternate care solutions and reduced costs accordingly.


Generate quick wins on critical use cases

Pick a use case that will make a meaningful impact on a key part of your business or in the lives of your members and focus resources on making an impact there. Start small, test a hypothesis, get the win and then focus on scaling to the larger population or enterprise.

Data quantity is not the problem. It’s all about generating insights from the data and optimizing to the right outcomes based on those insights. And that is the hard part and one of the reasons why we haven’t realized the $300 billion in collective value foretold by McKinsey in 2011.

Here are four insights and lessons we learned in 2017 after analyzing hundreds of millions of data points that you can immediately use to redirect your efforts toward what works:

  • For any consumer engagement or outreach campaign, you need to start with clean and up-to-date member contact information.
  • Choice overload is real for consumers. Start with only one campaign and keep it simple. Throwing spaghetti at the wall to see what sticks only increases costs and disguises the real signal.
  • If you are targeting interventions toward rural populations, use a nurse advice line.  It is one of the most effective channels for rural populations.
  • Rural adults and women with children are more impactable than urban healthy adults.

We’ve seen healthplans reduce avoidable ER visits by 25% and reduce associated costs by $42 per member per month. That kind of savings at scale fundamentally changes the cost and care landscape while at the same time fundamentally improving outcomes for patients through more appropriate care at the right time in the right place.

Download a whitepaper to learn more about how NextHealth clients achieve causal outcomes and use behavioral nudges to change member behavior.


The Healthcare Executive Group’s Top 10 for 2018) is member-driven effort to develop an accurate pulse of what’s on the mind of healthcare executives. For 2018, Clinical and Data Analytics made the top of the list for the first time since 2011. As it turns out some form of IT, data and analytics first appeared on the list of key issues for healthcare executives in 2012 and it’s been slowly climbing the rankings since:

  • 2012: #6 – Big Data, Warehousing and Analytical Capability Expansion
  • 2013: #9 – Innovation and Collaboration of Business and IT for Competitive Advantage
  • 2014: #8 – Big Data and Race to Advanced Analytics
  • 2015: #7 – Big Data and the race to advanced analytics and informatics
  • 2016: #8 – Big data and advanced analytics: identifying patterns, opportunities in vastly detailed data sets
  • 2017: #3 – Clinical and Data Analytics: leveraging big data with clinical evidence to segment populations, manage health and drive decisions
  • 2018: #1 – Clinical and Data Analytics: Leveraging big data with clinical evidence to segment populations, manage health and drive decisions

McKinsey Global Institute Report

HCEG Top 10 for 2018

Cat Paper in NY Times, Original Research Paper

See how the NextHealth analytics solution reduced avoidable emergency room visits by 25%.

Nicole Engel

Nicole Engel

Nicole is a health care industry veteran who has spent over a decade working with both market leaders, and entrepreneurial, high growth innovators.  Prior to joining NextHealth, she held various progressive Strategy and Commercial leadership roles with Medtronic, Boston Scientific, and Deloitte Consulting. Nicole has domain expertise in some of the highest health care cost categories such as Cardiac Care, Cancer, and Obesity, and is passionate about implementing solutions that reduce cost and improve patient outcomes.

Outside of work, Nicole enjoys spending time with her husband and three very active young boys, enjoying all the outdoor activities Colorado has to offer. She is an avid traveler, music lover and dreams of someday going to cooking school.

Nicole holds an MBA from the University of Chicago Booth School of Business, and BBA in Marketing and Spanish from the University of Wisconsin-Madison.

Geoff Urland

Geoff Urland

Geoff brings over 20 years of health care analytics, research, and teaching experience to his role in helping clients design, understand, and(most importantly!) make decisions from program evaluations and machine learning.  Geoff is passionate about helping business leaders understand the implications of analytics methodology and results for their businesses.  He leads of team of experienced health care analytics and program evaluation specialists who work with our clients to derive value and drive decisions from data.

Geoff is a voracious reader and loves hiking, soccer, and making sure his two children don’t injure each other while trying to figure out what to build with legos.

Geoff has a Ph.D. in Social Psychology from the University of Colorado, Boulder where he focused on social neuroscience, attitudes, and social perception.

