Since 2013 the CMCRC has expanded the coverage of its advanced data sciences program to address the challenges and opportunities facing healthcare funders, providers and consumers. The goals of the R&D program are to drive enhanced integrity and efficiency of the Health Market through development of advanced analytical and performance management solutions. These solutions will maximise use of administrative and transactional data5 of healthcare funders and providers, enhanced by the relevant findings and metrics from Australian and international research.
The program has secured multi-year funding from industry and the Government’s CRC Program as well as academic participation from the medical, health informatics and economics, data mining and information technology faculties and centres of 10 leading universities. A key requirement of the CRC program is that research has to be relevant to and driven by the needs of ‘end users’, who are termed industry participants. Our HMQ industry partners span the public health, private health and accident compensation insurance sectors. Additional health market organisations are expected to join this initiative on an ongoing basis.
The CMCRC plays a catalytic role in bringing together and managing the university-industry partnerships, as well as providing domain expertise, infrastructure and analytical solutions. The HMQ program benefits from having access to the CMCRC’s ongoing programs in the areas of social- network analysis, natural language processing and advanced machine learning.
The research program is divided into three, tightly coupled streams:
- Improving detection and management of fraud, abuse, waste and errors: Building on the CMCRC’s extensive experience in private health and accident compensation insurance, this stream focuses on solutions to enhance:
- Administrative integrity encompassing the detection of fraud and errors in the administrative processes that accompany healthcare interventions; and
- Clinical efficiency, quality, efficacy and equity through ensuring that the interventions carried out are necessary, efficient, procedurally correct and accessible to patients.
- Consumer empowerment and choice: Providing improved health outcomes, while delivering efficiencies in the healthcare sector requires the active involvement of all participant groups, including consumers. This stream focuses on the information bases, metrics, solutions and deployment strategies necessary to enable consumers to play a more informed and active role as market participants. The key end goals echo those of the first research stream – i.e. to enhance administrative and clinical quality.
- Improving data management: This stream recognises that the quality and completeness of data is essential to the other two research streams, and aims to provide the ongoing platform for evidence-based research and operational analytics for the health sector. To lay the foundations for improved analytics in the future, the focus of this research program is on harvesting, harmonising (or cross-referencing), linking and enriching healthcare (and now social services) data. This data will be enhanced by the relevant findings and metrics from Australian and international research and best-practice guidelines with the objective of delivering qualified intelligence to the point of decision or service.
The Head of the HMQ program is David Jonas, who also serves as Chief Operating Officer of CMCRC. David was the founding CEO of Lorica Health and has a long history in developing technology businesses and leading national cross-government and cross-sector technology initiatives. David’s leadership in e-government and e-commerce led to appointments to a range of Australian and European Union Government bodies. David is also on the Board of Infoxchange (www.infoxchange.org.au) a leading not-for-profit provider of technology solutions to Government and NGO social services organisations.
The HMQ research program is led by A-Prof Federico Girosi of Western Sydney University. Federico holds a PhD in Health Policy from Harvard University and PhD in Physics from the University of Genoa, Italy. He conducted research for 10 years at the Artificial Intelligence Laboratory at the Massachusetts Institute of Technology (MIT). While at the RAND Corporation, Federico led the team that developed the COMPARE micro-simulation model for the analysis of the proposed ‘Obama Care’ health insurance reform. Federico is joined by Professor Adam Elshaug MPH PhD, Co-Director of the Menzies Centre for Health Policy at the University of Sydney.
Prof Christine Bennett AO, Dean of the Medical School at the University of Notre Dame, Sydney has joined the CMCRC Board to help to oversight the expanded Health R&D Program. Christine was the Chair of the National Health and Hospitals Reform Commission and former Chief Medical Officer of Australian private health insurer, BUPA.