Modeling the U.S. healthcare system as an enterprise: Multi-scale hybrid data analytic methods

This paper presents a multi-scale data analytics approach for modeling the U.S. healthcare system as an enterprise. The U.S. healthcare enterprise encompasses public and private entities with significant government involvement in policies and programs that have widespread interactions and effects at all levels of the system; In other words, the U.S. healthcare system is a complex adaptive system. As such, integrated holistic data analytical methods are needed to understand the enterprise-wide interactions and outcomes. An enterprise systems engineering (ESE) approach is applied to organize diverse data sets and perform integrative analyses of patient populations, health services, providers, facilities, technology, insurers, pharmaceuticals, research, and the U.S. economy. Hybrid models are applied to the ESE of health services and proposed interventions to affect outcomes and costs. Type 2 diabetes management is used as a case study with selected policy and technology interventions to deal with the lifetime complications and consequences of this condition. The hybrid modeling structure explores agent-based methods to portray the movement of patients in the state-space, systems dynamics to capture policy and programmatic influences, discrete event methods to describe sequential service processes, and economic analysis methods to capture costs and impacts on the healthcare enterprise in the context of the overall economy. The paper addresses the need for an enterprise-level system-of-systems (SoS) approach to organize the vast and diverse data sets published by various agencies into an open-source data analytic framework. The framework describes the healthcare enterprise to support the comprehensive analysis of the impacts of policies and programs across the many dimensions and scales. Policy and programmatic areas of interest include insurer coverage decisions for new or modified health services, new technologies for diagnostic, therapeutic, and preventive services,- and other major influences on the cost and quality of healthcare services.