Laura Dettmann

Laura Dettmann

Laura has nearly two decades of marketing, sales and strategic account management experience in the health plan industry. Prior to joining NextHealth, Laura held strategic sales roles at Welldoc, where she helped grow and support health plan relationships—including consulting on digital health strategies and potential solutions for chronic condition management—and HealthSparq, where she helped enhance the health plan member experience via provider search, cost transparency and care navigation solutions. She also worked at Staywell (most recently purchased by WebMD) to support health plan marketing communications, wellness and digital health coaching strategies. Laura began her career at Florida Blue where she worked on the Marketing Innovation team.

Laura works from her home office in Raleigh-Durham, NC. She loves running and her goldendoodle, Chippy. Fun fact: Laura used to own a vineyard and alpaca farm in Wisconsin!

Laura holds an MBA from the University of North Florida and BA in Industrial Relations and Advertising from the University of North Carolina at Chapel Hill.

Nasir Ali

Nasir Ali

Nasir is a strategic product leader and has worked most of his career at the intersection of healthcare and technology. Most recently he was leading the core product and services teams at SignifyHealth. Previously he spent about 9 years in product management leadership roles at TriZetto on both the Payer and Provider side of the solution portfolio. At TriZetto, he helped the company through a successful exit from private equity investors to Cognizant Technology Solutions. Prior to TriZetto Nasir held similar strategic roles at other healthcare entities in the PBM, Medical Device and Health-tech space.


Nasir is a resident of Colorado and enjoys hiking and mountain biking with his wife and two daughters. Fun Fact – Nasir climbed three Colorado 14ers last summer and plans to add a few more to the list this summer. 


Nasir holds a bachelor’s degree in mechanical engineering and a master’s in business administration. He has also completed postgraduate work in product strategy.

Leon Eagan

Leon Eagan

Leon has over 20 years of experience in building and securing IT systems and infrastructures. Most of his career has been in heavily regulated and sensitive environments, including healthcare and the payment card industry.  Prior to joining NextHealth, Leon worked at McKesson/RelayHealth managing and safeguarding a healthcare analytics platform and its data in the cloud.

Leon enjoys live music, sporting events, games played with friends, and of course continued learning in the fields of technology and security.

BS in Business Information Systems and an MBA in Technology Management

Creating a Baseline: 5 Steps to Measure Everything and Improve Affordability

Blue Cross of Idaho (“BCI”) was focused on improving affordability for its members and customers. Their Healthcare Economics Division had identified the need to complete a baseline evaluation of over 50 initiatives across a range of use cases. However, their capacity to complete the analysis averaged one program per month – thus projecting a requirement of over 4 years to complete their work. Additionally, the team wanted to provide a granular level of reporting on each initiative across a variety of key performance indicators such as net paid claims savings, drivers of consumer behavior by cohort, utilization, cost, impacts on utilization of alternative care settings, etc.  

By leveraging the NextHealth platform, BCI was able to “leapfrog” its capability to conduct the evaluation process and assessed all 50+ programs in six months. In addition to establishing essential baselines, the plan gained:

  • Trust in the data by using an analytically rigorous program setup and methodologies  
  • A platform for data sharing – expediting communications with stakeholders  
  • Data-backed reports leverage with customers, brokers and sales teams – facilitating a market advantage and opportunity to propel business growth

The first step toward affordability – knowing what works – with the advanced breadth, depth and speed of the NextHealth platform, is key to plans understanding what they have, what they need to look at, and where to go from there.  

Drew Hobby, Senior Vice President of Healthcare Economics at Blue Cross of Idaho, recently shared some of his company’s best practices in a webinar hosted by NextHealth. What follows are the 5 steps he outlined in moving to improved affordability.

We have to move quickly. We only have so many resources at Blue Cross of Idaho, and it’s critical that we are allocating them in the exact right way and getting the most value out of those resources.” 

Step 1: Start with a baseline 

Prior to NextHealth, Blue Cross of Idaho was evaluating one clinical program a month. At that pace, it would have taken them four years to complete a baseline analysis of all of their initiatives. But by leveraging NextHealth’s advanced analytics platform, the plan measured 50+ programs in just six months with a level of granularity that allowed them to prioritize their affordability efforts.   

