Remember when generic ads arrived in the mail and ran in magazines? Today, it seems that if you even think about a product or service, targeted ads appear on your smartphone and in your online news feed. It’s creepy, but it can also be helpful because a targeted approach results in more relevant content and produces better outcomes.
What if that same digital power was applied to healthcare so that it moves from evidence-based medicine to patient-customized care? This is possible with current technology and can drive engagement and improved outcomes.
The Business of Illness
The healthcare system today is organized around sick care rather than avoidance of care, and it’s hobbled by a variety of challenges, such as a payment model focused on services performed that often has little to no consideration for patient outcomes. Within this system, one physician’s office may not know what another is doing, and the burden of keeping track of one’s care often falls on patients when they are most vulnerable.
Value-based and other alternative payment models, such as accountable care organizations and bundled payment arrangements, are designed to address the shortcomings of our current “sick care” system by aligning financial incentives with positive patient outcomes. However, similar to our current system, the digital infrastructure needed to support avoidance of care is lacking. Additionally, these models tend to be hobbled by the same challenges with coordination and physician and patient engagement, and they are not yet widely implemented.
Although there have been transformative moments in healthcare, the field is evolving slowly. However, we are on the cusp of change. Digitization and the opportunity to use data in new ways will soon drive improvements, providing the ability to segment patients, personalize care experiences and change behaviors. Understanding these capabilities is crucial for health system leaders because they are key to enabling the transition from a sick care system to one that emphasizes wellness—regardless of the payment model in use.
CEOs and board members can play a pivotal role in advancing this transformation by embracing digitization and implementing the steps outlined in the accompanying sidebar, which can guide their organizations toward a more technology-driven future.
A recent study from Deloitte Insights examined healthcare spending in 2019 and projected well-being focused versus reactive care expenditures every seven years leading up to 2040.
As the accompanying chart illustrates, while spending today is overwhelmingly reactive and sick-focused, the influence of digitization reverses the trend over time. This focus on well-being will be a result of using data to better understand patients and their needs, and developing personalized, proactive care plans.
Seamless Patient Experience, Unified Patient Data
Although most health systems have adopted EHRs, they are built for billing and are specific to the health systems and hospitals using them. Furthermore, the data is siloed, and too often, patients are unable to access their health information. Unified data centers the information around the patient and provides access to the patient and their care team regardless of where they are.
At the heart of a wellness-centered healthcare model is a data platform where a variety of disparate data sources are collected, processed, normalized and unified to help users understand it. However, “dirty” data, or data that is somewhat faulty, does not provide good outcomes, and even with data as simple as lab values, there can be different standard values from lab to lab.
It’s important to understand these nuances so that data is contextualized and identified correctly for each patient. With that data, hospitals and health system leaders can unlock new use cases, better clinical insights about patients, improved patient engagement and coordinated care to ensure fewer errors, more automation, better reporting, better outcomes and lower costs.
This is a large gap to bridge and requires technologies that integrate data from multiple sources, clean it and help create that unified record. It requires platforms, connectors, data activation and application programming interfaces that collectively enable the patient to have the right information to get the care they need. Fortunately, such technologies exist.
Although the standalone digital model has limited use cases, a hybrid digital platform with a brick-and-mortar infrastructure will enable the use of digital to expand and liberate health data.
The growth of virtual care proved that we could triage some health issues while keeping patients at home. However, virtual medicine cannot fully replace in-person healthcare. So, how do we integrate a physical component to optimize the benefits of digital care while meeting patient needs?
One EHR software vendor currently offers a hybrid model that allows members to connect with a provider at any time and even have a provider dispatched to their home for nonemergency conditions. In the few markets where it is currently offered, vast improvements in care are being realized. Over time, this type of connected, hybrid digital/brick-and-mortar model will be widely adopted.
