For centuries, the central challenge in health care was ignorance. There simply wasn’t enough information to know what was making a person sick, or what to do to cure the patient.

Now, health care is being flooded with information. Advances in computing technology mean that gathering, storing and analyzing health information is relatively cheap, and it’s getting cheaper by the day. As computers continue to fall in price, the cost of sequencing a single person’s genome is tumbling, too.

Entrepreneur Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to give doctors the ability to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails.

Information from patients around the globe could then be compared, in theory. Computers could ultimately help doctors match specific treatments at the molecular level to the people for whom they would work best. Software might also detect patterns in data that would suggest new uses for existing drugs.

Collecting biochemical and genomic data on billions of people around the world is just the tip of the data iceberg that a few dozen health information technology experts described recently in New York at a gathering sponsored by Forbes magazine.

“You now have all of health care digitized, which is pretty cool,” said Paul Black, president of the electronic health records company Allscripts.

But it’s still unclear how to make sense of all the digital information on a big-picture scale. “There’s different approaches in the marketplace to how you would make this all be actually valuable to people,” Black said.

Some doctors are finding it valuable to “see the community information, versus just the campus information,” meaning: If they know where their patients are going for health care beyond their hospital or office, and whether they’re actually filling all the prescriptions they’ve been given, doctors make different treatment decisions nearly 70 percent of the time, Black said.

Companies like Castlight Health are betting that they can come up with ways to analyze seemingly unrelated data about how and why people use health care to improve health and save corporations money.

Castlight’s Dr. Dena Bravata said, “We can now actually marry information from [corporate human resources] systems — Are you a high performer in your company? What’s your absenteeism been? — with medical claims to really understand that, among our high performers we’re having a lot of absenteeism because their kids’ asthma is not well controlled.”

There are concerns about privacy and data security. Blackberry CEO John Chen pitched his company’s mobile devices as secure enough to meet federal medical privacy laws. But the Forbes event was more focused on the potential benefits in the new Big Data world.

There’s a lot of optimism that having a more complete picture of peoples’ health and how they use the health care system will save insurance companies money, and drive health care premiums down. Kevin Nazemi, co-CEO of Oscar Insurance, believes that a new generation of wearable wireless sensors will soon help doctors detect health problems early enough to prevent expensive treatments.

But, Nazemi said, it’s still hard for insurance companies to justify investing up front in data systems when “the value is reaped in Year 4 or 5 in a market where [people switch insurance] on average every three years. You know, dollar in, 25 cents back. How do you think of that?”

David Goldhill, who runs a cable TV network and is the author of the book Catastrophic Care, is skeptical that technological breakthroughs, even if they make people healthier, will ever tame health care spending.

“We didn’t go from 4 percent to 17 percent of GDP on health care spending because Americans got a lot less healthy,” he said. “The increase in spending in health care isn’t because, ‘Oh my God, we’re sick and if we can just cure ourselves, it’s going to go away,’ ” he said. “It’s a business model issue, it’s the way we subsidize and manage demand.”

Some see a future when wirelessly enabled skin patches are cheap, common and accumulating personal health data on a massive scale, and all that data leads to better cures and detects health problems before they blossom into expensive diagnoses. Others, an era where every minute abnormality, dangerous or not, is identified and money is spent needlessly treating it.

Yale School of Medicine cardiologist and Shots contributor Harlan Krumholz is optimistic about medicine’s ability to reel in meaningful insights in that vast sea of data. But, he says, it’s going to require a major shift in culture in clinics and hospitals. He says it’s still the norm for doctors to rely on their memories to determine whether a given drug is right for a particular patient, “as if nobody’s walking with a computer on their holster.”

This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Department of Health and Human Services announces partnership with technology company PayNearMe to encourage consumers to visit Health Insurance Marketplace

When Anna Duleep went shopping recently for 2015 health coverage on the Connecticut insurance exchange, she was pleasantly surprised to find a less expensive plan.

To get the savings, the substitute math teacher had to change from for-profit giant Anthem Blue Cross and Blue Shield to a fledgling carrier she’d never heard of. Still, Duleep, 37, liked saving $10 on her monthly premium of about $400 and knowing that her new plan, HealthyCT, is a nonprofit governed by consumers. She also liked that all her doctors participate. “I just figured, ‘why not change?’” she said.

HealthyCT, which cut its 2015 premiums by an average of 8.5 percent, is one of at least a half dozen co-ops created through the Affordable Care Act that have lowered 2015 premiums in a bid to boost membership in their second year of operation. But those low premiums are upsetting so-called “legacy” insurance plans like Blue Cross and Blue Shield affiliates that have traditionally dominated insurance markets.

Idaho Blue Cross CEO Zelda Geyer-Sylvia said that while she welcomes competition, it’s not fair to have to compete against a carrier getting millions in low-interest federal loans.

“It’s unfortunate, because this is going to be very disruptive to the market,” Geyer-Sylvia said about Montana Health CO-OP, which moved into Idaho this year and undercut competitors’ rates.

