Private insurers are using data to drive innovation in American health care, leading in digital interventions and those that address social determinants of health. As Master of Health Care Innovation alumna Andrea Cooke explains, private insurers are at the forefront of using customer data to identify social risk factors. And they work strategically with community organizations like food banks and housing support programs to initiate targeted interventions to improve health.

Speaking as a guest in the MHCI’s American Health Care System course, Cooke, who is Director of Regulatory and Legislative Policy for the Blue Cross Blue Shield Association, surveys programs and strategies originating from the private sector, outlining a dual approach that:

1. Attempts to alter patients’ behaviors and social circumstances to improve their health.

2. Incentivizes care providers to reinforce these efforts by screening patients for factors like food and housing insecurity.

Insurers use data from their customers to make strategic investments in affordable housing and grant programs for nonprofits working to address food and transportation insecurity, as well as neighborhood safety. However, in doing so, they must be cognizant of a number of factors related to equity and privacy. As Cooke explains, any initiative that leverages customer data must ensure that:

• The data is protected.

• The algorithms that interpret that data are as free as possible from bias.

• Unintended side effects that might widen disparities are, to the greatest extent possible, identified and eliminated.

One of those unintended consequences of innovation among private insurers is increased fragmentation of the health care ecosystem. If some insurers in some markets implement beneficial programs and others do not, this can lead to widening disparities—adding another dimension to the existing landscape of health care haves and have-nots in the United States. For example, in rural areas with fewer insurance options, residents may have less access to innovative programs.

In a heterogeneous health care system, Cooke points out, government actors are not the only innovators—or even the only policymakers. And frequently, because of their flexibility and the pace at which they can work, private insurers are able to leverage data to put themselves at the forefront of addressing patient needs through their investments, community partnerships, and forays into digital health.

Learn more about the role of insurers in health policy in Dr. Ezekiel J. Emanuel’s American Health Care System course. And learn more about social determinants of health by taking Profs. Kevin Ahmaad Jenkins and Kimberly Arnold Jenkins’ Advancing Health Equity.

Andrea Cooke, MBA, MHCI is a Director of Legislative and Regulatory Policy, Federal Policy, Blue Cross Blue Shield Association (BCBSA). Her work focuses on Medicare Advantage policy including MA Quality, Fraud, Waste, and Abuse, and other regulatory issues. She is also the CEO and co-founder of the Alliance for AI, a nonprofit dedicated to responsible AI governance and public interest in emerging technologies.