Aiming for the root cause

By Nashville Post Magazine
At a recent health care and technology conference in Nashville, Elizabeth Ann Stringer shuns success stories to pitch her company’s potential.

Elizabeth Ann Stringer of axialHealthcare
Elizabeth Ann Stringer

Instead, she turns to a missed opportunity.
The chief science officer at Nashville-based Axial Healthcare calls up the anonymized health information of a recently deceased 43-year-old woman from East Tennessee. The woman had a history of sleep apnea yet was prescribed respiratory-depressant opioids. She was prescribed opioid doses well beyond guideline limits; she had been co-prescribed sleep aids.
The woman died of cardiac arrest just one day after receiving her final opioid prescription.
“She was receiving very substandard care,” says Stringer, who holds a PhD degree in neuroscience from Vanderbilt University and did postdoctoral work on the effects of opioids on the brain at Stanford University. “This should never, ever happen, but it happens every day.”
The impact of the late woman’s interaction with the health care system reaches beyond her tragedy, however.
The collective effects of opioids and other drugs on her body led to compounding costs — and opportunity costs — in the health care system in general.

“Resources are being diverted from other people and going to this individual who’s receiving poor care,” Stringer says. “It is a major [financial] drain when people are not properly cared for.”

Instead of returning to academia, Stringer joined Axial Healthcare, in part to address the problems illustrated by the case at hand. The company, founded in 2012, has built analytical platforms that take health insurance claims data and other inputs and turn it into guidance for health care providers, patients and insurance companies, particularly concerning opioid usage and prescribing habits.
According to Axial Healthcare statistics, one company product (through which pharmacists talk to providers about opioid prescribing patterns and at-risk patients) resulted in multi-prescriber activity dropping 2.4 percent and the number of patients on opioids dropping by 1 percent.
Part of the problem, Stringer says, is lack of education. Pain is not taught thoroughly in medical schools, she notes, even though many patients present to providers for exactly that reason.
“Very often, providers don’t know how to treat pain,” she says. “What they do understand is that this medication — opioids — can help address the pain complaints, and patients are going to be happy when they leave the doctor’s office.”
The opioids do not address the underlying cause of the pain, but rather mask it. And in the process, acute pain can morph into chronic pain, leading to a cascade of problems for the patient and costs for everyone involved.
Axial Healthcare aims to reverse that dynamic. In some cases, it’s as easy as alerting a health care provider to a problematic prescription practice he or she might use but not recognize. In other cases, the analytics can identify pill mills or high-risk patients and initiate an intervention.
“It’s not just enough to analyze a problem,” Stringer says. “We want to build out capabilities that are able to intervene, move the needle and improve care.”
While the company’s work relies heavily on insurance claims data, the platforms are engineered to build on themselves, according to Stringer.
“The claims data is foundational, but all of our products produce their own data that then feeds back in,” she says. “The outcomes fed into the system help us tailor our models to become more specific and more effective with our recommendations.”
Via Nashville Post Magazine

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