Mamma Mea (Culpa)! Ingenix Goes Open Source

28 May Mamma Mea (Culpa)! Ingenix Goes Open Source

Mea Culpa (‘ə kŭl‘pə) n.

1. An acknowledgment of a personal error or fault
2. A statement of acknowledgment expressing regret or asking pardon

I have long been a big fan of Ingenix and their mission of using information analytics to help create value. They are an impressive organization with a plethora of technology, products, and services designed to unlock the hidden value of information. They are huge, pervasive, and can be found in nearly every health plan portfolio or health care infomediary arsenal. They have an impressive vision, strong financial backing and performance (have created an additional $1B to bottom line the last five years), and are poised to lead the information age in health care.

They are also controversial because to date they have been solely focused on creating value for the big bad insurers. They are a wholly owned subsidiary of the biggest of the 800 pound guerilla’s, United Health Group, and have recently had a nice little run in with the AG of New York as well as multiple other regulatory bodies for some naughty little business practices. They have vowed to cooperate with the latest investigation, but it could portend some serious problems for them if the ruling is negative in their favor. Doesn’t help that the industry CEO’s are discussing how they “will not sacrifice profits for membership”.

Therefore, I was very surprised to hear CEO Andy Slavitt (what did the photographer say?) discuss their new business imperatives for 2009 at their Annual Ingenix conference. I first was introduced to Andy last year at this time when Andy jumped on the Health 2.0 bandwagon with his speech at this same conference regarding his vision for next generation health care. He was the first large business CEO to adopt this term, and begin to incorporate it within the context of their business operations. I was unable to connect with Andy without success given that I am an unknown physician entrepreneur who blogs (although I did have several great conversations with various Ingenix team members).

Therefore, once I finally got around to it, I was amazed to listen to his most recent keynote address. Pay particular attention to the entire Section 3. Relevant quotes below:


Reviews His 5 Health 2.0 Challenges from the previous years
1. Creating consistent clinical outcomes
2. Reducing administrative costs by half
3. Bringing safer drugs to market more rapidly and less expensively
4. Improving the allocation and financing of care
5. Improving and simplifying the usability of the health care system.

Then he identifies Ingenix focus for 2008/9

We can stop going it alone. If we want to succeed as an industry we need to collaborate like an industry. Not a hospital industry, not a health plan industry, not a pharmaceutical industry, but one unified health care industry.

Ingenix works with our clients to solve these problems every day. Information is the life blood of the health care system. Getting that information to the right place, at the right time, to drive the right patient care will take the best of technology and all of our combined talents. Ingenix is fortunate to be in the position today of having the most comprehensive information analytics and technology to improve health care. But we don’t think that is good enough. We think that data from every EMR, claims system and PBM, flow freely, safely, and securely with built in standard analytics to meet all these needs. I would gladly have Ingenix share its historical strength we have as a leader in data and analytical methods, to position our entire industry to have common data and measurements. I would be happy to compete in the healthcare industry on the based on the delivery of results.

When I consider what we do best, three years ago, we were about a $600M company best known for the many products that we have. Since then, we have added a $1B in annual revenue. Why have we done that? I think it is because we don’t define ourselves by our products alone, but the problems we solve and the imagination of our people and clients. Believe it or not, our employees would rather be known to our clients for solving bigger problems and being known as industry leaders than for competing based on proprietary data and methodologies. This represents a whole new way of thinking for us if we are willing to improve.

We are willing to make progress by taking some bold steps. For one, we think the industries leading methodologies for measuring cost, severity, and quality of care should be open source in the public domain. This means our grouper technology, procedure risk adjusters, and evidence based medicine standards from Ingenix. We also think that CPT’s, DRG’s, and other core administrative methodologies should be broadly shared and understood. We should explain how the health care system works, how payment works, how quality is measured, making it understandable for everyone

I am amazed that this has not been picked up by anyone (or more likely, that I have not heard about it). This is the most insightful, “for the greater good”, “I will compete with anyone on value“, lay down the gauntlet statement by a health care CEO that I have ever heard. If, in fact, Andy is serious about this than I believe him when he says that Ingenix is poised to truly revolutionize the health care industry.

The problem, if I may be respectful and blunt at the same time, is that I don’t believe Ingenix will release its proprietary tools. And I would guess the reason that I have not heard anything about this game changing statement is that the rest of the industry must not believe it either. Whether people don’t know what it means for Ingenix to open source their proprietary analytic tools, or if people just view the comments as as a marketing ploy, or perhaps they just think it is a massive mea culpa following Ingenix’s New York outing, I am unaware of any reaction from the industry. Silence. I am sure there would be lots of interested parties (I would personally love to have access to any of the technologies that were mentioned for my own Episode of Care case study), but there does not appear to be a party to attend.

It appears, from the outside, that this is another one of those big company, “Hey guys, we are going to be open source” empty statements. While I applaud the comment, it looks like its just rhetoric because in the open source world you have to “Say, Do, and Be” to be taken seriously. Anything short of full transparency, backing up what you say with what you do (meritocracy), and earning legitimacy through your actions over time will earn you the ridicule of the open source community.

For example, Ingenix states that they are going to release their long held proprietary tools, their secret methodology sauce, and risk adjustment widgets. Really? When are they going to release it? Where will they release it? How will I interact with them if I want to collaborate? In what medium is Ingenix going to build community? What are their plans to nurture and develop a collaborative community, even among their competitors? Where can I share with Ingenix my information? Are Ingenix investors going to tolerate giving away the crown jewels to tap into the promised but not yet tangible support revenue stream? These are all big ticket items for which there is no publicly available information regarding how Ingenix will achieve their stated objectives.

