Mamma Mea (Culpa)! Ingenix Goes Open Source

28 May Mamma Mea (Culpa)! Ingenix Goes Open Source

Mea Culpa (mā‘ə kŭl‘pə) n.

1. An acknowledgment of a personal error or fault
2. A statement of acknowledgment expressing regret or asking pardon

I have long been a big fan of Ingenix and their mission of using information analytics to help create value. They are an impressive organization with a plethora of technology, products, and services designed to unlock the hidden value of information. They are huge, pervasive, and can be found in nearly every health plan portfolio or health care infomediary arsenal. They have an impressive vision, strong financial backing and performance (have created an additional $1B to bottom line the last five years), and are poised to lead the information age in health care.

They are also controversial because to date they have been solely focused on creating value for the big bad insurers. They are a wholly owned subsidiary of the biggest of the 800 pound guerilla’s, United Health Group, and have recently had a nice little run in with the AG of New York as well as multiple other regulatory bodies for some naughty little business practices. They have vowed to cooperate with the latest investigation, but it could portend some serious problems for them if the ruling is negative in their favor. Doesn’t help that the industry CEO’s are discussing how they “will not sacrifice profits for membership”.

Therefore, I was very surprised to hear CEO Andy Slavitt (what did the photographer say?) discuss their new business imperatives for 2009 at their Annual Ingenix conference. I first was introduced to Andy last year at this time when Andy jumped on the Health 2.0 bandwagon with his speech at this same conference regarding his vision for next generation health care. He was the first large business CEO to adopt this term, and begin to incorporate it within the context of their business operations. I was unable to connect with Andy without success given that I am an unknown physician entrepreneur who blogs (although I did have several great conversations with various Ingenix team members).

Therefore, once I finally got around to it, I was amazed to listen to his most recent keynote address. Pay particular attention to the entire Section 3. Relevant quotes below:

Reviews His 5 Health 2.0 Challenges from the previous years
1. Creating consistent clinical outcomes
2. Reducing administrative costs by half
3. Bringing safer drugs to market more rapidly and less expensively
4. Improving the allocation and financing of care
5. Improving and simplifying the usability of the health care system.

Then he identifies Ingenix focus for 2008/9

We can stop going it alone. If we want to succeed as an industry we need to collaborate like an industry. Not a hospital industry, not a health plan industry, not a pharmaceutical industry, but one unified health care industry.

Ingenix works with our clients to solve these problems every day. Information is the life blood of the health care system. Getting that information to the right place, at the right time, to drive the right patient care will take the best of technology and all of our combined talents. Ingenix is fortunate to be in the position today of having the most comprehensive information analytics and technology to improve health care. But we don’t think that is good enough. We think that data from every EMR, claims system and PBM, flow freely, safely, and securely with built in standard analytics to meet all these needs. I would gladly have Ingenix share its historical strength we have as a leader in data and analytical methods, to position our entire industry to have common data and measurements. I would be happy to compete in the healthcare industry on the based on the delivery of results.

When I consider what we do best, three years ago, we were about a $600M company best known for the many products that we have. Since then, we have added a $1B in annual revenue. Why have we done that? I think it is because we don’t define ourselves by our products alone, but the problems we solve and the imagination of our people and clients. Believe it or not, our employees would rather be known to our clients for solving bigger problems and being known as industry leaders than for competing based on proprietary data and methodologies. This represents a whole new way of thinking for us if we are willing to improve.

We are willing to make progress by taking some bold steps. For one, we think the industries leading methodologies for measuring cost, severity, and quality of care should be open source in the public domain. This means our grouper technology, procedure risk adjusters, and evidence based medicine standards from Ingenix. We also think that CPT’s, DRG’s, and other core administrative methodologies should be broadly shared and understood. We should explain how the health care system works, how payment works, how quality is measured, making it understandable for everyone

I am amazed that this has not been picked up by anyone (or more likely, that I have not heard about it). This is the most insightful, “for the greater good”, “I will compete with anyone on value“, lay down the gauntlet statement by a health care CEO that I have ever heard. If, in fact, Andy is serious about this than I believe him when he says that Ingenix is poised to truly revolutionize the health care industry.

The problem, if I may be respectful and blunt at the same time, is that I don’t believe Ingenix will release its proprietary tools. And I would guess the reason that I have not heard anything about this game changing statement is that the rest of the industry must not believe it either. Whether people don’t know what it means for Ingenix to open source their proprietary analytic tools, or if people just view the comments as as a marketing ploy, or perhaps they just think it is a massive mea culpa following Ingenix’s New York outing, I am unaware of any reaction from the industry. Silence. I am sure there would be lots of interested parties (I would personally love to have access to any of the technologies that were mentioned for my own Episode of Care case study), but there does not appear to be a party to attend.

It appears, from the outside, that this is another one of those big company, “Hey guys, we are going to be open source” empty statements. While I applaud the comment, it looks like its just rhetoric because in the open source world you have to “Say, Do, and Be” to be taken seriously. Anything short of full transparency, backing up what you say with what you do (meritocracy), and earning legitimacy through your actions over time will earn you the ridicule of the open source community.

For example, Ingenix states that they are going to release their long held proprietary tools, their secret methodology sauce, and risk adjustment widgets. Really? When are they going to release it? Where will they release it? How will I interact with them if I want to collaborate? In what medium is Ingenix going to build community? What are their plans to nurture and develop a collaborative community, even among their competitors? Where can I share with Ingenix my information? Are Ingenix investors going to tolerate giving away the crown jewels to tap into the promised but not yet tangible support revenue stream? These are all big ticket items for which there is no publicly available information regarding how Ingenix will achieve their stated objectives.

I don’t underestimate Ingenix – they have assembled an incredible powerful team, with incredible array of assets, and are incredibly positioned for what will surely be an unprecedented information boom – but I don’t want Ingenix to underestimate the open source community either. Ingenix has shown that it can compete in the “cathedral” (insurance/industry) markets, but it remains a significant question if they can compete in the “bazaar” (consumer/collaboration).

Different game, different rules. I hope they begin with the first, “SayDoBe” (this will be much better than doing another “Mea Culpa Redux”).