Data mining of complication rates reveal opportunity to improve patient care

Therapy: Bariatric surgery (obesity)

Revenue: $225 million

Patients: 9,300

Achievable ROI: $5 million

IP Rights Status: Available for license

A Blue Cross® Blue Shield® health plan commissioned a quality of care analysis for the treatment of morbid obesity. Aggregate treatment costs for bariatric surgery were growing faster than projected, and complication rates began to rise. As the treatable patient population was expected to grow by 65% in 10 years, management sought to better understand the relationship between quality of care (QOC) and bottom-line performance.

Four study objectives were identified:

1. Compare common recurring surgical costs

2. Evaluate hospitals and physicians

3. Analyze complication costs

4. Demonstrate achievable savings by comparing patient costs to a benchmark measure

Using data mining and statistical analysis techniques, an estimate of achievable cost savings that would result from improved patient QOC was developed. The result? An achievable ROI of $15 million within two years for employing a bariatric surgery Centers of Excellence program.