“A lot of folks have access to data and can do analytics. That’s very different than actually executing and taking actions that drive medical expense reduction for your customers.” 

Step 2: Establish a governance structure to support fast, data-driven decisions  

In response to client demand, Blue Cross of Idaho implemented a new operating model dedicated to reducing healthcare costs for customers by capitalizing on data insights. Establishing a Healthcare Economics Division consisting of an Analytics group and a Healthcare Solutions team ensured integration with the business needs, data-driven insights, and a way to move those insights rapidly into workflow.   

“We earn a lot of value in telling customers about programs that are driving positive results and equally, programs that are not. And then, ‘Here’s why,’” 

 Step 3: Uncover insights with a wide array of key performance indicators 

Know what is working and what is not beyond the total cost of care by including a wide variety of additional KPIs to evaluate within a program. NextHealth’s platform with its ability to craft custom KPIs makes it easy to achieve highly granular studies to generate actionable insights and uncover previously unseen opportunities to further impact cost reduction. This deep level of understanding allows plans to articulate whether a solution is working and where there is opportunity to improve. 

“NextHealth was huge in helping us feel very comfortable with the propensity score and the matching of comparing cohorts…which makes us really comfortable with calculating the ROI. If we are sitting down in front of a large account, we need to be very confident with the integrity of the case study.” 

Step 4: Utilize trustworthy results to build customer relationships 

Organizational trust in analytic reporting is not always a given. But the methodological rigor embedded in the NextHealth platform (for example, propensity score matching and over 300 covariates to select comparative cohorts), instills confidence in the study results and thus earns greater credibility with health plan employer customers. The platform puts rapid, actionable, credible data in plan executives’ hands, enabling them to demonstrate value to their customers in the most compelling way 

“We can continuously measure all existing and new solutions every month in perpetuity. NextHealth allows us to do it rapidly and with integrity so our team can spend time focused on what’s driving solutions instead of digging for data.” 

Step 5: Measure repeatedly to drive optimization

NextHealth’s scalable platform stands alone in its delivery of speed, scale, and granularity. That means that valuable resources formerly spent on data analysis can be more productively focused on evaluating results, solutions and program design. Programs can be evaluated continually, producing metrics for future program design. Solutions can be designed and measured using very specific inputs and forecast from a medical expense improvement standpoint that flows all the way though the value chain. Determining which solutions are working and whether there is additional opportunity drives ongoing expense reduction, and the NextHealth platform means it’s all available in real time.  

The NextHealth platform empowers health plans with unique capabilities to measure all of their clinical programs in a comprehensive and efficient manner, and then use the results to further investigate and drive affordability efforts. Blue Cross of Idaho was able to radically speed up their program evaluation and focus their attention on what mattered most – improving affordability and improving outcomes. To learn more, please contact us.

NextHealth Technologies Welcomes a New CTO to Continue to Innovate and Scale its Analytics Platform

NextHealth Technologies Welcomes a New CTO to Continue to Innovate and Scale its Analytics Platform 

Industry veteran, Mehrshad Setayesh, brings decades of engineering and analytics leadership 


Denver, CO, November 4, 2019 — NextHealth Technologies, whose analytics platform helps healthcare organizations rapidly evaluate their entire portfolio of cost, service and access initiatives to know what works and improve affordability, today announced the appointment of Mehrshad Setayesh as Chief Technology Officer. 

Mr. Setayesh brings considerable leadership experience in engineering to the company and will be responsible for driving NextHealth’s technology strategy and product development. He joins from Oracle where for the past 7 years he had been managing a large distributed engineering team responsible for a social media gateway for all Oracle clouds. Prior to that, Mehrshad was part of a startup called Collective Intellect (CI) purchased by Oracle in 2012. As CTO at NextHealth, he will oversee the teams responsible for technology architecture, software development, technology operations and infrastructure management. His expertise lies in building strong engineering teams and fostering growth, cooperation, respect, planning, and practical execution 

 “As NextHealth continues to help our health plan customers create and support a culture of measurement to drive affordability,” said Eric Grossman, CEO of NextHealth. “I have no doubt that Mehrshad will provide the technical vision we need to continue to scale and grow our product.” 

