Preparing for Surprise

Carol McCall (GNS Healthcare)
Location: Grand Ballroom B
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Mark Twain once said “it ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”

Knowing things ‘for sure’ is hard, especially in healthcare, as the WSJ noted in recent articles (one drawing attention to the irreproducibility of clinical trial results, calling it one of medicine’s dirty secrets, and another critical of an increasingly common type of medical investigation, the observational study).

These are big, big issues. We want medicine to be scientific, because we believe that science works (and we want, with all our hearts, that which works). But as Kathryn Schulz points out, being wrong is hard, especially when it turns into an inflammatory statement (money and reputations are at stake, after all). And yet, as the WSJ points out, we often are.

To address the issues we face in healthcare we must be able to be wrong. We must quell our (false) certainties and, rather than “look for what we’re looking for”, allow ourselves to be surprised. How can we prepare to be surprised?

Big Data can help. By letting go of old paradigms that start by assuming only certain variables are key and end by correlating only these, we can stress-test all possible hypotheses and apply methods that give us more than correlation, which say that “A causes B”, (rather than just “A and B are correlated”). After all, don’t we really want to know, if we possibly can, what causes what?

Photo of Carol McCall

Carol McCall

GNS Healthcare

Carol McCall is a health actuary with a background in innovation, predictive analytics and health services design. Her specialties are creating novel computational approaches that leverage ‘big data’ in healthcare, and designing services and business models that expand the traditional notions of health, care, community and sustainability.

Carol is the Chief Strategy Officer for GNS Healthcare, a Big Data Analytics company whose industrialized knowledge discovery platform extracts cause-effect relationships directly and at scale from observational data. Her personal goal is to leverage these capabilities to redesign the entire notion of ‘evidence’ and ignite a true learning system in the healthcare system.

Prior to joining GNS Healthcare, Carol was Chief Innovation Officer for Tenzing Health, a subsidiary of Vanguard Health Systems, where she merged creative analytic approaches with human-centered design. Building team-based care models whose approach extended into the community, these approaches were shown to materially improve health, dramatically reduce costs and open new opportunities in a community’s economic sustainability.

At Humana, Carol led their R&D efforts in their Innovation Center where she pioneered using sophisticated analytics to build a diverse portfolio of prediction, knowledge discovery and simulation models. She also launched Humana’s innovations in personalized medicine, led Humana’s Health Services Research Center (HSRC), and helped launch Green Ribbon Health, LLC, a Florida-based company with innovations in health support services for seniors, later serving on its Board of Directors. In other roles at Humana, Carol served as their Chief Information Officer and as VP, Pharmacy Management.

Outside of Humana, she served as EVP of Managed Care Business Development for Allscripts Healthcare Solutions and as an actuarial consultant for Milliman, where she helped fashion novel risk-sharing arrangements and implement risk adjustment methodologies.

In policy and advisory roles, Carol served a four-year term as member of the nation’s National Committee on Vital and Health Statistics, served as an advisor to the HRP Scientific Program Board, and was a member of the HSRC’s governing board. She currently sits on the advisory board of Keas, a consumer health company.

Carol is a fellow of the Society of Actuaries and a member of the American Academy of Actuaries.


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