The biggest game changer in digitization is interoperability, which has spurred a movement to platforms. One example is an app store, which exists because multiple vendors opt to port their technologies to a given platform. As a result, consumers gain a seamless experience—obtaining the same app regardless of which smartphone or tablet they use. In healthcare, this equates to options for different vendors’ EHRs. But a health data platform allows providers and health systems to keep existing EHRs, while at the same time enjoying the benefits of a connected platform that communicates with existing and new technologies.
A large Midwest accountable care organization was able to share information across its network with a data platform using automated, efficient patient assignment processes. Care management staff can be assigned to monitor and coordinate care for specific patients, and can track outcomes and create personal care plans to plug gaps in care. They have reduced readmissions by more than 7% and have the ability to generate better outcomes and cost savings. This coordination also enables an increase in primary care services, which typically results in fewer admissions and less costly care.
A Chicago health system sought an opportunity to transform care and harmonize its various payer arrangements, turning to a data platform to simplify data aggregation. With source data from EHRs, the platform also took claims data, other care management data and social determinants of health data to aggregate and normalize.
Unifying that data allowed for a more comprehensive view of the patient—a process typically requiring several systems. Adopting a cloud-powered data platform resulted in fewer systems for care managers to work with, as well as better tracking of appointments, medications and documentation.
The Digital Imperative
Although digitization has been incredibly beneficial, there are drawbacks. Investments in digitization are currently locked in silos, the workflow can be clunky and it can be difficult for physicians to get a comprehensive view of patient information. Advancing digitization will require breaking down silos and organizing data around the patient, which could be a challenging discussion in light of the investments made in EHRs.
However, healthcare singularity is coming. Digitization creates an open ecosystem that enables us to unify data sources. In the end, healthcare must enable patients to get better care. A digital infrastructure provides the ability to deliver on this promise.
Brian Silverstein, MD, is chief population health officer at Innovaccer and an adviser with The Governance Institute (brian.silverstein@innovaccer.com).
Healthcare Era
Good governance in the digital healthcare era involves leveraging technology and data to improve patient outcomes and experiences while ensuring ethical and responsible use of digital tools. The to-dos listed below provide a starting point for executives and board directors to navigate the evolving landscape and foster effective governance practices.
- Embrace a patient-centric approach: Shift the focus of healthcare organizations from reactive care to proactive wellness by prioritizing patient outcomes and experiences. Encourage discussions and strategies that align with delivering personalized and engaged care.
- Engage with patients and stakeholders: Actively seek input from patients, caregivers and other stakeholders to understand their needs and expectations in the digital healthcare landscape. Foster open communication channels and incorporate their perspectives into governance discussions and decision-making processes.
- Drive collaboration and coordination: Encourage collaboration among healthcare providers, payers, other organizations (e.g., community resources) and stakeholders to address the fragmented nature of the healthcare system. Support efforts to establish coordinated care models that prioritize continuity of care and reduce errors.
- Foster data interoperability: Promote the adoption of technologies and platforms that enable seamless integration and sharing of patient data across various systems and providers. Support initiatives that facilitate the creation of a unified patient record accessible to both patients and their care teams. EHRs are necessary but not designed for this; they cannot ingest and normalize multiple data sources.
- Evaluate the return on investment: Monitor the ROI of digital healthcare initiatives and assess their impact on patient outcomes, cost savings and organizational performance. Continuously evaluate and refine strategies to ensure maximum value is derived from digital investments. Ideally, partner with vendors that can provide this value-based reporting.
- Foster a culture of innovation and learning: Encourage a culture of continuous improvement, innovation and learning within the organization. Support initiatives that promote professional development and knowledge-sharing among healthcare professionals, enabling them to adapt to digital advancements effectively.
- Stay informed about emerging technologies: Stay updated on the latest advancements in digital healthcare technologies and their potential impact on patient care and outcomes. Encourage discussions and explorations of innovative solutions that can drive improvements in healthcare delivery.
- Collaborate with regulatory bodies and policymakers: Engage with regulatory bodies and policymakers to shape policies and regulations that promote the adoption of digital healthcare solutions while addressing potential ethical, legal and regulatory challenges. Advocate for an enabling regulatory environment that supports innovation and patient-centered care.