• Gregory B Steinberg, Bruce W Church, Carol J McCall, Adam B Scott, and Brian P Kalis.
• Aetna Innovation Labs, PO Box 359, Dingmans Ferry, PA 18328. E-mail: gsteinberg@ aetna.com. Bruce W. Church, GNS Healthcare, 1 Charles Park, Third Floor, Cambridge, MA 02141. E-mail: bruce@gnshealthcare.com.
• Am J Manag Care. 2014 Jun 1; 20 (6): e221e228e221-8.

ObjectivesWe applied a proprietary "big data" analytic platform--Reverse Engineering and Forward Simulation (REFS)--to dimensions of metabolic syndrome extracted from a large data set compiled from Aetna's databases for 1 large national customer. Our goals were to accurately predict subsequent risk of metabolic syndrome and its various factors on both a population and individual level.Study DesignThe study data set included demographic, medical claim, pharmacy claim, laboratory test, and biometric screening results for 36,944 individuals. The platform reverse-engineered functional models of systems from diverse and large data sources and provided a simulation framework for insight generation.MethodsThe platform interrogated data sets from the results of 2 Comprehensive Metabolic Syndrome Screenings (CMSSs) as well as complete coverage records; complete data from medical claims, pharmacy claims, and lab results for 2010 and 2011; and responses to health risk assessment questions.ResultsThe platform predicted subsequent risk of metabolic syndrome, both overall and by risk factor, on population and individual levels, with ROC/AUC varying from 0.80 to 0.88. We demonstrated that improving waist circumference and blood glucose yielded the largest benefits on subsequent risk and medical costs. We also showed that adherence to prescribed medications and, particularly, adherence to routine scheduled outpatient doctor visits, reduced subsequent risk.ConclusionsThe platform generated individualized insights using available heterogeneous data within 3 months. The accuracy and short speed to insight with this type of analytic platform allowed Aetna to develop targeted cost-effective care management programs for individuals with or at risk for metabolic syndrome.

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