In brief

In brief

  • Highmark Health’s chief analytics officer is using analytics to reduce friction and fragmentation to ultimately transform healthcare.
  • Predictive and prescriptive analytics are helping to improve the member experience and optimize resources.
  • Clarke says “basic” analytics that focus on usability and integration into workflow can have dramatic impact.


Accenture: Tell us about your role and responsibilities at Highmark.

Richard Clarke: As chief analytics officer, I am responsible for data and analytics across our blended health organization. We run a centralized data model and a more federated analytics model, where advanced analytics—both predictive and prescriptive modeling—is under a center of excellence in my organization. Diagnostic and descriptive analytics are run by analytic domain, some within my organization and some federated out into various business units and functional areas.

A: What first led you to work in the analytics field? 

RC: I have been doing analytics in some form or fashion all of my career. I trained as a neuroscientist at the University of Pittsburgh where I combined wet lab research with kinetic modeling to study the form and function of NMDA receptors. The discovery process of forming hypotheses and then quantitatively testing them is something that I have always enjoyed.

Now, I can apply that thinking at work, focusing on the end-to-end process; identifying a use case and intended outcomes, building analytic solutions, connecting them to business processes, driving front-line adoption, and ultimately measuring how well we can actually impact those intended outcomes.

One can have dramatic impact through intentional deployment of more 'basic' analytics that focus on usability and integration into workflow.

A: What types of data do you collect at Highmark to help improve outcomes and experiences?

RC: I guess it would be too flip to say, “all the data we can,” but that is a bit of the answer. We believe in building a learning healthcare system through which we can deploy, test and continuously optimize various interventions and their outcomes. This works spans our endeavors across affordability, health outcomes and the customer and clinician experience.

We are continuously expanding the data we collect to inform those outcomes. For instance, integrating emerging technology with wearables and leveraging patient-recorded outcomes. We must be experimental to optimize all the data that is out there and, in some cases, building processes to create the data we need to learn and continue to optimize our solutions.

A: We often think of analytics scientifically, but there are many ways to apply data insights. For instance, how does Highmark use analytics to help humanize the care experience?

RC: The friction and fragmentation in delivery of the right information at the right time to the right person is a top cause of the problems we have in our healthcare system now.

We aim to change this through our Living Health strategy. We envision a world where actionable information is delivered to a clinician right in their workflow before the user goes through a hunt and peck ordeal. We are using analytics to move care upstream, enabling our clinicians to engage before issues arise. We are also actively exploring how AI and data science tools will make the patient-provider interaction seem almost technology-free with such things as voice commands and ambient scribe technology. This is all in service of our goal to deliver solutions that are simple, proactive and personalized.

A: Can you share any stories of how analytics has helped those served by your organization?

RC: This is something we discuss often within our company. Putting our customers at the center of what we do is one of our core behaviors. One story that came up recently in conversation centers around social determinants of health and high-risk maternity.

Recently, with the help of analytics, we proactively identified a member who had a high-risk pregnancy. We identified behavioral health concerns and potential issues with transportation and healthy food. We connected this member with Highmark case managers and social workers. Through a series of engagements, the Highmark clinical team was able to connect this member with various supportive services. With this help, the mother had a successful delivery and was able to get back to work quickly. The integration of data to proactively identify a need and pair her with the right network of care and support helped deliver a positive outcome.

A: What are some of the key projects you are working on right now?

RC: We have so many exciting things going on, but the biggest is our Living Health strategy. This strategy is all about transforming healthcare by deploying proactive, personalized and simple solutions that cover the full range of health – social, physical and mental. We are striving to reduce fragmentation to many stakeholders, and we can only be effective if we integrate across payer, provider and community in a blended way. Data and analytics sit at the heart of this strategy and my team is actively working with both Google Cloud and Verily on a number of exciting use cases.

We also have an internal program called “Think Up” that encourages employees across Highmark to reinvent the way they do work. This has led to some amazing breakthroughs. For instance, we were able to optimize scheduling at our oncology sites to make sure we were improving the member experience and using resources in an optimal way. We have also deployed many intelligent automations that reduce admin tasks and let our staff work at the top of their license.

A: How has data come into play in the fight against COVID-19 at Highmark?

RC: Our work supported many of our clinical partners on the front line. Early on, we built models to inform the disease progression and identify early hotspots. We also rapidly built models to inform the risk of hospitalization if a member got COVID-19 and used those to inform outreach to help members stay socially distant and continue to receive necessary care virtually. Our work then evolved to include assisting with the dual goals of rapid and equitable distribution of the COVID-19 vaccine through Allegheny Health Network and key partners. All in all, COVID-19 has accelerated the use of data and analytics across our enterprise.

A: Are there any misperceptions or fears about analytics that you feel are important to debunk?

RC: I think there are two important misperceptions. One is that some people feel they need the most sophisticated AI algorithms to have an impact through analytics. That is simply not true. One can have dramatic impact through intentional deployment of more “basic” analytics that focus on usability and integration into workflow.

Secondly, there is a sense of loss of control with analytics—that it’s a black box in which one loses the ability to make decisions. The reality is that analytics is augmenting human decisions. It’s not taking them away.

A: What do you like most about your job?

RC: Watching my team take early-stage ideas and run with them. I am continuously amazed by what can be accomplished when you unleash a bunch of smart, passionate people on a problem. I get so inspired by their progress updates because they take an idea and make it 100 times better and more impactful than anything I could have imagined. It makes me just want to get out of their way.

A: What has been the most important professional advice you’ve ever received?

RC: Early in my career, a colleague gave me the advice to always take the long view. To not get too upset by near-term challenges, or too excited over near-term successes. Define the end goal and keep your focus there, not letting the interim twists and turns throw you from the path. Not always the easiest advice to follow, but over my career, I have found it to be incredibly helpful and to apply in many scenarios, from strategy to relationships.

A: What do you like to do outside of work? Do you have any special hobbies or interests?

RC: I love spending time with my wife and two kids who are 13 and 10. I also enjoy reading fantasy novels and playing golf. It’s been fun as I am just starting to golf with my son. We were obsessed with the Ryder Cup. It was interesting to watch as it’s the first sport I have seen to integrate connected devices into the viewing experience, so you could see things like the heart rates of the players as they teed off on the first hole. Imagine the analytics we could run just from one game!

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