The co-ops say that’s just what Congress intended when it tucked them into the health law to mollify those seeking a government-run insurance plan. “Lower prices for consumers are very good news,” said Jan VanRiper, chief executive of the National Alliance of State Health CO-OPs (NASHCO), a trade group.

Two dozen co-ops, which received $1.9 billion in federal loans, were designed to compete with established carriers and lower prices.  For 2015 at least, co-ops are offering the lowest-cost silver plans in all, or large parts of Arizona, Connecticut, Colorado, Idaho, Illinois, Maine, Maryland, New Mexico and New Jersey, according to NASHCO. The silver-tiered plans are the most popular type of plan on the federal and state insurance exchanges.

VanRiper disputes that co-ops are competing unfairly, saying they have to pay back their start-up loans in five years and could not have met state solvency requirements for insurers or paid claims before generating premiums without that money.

Lagging First-Year Sign-ups

Nationally, about 450,000 people are enrolled in co-ops in 26 states — far fewer than the 575,000 the government had projected for their first year. “Last year co-ops priced a little blindly because they did not have any claims experience and this year some are pricing more competitively,” VanRiper said.

But co-ops with low sign-up numbers in their first year have taken steps to lower their costs — and premiums.  In addition to HealthyCT, other co-ops that cut their rates for 2015 include Meritus of Arizona, Evergreen Health Co-op of Maryland, Oregon’s Health CO-OP, Colorado HealthOP, Land of Lincoln Health in Illinois and Health Republic Insurance of N.J.

Blue Cross’ Geyer-Sylvia argues that Montana Health CO-OP’s low rates are “unsustainable” because they won’t get enough premium revenue to pay claims over the long run. In the meantime, they could pull consumers away from Blue Cross and three other carriers on the Idaho exchange.

Consumers may not realize, she said, that the lower premiums will mean reduced government subsidies for everyone who is eligible for them. That’s because the subsidy is pegged to the second-lowest-cost silver plan.  That cost is decreasing in Idaho because the co-op has introduced lower-priced plans than its competitors.  As a result, consumers enrolled in more expensive options, such as Blue Cross’ plans, will have to pay more since they must cover the difference between the premium and the government’s financial help. On the flip side, consumers would save money by switching to the co-op’s plans.

Here’s how those price differences would play out for a 48-year-old man in Eagle, Idaho:  He can get a silver plan for as low as $266 a month with the Montana Health CO-OP, which markets itself as Mountain Health CO-OP in Idaho. The lowest-cost Blue Cross plan is $303. The Mountain Health CO-OP plan also has lower deductibles — $3,650 compared to $4,000 for the Blue Cross plan.

Sabrina Corlette, senior research fellow at Georgetown University, said many co-ops are increasing competition and driving down costs, as Congress intended. “There’s no question in many markets, co-ops are really driving some price competition and making legacy carriers more competitive in their pricing,” she said.

Corlette cautioned that the long-term financial health of the co-ops is uncertain because their first-year enrollment lags projections and they must repay their loans.  Low enrollment could hurt the plans if they don’t get enough premium revenue to pay their medical claims. Higher-than-expected enrollment could result in budget-breaking health costs, she said.

Brendan Buck, spokesman for America’s Health Insurance Plans, the industry’s trade group whose members do not include the Obamacare co-ops, is also dubious about their viability. “These plans do not offer the kind of stability that consumers are looking for,” he said.

Making Inroads?

Despite difficulty getting traction in some states, co-op officials say that they are gaining ground.

The experience of Land of Lincoln Health, the Illinois co-op, may be illustrative. After attracting just 3,800 members this year, the co-op slashed premiums by an average of 20 to 30 percent, making it the lowest-priced silver plan in large portions of the state for 2015, company officials say.

As a result of those changes, President Jason Montrie said he expects enrollment to surpass 50,000 next year. The co-op, which was started by a Chicago-based hospital trade group, was able to drop premiums by partnering with large hospitals systems, he said.  If enrollees use providers affiliated with those systems, they will face lower costs, but if they go to other doctors and hospitals they will have to pay more.

Like Land of Lincoln, other co-ops said they lowered premiums without resorting to narrow networks that exclude many hospitals and physicians. Monthly premiums are only a portion of consumers’ costs— co-pays and deductibles usually apply. But premiums are usually the first thing potential buyers look at when they go to the online insurance exchange, Montrie said.

HealthyCT CEO Ken Lalime said his plan also decided to offer more competitive rates for 2015 to increase enrollment. “Bringing increased competition to the market was not an instantaneous thing to happen,” he said.

Co-ops that did price competitively in their first year saw robust enrollment. The Maine Community Health Options Co-Op grabbed 83 percent of the exchange market in 2014, largely because it offered the lowest-cost silver plans. Before 2014, Anthem was the dominant player in Maine’s individual market.

“It just goes to show you can do well by people and do well financially,” said CEO Kevin Lewis.

Montana Health CO-OP spokeswoman Karen Early — a former spokeswoman for Blue Cross of Idaho — said her plan will save consumers money without sacrificing care or service.

But she does agree with her old boss on one thing:  “We will disrupt the market,” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

New HHS grants increase, improve learning opportunities for young children