About NextHealth Technologies

Know what works. Make it better. ®  NextHealth’s AI-powered advanced analytics platform integrates data-driven decision making into workflow to improve healthcare affordability. Our HITRUST-certified SaaS solution integrates scientifically rigorous methodologies, powering the delivery of trusted, granular insights about what works for whom, why, and what to do next – from the program to the population and down to the individual member level. NextHealth’s platform scales to systematically amplify the ROI of any cost, service, or quality initiative including ER reduction, disease, case and utilization management, gaps in care, telehealth and many more. All deployments include expert services support.

Mehrshad Setayesh

Mehrshad Setayesh

Mehrshad is a veteran technology innovator with more than thirty years of experience under his belt. As CTO, Mehrshad leads NextHealth’s team of engineers and developers with a mission to improve healthcare affordability.  With passionate belief in the power of individuals and teams, Mehrshad is a value-based leader who turns complex software ideas into optimized, scalable businesses. He joined NextHealth Technologies from Oracle Inc. where he managed a large distributed engineering team responsible for a social media gateway for all Oracle clouds. Prior to his role at Oracle, Mehrshad was part of the startup company, Collective Intellect, which was then acquired by Oracle Inc.


An avid athlete, Mehrshad believes a healthy body cultivates a healthy mind and spirit. He enjoys long distance swimming, downhill skiing, hiking, traveling and spending time with his family.


As a trilingual, Mehrshad began his computer science degree at Switzerland’s EPFL, The Swiss Federal Institute of Technology of Lausanne. He went on to obtain his BS in Computer Science and MS in Software Engineering from Southern Methodist University

NextHealth Technologies’ Growth Continues with the Addition of Two Senior Executives to its Leadership Team

NextHealth Technologies’ Growth Continues with the Addition of Two Senior Executives to its Leadership Team

Industry veterans will accelerate value by incorporating best practices into methodologies and delivery for NextHealth clients


Denver, CO, October 28, 2019 — NextHealth Technologies, whose analytics platform helps healthcare organizations rapidly evaluate their entire portfolios of cost, service and access initiatives to know what works and improve affordability, announced today the addition of Peter Everett as Chief Operating Officer and Aria Martin-Ward as SVP of Client Services.

Mr. Everett will bring over 20 years of leadership experience to his role of overseeing all major operational areas of the company, including engineering, analytics, services, human resources, and information security. Ms. Martin-Ward, a long-time veteran in the healthcare IT software industry, will be responsible for value delivery as the leader of NextHealth’s client services teams. “As NextHealth continues to expand to help our health plan customers achieve affordability, we are thrilled to add such accomplished and proven leaders to our executive team,” said Eric Grossman, CEO of NextHealth.

Mr. Everett is a highly accomplished executive and entrepreneur in the healthcare technology space. He was one of NextHealth’s original investors and has served as a member of the board of directors since the inception of the company. Prior to NextHealth, Peter was founder and CEO of HealthConnect Systems, a leading SaaS provider of healthcare sales automation solutions. Peter also worked on Wall Street for over ten years providing merger and acquisition advisory and capital raising services to technology companies, most recently as Principal at JP Morgan.

Prior to joining NextHealth, Ms. Martin-Ward spent 7 years with GHX (Global Healthcare Exchange) overseeing the solution delivery teams that managed all customer project implementation, integration, training and product education activities. Before joining GHX, she led the implementation team at Epocrates, a medication reference software platform. For nearly a decade prior, she was a senior executive at Sage Software.

About NextHealth Technologies

Know what works. Make it better. ®  NextHealth’s AI-powered advanced analytics platform integrates data-driven decision making into workflow to improve healthcare affordability. Our HITRUST-certified SaaS solution integrates scientifically rigorous methodologies, powering the delivery of trusted, granular insights about what works for whom, why, and what to do next – from the program to the population and down to the individual member level. NextHealth’s platform scales to systematically amplify the ROI of any cost, service, or quality initiative including ER reduction, disease, case and utilization management, gaps in care, telehealth and many more. All deployments include expert services support.