Q: What's finally bringing about that change? Improvements in the technology or shifts in attitudes and awareness?

A: Oh, I think it's both. I think it's both, and I think the more critical rate limiter is the attitudes and the intrinsic behavior, which, quite frankly, I think is amplified by a lot of the stakeholder business models, and it's also amplified by backward-looking regulatory issues. And I think we're going to have to blast through both of those things to get maximum functionality when you think about healthcare enabling through healthcare information technology.

Q: Describe Geisinger's use of analytics. Is there a mission statement or overarching philosophy to how you use BI?

A: Well, our top strategic aim is innovation and quality. Our structural advantage that we talk about internally and externally over the past 15 years is this payer-provider sweet spot. We've tried to figure out how our version of vertical integration between payer and provider can really optimally mesh the information and the use and analysis of it from both sides of the house. That's a 35,000-foot glib summary of what drives us, and continues to drive us.

But the end point is change in behavior. We realize that in order to capture the 30 to 40 percent of value that is now lost because of stuff in healthcare that doesn't help human beings – actually hurts them. In order to capture that, we have to fundamentally change behavior. And we have to change it on behalf of our providers as well as our patients, and on the insurance side of the house.

The way to change behavior is not just changing the incentives. Everybody has been – appropriately – whacking fee-for-service, and that's OK. I'm all right with that. You have to change the incentives but you also have to enable people with timely feedback about what they're doing, and the consequences of that, and what they should be doing. And that's all about data.

Again, we think that in order to achieve that continuing aspiration of innovation and quality, we've got to have, from both sides of the house, behavior change enabled by timely and usable data.

Q: Talk a bit about Geisinger's ProvenCare program, which puts evidence-based standards and patient engagement to work in the service of fixed-price procedures. How does data play into it?

A: A good example would be use of erythropoietin in patients who have anemia that's associated with chronic renal disease. This is really a paradigm; it's the result of lots of high-price but very effective biologicals. And the questions we asked when we looked at this group of patients with anemia secondary to chronic renal disease, is are they getting the best outcomes in terms of alleviation of their anemia?

What we found, in looking at the data and analyzing the data – and then looking at every step along the way at how this care was given to this group of patients throughout our system – we found that about 20 percent of those patients actually didn't need to be receiving the high-cost biological that is EPO. They could just as well have been treated with iron, at about one one-hundredth of the cost.

And, by the way, EPO has side effects, and those are cardiovascular toxicities, so stripping out the use of that high-expense biological was not only a cost-savings, but also a savings in terms of avoiding toxicity for a huge number of these patients.