Predictive modeling and associated prescriptive (re)actions in healthcare

In the context of healthcare, the analogy of a pinball machine gives one pause. The very juxtaposition is arresting—and to be certain, only one is a game.

Nonetheless, it can be useful to leverage (yet not tilt) the iconic American pinball machine in the discussion of healthcare predictive analytics, as it is a tangible example of a self-contained system, subject to outside forces, in which millions of independent and interdependent actions occur. These instances combine to form iterative combinations of actions and reactions that can serve as a representation of the millions of data points that drive healthcare predictive analytics. And the game of pinball itself can function as a real-world model for understanding the flow and types of decisions healthcare providers can make based on insights gleaned through data-mining and predictive modeling.

Further, the literal game of pinball and the stalwart commitment of those who play it offers valuable lessons that we can apply in our everyday life—at work and at home.

Understanding the pinball analogy in the context of healthcare predictive modeling

Pinball was once mistakenly thought a game of chance—leading to the famously dramatic outlawing of the game in NYC—but of course, as any serious pinball player knows, it is in fact a game of skill in which there is an undeniable element of randomness.

This element of randomness does not mean that the game is inherently unpredictable. It can be known, for example—based on the force with which the pinball is struck and the point of impact on the flipper, as well as environmental factors such as ambient temperature, overall pinball-machine state-of-repair, and the given outside forces in play—where that pinball is most likely to go next. As consecutive iterative series or combinations of similar shots occur, it becomes possible to “map” the most likely path the pinball will take if a set of specific shots are executed. It is certainly possible to identify the specific shots (or misses) that never work—yet just as important, over time one can also start to understand the effective techniques for recovering from these unintentional or unexpected occurrences.

For those now wondering whether the pinball represents the patient in this analogy, I will say: it’s more about the journey. The path of the pinball represents the outcome of a decision-making process—and the full path that the pinball traverses represents the continuum of care. Mapping these paths and uncovering the characteristics that make it likely or unlikely a given patient will traverse them—in short, predictive modeling powered by data mining—makes it possible to identify the right points of intervention and actions to keep patients on the right path, get them on the right path, or redirect the path they’re on so that they’re more likely to realize improved outcomes (i.e., better health and more efficient health-system utilization).

What got me thinking about pinball

On a recent trip to Louisville to meet with members of our technology team, our group found its way to what might be described as a classic American tavern. There were pool tables, air-hockey tables—and of course, a pinball machine. The sight of it took me back to a simpler time, specifically my sophomore year of high school.

Simpler, yes—but also heady. Sophomores, juniors, and seniors were allowed to go off-campus for lunch, and a mere three blocks from the school was a pub & grill—a tavern—not dissimilar to the one I visited recently in Louisville. And it was to that tavern I would go every day at lunch—not only for a bacon cheeseburger, but to engage in a battle of wits and reflexes the likes of which this naive world had never seen.

I went—every day—to play pinball.

You might be wondering, what drives a young man to such incredible heights? What keeps him going—day in, day out—in the face of frigid Wisconsin winters and the knowledge that, technically, he is already late for his afternoon Journalism class?

I would say, looking back, that what powered me through those hours of pinball was an unceasing commitment to excellence. An unwillingness to let fear or even established societal norms stop me from pursuing my goal (in this case, unlocking a jackpot). I know I am not alone in this—for indeed, my friends in those years played pinball with every bit the competitive fire that I did. We knew we were on the cusp of achieving something extraordinary—and we knew we would never pass that threshold if we let fear or the agendas of others determine our actions. We would be the ones who decided it was time to call it quits. We would decide when we’d run out of quarters. The distant ringing of the bell for afternoon classes was but a fading reminder of the obligations that would do nothing to further our goal of unlocking a jackpot—and the detention we might or might not be forced to endure was a small price to pay in light of what we were trying to achieve.

I hope that all of us—serious pinball players, recreational pinball hobbyists, and even those who’ve never played the game—can find a bit of inspiration in those young men’s commitment to going above and beyond, whether in pinball or in daily life. What’s worth pursuing is worth working hard for—and the payoff is far more rewarding when you know, truly, you’ve earned it.