I don’t underestimate Ingenix – they have assembled an incredible powerful team, with incredible array of assets, and are incredibly positioned for what will surely be an unprecedented information boom – but I don’t want Ingenix to underestimate the open source community either. Ingenix has shown that it can compete in the “cathedral” (insurance/industry) markets, but it remains a significant question if they can compete in the “bazaar” (consumer/collaboration).

Different game, different rules. I hope they begin with the first, “SayDoBe” (this will be much better than doing another “Mea Culpa Redux”).

7 Comments
  • Bart Collet
    Posted at 12:54h, 30 May Reply

    There’s a lot of sense in choosing for open source in health care. Mainly because it’s customer-centric:

    * Open standards are a must
    * Open communications improves internal communication (business intelligence & logistics) and external communication (to customers, MD, family, …), with no restraints to the number of users
    * Open source greatly improves on user-friendlyness (less bloat & clutter, more flexible, rapid development, cutting edge techniques to make it look GREAT, no restraints for creativity and completely cross-platform)
    * Open source gives the opportunity to create more value & improved quality

    Resistance is egocentric and can’t guarantee added value, even on relatively short term

  • scottshreeve
    Posted at 15:23h, 30 May Reply

    Open Source adds tremendous “value” by removing away the proprietary crutch and allowing people to compete on the solutions that customers need. In fact, the values of health care and open source are nearly 100% aligned as you note.

    I am not a religious advocate of open source, as I believe that each company can and should create their own “secret sauce” to allows them to create a different value proposition than the competition; however, I absolutely believe that common infrastructure concepts should be open, transparent, and shared in a way in which collaboration can happen.

    Ingenix’s comments are interesting; because they are willing to give away some of their formerly proprietary information/tools in order to enhance collaboration because they are already moving up the value chain (see my previous posts).

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  • Susanne Madden, The Verden Group
    Posted at 05:33h, 31 May Reply

    Guys, let’s look at some of the facts here. Ingenix have very successfully controlled data and information for many years – haven sown up the market on claims data from the perspective of UCR (which is what they are being looked at by the NYS AG), I have to question the celebratory tone of this blog and caution that the ‘open source’ we are about to receive is not necessarily the information that has been disseminated to date. Before we get carried away with open information, can we at least question the info first?
    And what does it really mean for this to be ‘open source’? Let’s do a little bit of homework here first, and communicate to blog readers about the findings, before we go off touting this is a great thing. Who’s to say this isn’t just the next great hood-winking?
    Sketically yours
    Madden

  • Tim Elwell
    Posted at 14:19h, 31 May Reply

    As we will concede, there is a difference between actually ‘thinking about releasing’ and ‘actually releasing’ previously proprietary applications and associated code. What I think we are experiencing is the slow realization that the industry understands that in order to actually make major healthcare delivery improvements, things have to change. With this realization can be ‘grief’ and the burden that comes with this realization.

    Borrowing a chapter from Kubler-Ross (http://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model) five stages of grief, I believe most large proprietary companies are in the Denial and Anger stages relative to Open Source. Open Source is viewed as a threat to them and they continue to bury their heads in the sand. It will only be after they lose their market that they’ll wake up.

    Directional statements like the one we saw from Ingenix is actually a very positive sign as the patient is moving toward real acceptance. Given the fact that we have seen no actual code release from Ingenix, I’d place them in the ‘Bargaining’ stage. I expect they are trying to figure it out but are being transparent about their interest.

    Ingenix is a great company with great technology and I am encouraged by their statement and I hope they make good on their promise.

    Having gone through the process of evaluating an existing product and performing the required due diligence and understanding what is actually useful to an open source community and agreeing on the appropriate FOSS License does not happen quickly but it is needed in order to get to the actual “Acceptance’ stage.

    With blogs like this, Ingenix might move more quickly toward the Depression stage which is needed to achieve true Acceptance. If they want help in open sourcing their products, I’m sure there are many of us who would be happy to advise.

    As a company interested in creating open source interoperability solutions in support of health information exchanges (HIE), Misys welcomes Ingenix to the party. It’s beginning to get interesting.

    Tim Elwell

  • scottshreeve
    Posted at 05:06h, 02 June Reply

    Susanne,

    Thanks for your comment. I can tell from your comments that you may not have familiarity with the term, concept, and philosophy of “open source”.

    Tim Ellwell, whose comments are above, is someone who gets open source as a principle but also more importantly the practical realities of taking a previously proprietary enterprise application into the open.

    Ingenix is making motions to open source some of their “tools”, and the standards that the tools utilize, so that they can “move up the value chain.” This allows them to avoid spending energy on recreating the wheel (standards like evidence based medicine, outcomes measurements, quality metrics, etc) and instead focusing on the value that their technology can produce. Open Sourcing these tools has nothing to do with the “information” per se (data that Ingenix has), but rather sharing a common toolset that can be shared with multiple players to create new types of data.

    By the way, I have done my homework, including direct communications with their top leadership. Ingenix has been forth right about the stage they are in, and that their plans are being vigorously discussed internally. I will look forward to some announcements from them over the coming weeks and months ahead.

    Also, I am confident that if Ingenix follows through with their statements, it will be a watershed event in health care information technology.

  • Bart Collet
    Posted at 08:06h, 13 June Reply

    I elaborated my point ‘a little’:
    http://www.zorgbeheer.be/index.php?option=com_content&view=article&id=66
    “The more you look at it, the more sense it makes to deploy open source software in healthcare. Open source software is customer- and user-centric, it evolves bottom-up. Moreover, open source software can add maximum value, even on relatively short term.”
    Thank you for your article on open source values. Your article allowed me to broaden the base of arguments about open source software.
    Keep blogging strong!

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