New Models Will Therefore Prevail
As MEDai recently framed it, “the question is, how can better care, better health and lower cost be simultaneously achieved when many view them as mutually exclusive?”
It is my argument that predictive analytics make the Triple Aim viable. Simultaneity is achievable as a result of these new technologies, which makes predictive medicine and, more broadly, predictive health, a real possibility. But all this is going to require organizational change too.
The best example of this is how payers are increasingly partnering with ACOs and other new delivery models to create shared offerings that are integrated up and down the value chain.
Specifically, they want to responsibly collide heterogenous data sets and streams including but not limited to: historic claims information, cost estimates, patient and clinician-reported outcomes, and care plans, not to mention electronic medical records and genomics.
Combining data allows these organizations to better align their economic interests. That alignment spurs new, better offerings to individuals and organizations alike. This is already a huge trend and one that will continue.
This has been called “the future of insurance,” and Optum lays out how it should work in detail here. No doubt, “strategic IT plays a central role in setting up successful population health models” like these, says Healthcare Informatics.
Perhaps, most importantly, this “one-sided risk model,” which has been discussed since early 2013, is finally coming online.
There is, of course, a question of exactly how much data to share, but the value sharing is not in dispute. Aetna’s point of view on this issue can be found here. It also goes without saying that the data that is shared ought to be accurate; this case tells of such a collaboration gone wrong.
We’ve had a few stops and starts, but the larger shift has, if anything, sped up, because, as MEDai also said in the same report I referenced above:
“Payers…partner with ACOs because they have the critical claims data that ACOs need to better monitor patients’ health, identify gaps in care and manage risk. Reimbursement within these models requires a different kind of tracking system for payments than that used for fee-for-service. Rather than paying for individual services, plans will increasingly reimburse for improved member health and wellness, coupled with demonstrated cost savings.
But this type of reimbursement model requires greater transparency and sharing of health information as well as better methods for tracking to improve decision support and also better methods for tracking compliance with evidence-based guidelines. Payers who can provide analysis of quality initiatives and care delivery in real-time will become the partners of choice for ACOs who need to meet quality-of-care performance thresholds.”
New, aligned models of care won’t fund success, however, without the right platform running them. Technological infrastructure is also key. Getting the data is just step one, if complicated and a long time coming. Getting value out of the data is another endeavor entirely. This is where the market stands today.
We have both aligned and contorted ourselves to put all this information together. It better have been worth it. IS there really a pot of gold at the end of the proverbial rainbow?
We’ve yet to widely adopt the information systems necessary to unify, normalize, decorate and crunch the data, though several very good softwares are on offer. Advantages that other industries like energy, finance, logistics and advertising today enjoy from similar investments remain scant in healthcare across the board. We’re just rounding out the data gathering and plumbing phase, and only just starting to achieve value from all that work. Again, 2016 will be the year all of this comes to a head.
Of course, any mention of a need for increased investment is justifiably met with suspicion these days. This is the easy position for anyone who doubts my analysis. The reason is that, as PwC Health Research Institute has pointed out:
“In most industries, new technology decreases cost. Consumer devices become smaller, more powerful and cheaper over time. Manufacturing equipment is faster, more accurate and lowers the unit cost of production. But even after 10 years of major investments in health technology, the results have largely failed to decrease the cost of health delivery.”
Which is certainly regrettable. But here’s why I think this time is different.
Keep The Faith
Unlike 10 years ago, we can today achieve an interoperable, agile health-IT infrastructure, such as PwC prescribes. Incentives are now finally aligned to “coordinate data collected across care settings so it can be integrated, analyzed and used to provide rapid feedback to consumers and doctors.”
We can then use data analytics to create strategic insights and actionable results. Per PwC, “healthcare executives view data mining and analytics as having the highest strategic importance during the next five years.”
That’s where IBM Watson, Lumiata, Accordion and BaseHealth come in. This report from Rock Health is also worth your time to dig deeper on this subject. The best of computer science is finally being combined with the best of the biological sciences and healthcare informatics to create a perfect storm of innovation.
Action is based on what you can, should, will and even must do. Adaptable systems that incorporate the wide ranges of new data available, and help create actionable recommendations, are both literally and figuratively the future.
That future is no longer distant. It is finally at hand, and I for one am eager to see the inflection we’ve all been waiting for. If you’re not knee-deep in this stuff already, you need to be soon.
Opinions expressed by HIT Consultant Contributors are their own.