I am often amused, and slightly irritated, when I see a news headline, social media comment, or blog post on the success of Healthcare Reform and the Affordable Care Act (ACA) measured as an increased percentage of insured Americans. Another common measurement, eliciting similar emotions within, is that of the National or State Run Exchange marketplace success measured in the number of new policies sold. Much of the news around increased enrollment through the state and federal Health Insurance Exchange (HIX) marketplace is often countered by news of the nation’s largest health plans considering an exit from the marketplace due to unsustainable costs associated with the mix of members acquired. None of these factors should be considered as successful or unsuccessful indicators, in-and-of themselves. Rather, these statistics are simple indicators of progress towards the end goal.
As we will explore further in this post, and those to follow, the ultimate success will be measured through improved access and engagement by all to quality healthcare and wellness services. This access and engagement must be facilitated through transformation technology solutions which will enable consumers to engage at levels, and through channels, never before seen.
Consumers/Members/Patients are continually inundated with engaging solutions in almost every aspect of their daily lives, from access to their personal financial tools, to their interaction with core personal services including travel, education, domestic services, etc. Nearly every mature industry, outside of healthcare, has mature online and mobile services readily available that enables the consumer to manage that element of their life when they want, where they want, and from the device they prefer. Consumers want unrestricted access to products and services as part of their customer experience. Consumers are also increasingly making buying decisions based on the availability and quality of online and mobile services made available by the provider. And, they are also increasingly looking elsewhere when dissatisfied with online and mobile access, even if the quality of the product or service provided was adequate.
When these consumers log on to online retailers, they are often presented with product and service offers based on that retailer’s awareness of the individual’s preferences. However, when these same consumers visit their Primary Care Physician or other medical provider, the provider is often clueless about the patient, and their needs or desires, until they complete the T-Sheet check in process….manually….insecurely….on paper…to be passed around and re-keyed many times into many systems.
So, what is the goal, what does success look like for the Healthcare industry? The goal is not reached simply by ensuring every American is covered by an employer or individual health insurance policy. The goal is not reached when every American has access to see a doctor when needed, from where desired. While both of those statistics are positive results along the journey of healthcare reform, the end goal of Healthcare Reform needs to be centered around consumers, members, patients being more proactively engaging in their own healthcare and wellness. Having access, digitally, to the information and services they need to manage their care will engage patients in their own healthcare as they are in other aspects of their life.
There are multiple examples of how technology can help improve patient engagement. Remote patient monitoring, through connected devices, will enable passive communication between the patient and provider, outside of the institutional setting. Telehealth and eHealth platforms could enable lower costs, and more timely interactions between doctor and patient and expand the traditional point of care. Predictive analytics and machine learning tools could be leveraged to proactively notify care teams of changing patient conditions and alert early when intervention may be needed. These are just a few scenarios that illustrate how readily available technology solutions can help improve the quality of care while driving down the cost of care.
Through preventative care, wellness services and engaged patients, the collective “we” can effectively drive down the overall consumption of high-costs healthcare services and the costs of Healthcare across the board. Too often, not only the currently uninsured, but even those with great insurance coverage, utilize Emergency Room Services as their “Primary Care” provider. Often those with chronic disease or illnesses only engage with a healthcare professional during an episodic encounter, or emergency event within the predictable spectrum of that chronic illness or disease. So, the success measurement cannot be simplified to the easily identified metric of % of population covered under health plan coverage, as many insured Americans do not utilize the services available to them efficiently. Success needs to be measured as a factor of how engaged the overall population is in their own health and wellness. If the ultimate national, and industry, goal is to “Bend the Cost Curve” down, efforts need to be focused on engaging the population to utilize lower cost preventative care and wellness solutions rather than high-cost emergency or episodic care.
The key to that engagement is providing access to healthcare services the way patients want to access those services. To quote former Apple CEO, John Scully, “The healthcare industry missed the PC revolution, it missed the internet revolution, and it can’t afford to miss the mobility and cloud revolution.” So, why is this observation so relevant to the Healthcare reform discussion? For many decades most Healthcare platforms were built for a specific function within the organizations they served. Those platforms may have been focused on managing patient electronic medical records and EHR’s within the Provider platform. The systems may have been an optimized, high-volume claims processing and provider reimbursement platform within a Payer Organization. The system may have been an agile Fraud and Abuse decision engine to monitor activity between both ends of the spectrum. These are a few examples of hundreds, or even thousands of platform solutions that may exist within a Healthcare Payer/Provider ecosystem. Each platform category likely has their best of breed and natural complimentary counterparts, but one thing is certain, most of these optimized industry platforms were likely not optimized to drive Consumer/Member/Patient ENGAGEMENT!
These goals and objectives lead to the natural conclusion that the healthcare industry is in its infancy of transformational changes. While this transformation includes process and education along the journey, the heart of the transformation lies in Health Information Technology (HIT). The key to success will be providing access to care and wellness services outside the walls of the traditional institutional setting and becoming part of everyone’s everyday life.
With the appropriate alignment of HIT solutions, engagement can be achieved between the Payer, Provider and Patient. Technology can enable better access to the data collected within the various ecosystem platforms. Technology can enable more efficient collaboration and information sharing between all participants, Payers, Providers, and Patients. Engagement can grow by providing the consumer, the patient, better tools to actively participate in their wellness and engagement with their care team. Engagement can grow through more effective and efficient use of data provided by, and collected from, the Patient through proactive outbound care team engagement and through remote patient monitoring. Every effort which results in the patient increasing the level of their wellness and lowering the cost of the patient/provider interaction, will be a step towards the end goal.
Please check back for the next post in this series where I will explore how Health Information Technology can be leveraged to increase engagement across the healthcare ecosystem.