Digitizing the Customer Focus – A Key for US Healthcare (Part 2 of 2)
This is Part 2 of our 2 part blog series on customer focus in US healthcare. In Part 1, we discussed the challenges and how ‘customer experience’ is important in the current market. In this blog, we’ll look at trends in US healthcare, but we’ll also look at the emergence of IoT and the resulting proliferation of data and how actionable insights can improve ‘outcome-based quality care’ for better customer engagement, satisfaction and outcomes.
Outcome based Quality Care
The basic purpose of outcome based quality care is three-fold: prevent people from getting sick in the first place, preventing sick people from getting sicker, and avoiding acute care events.
Hospital Value-Based Purchasing (HVBP) program incentive payments are linked to ‘Improved Clinical Programs’. One provision of the Patient Protection and Affordable Care Act (PPACA) is the Hospital Readmissions Reduction (HRR) Program, which requires the Centers for Medicare & Medicaid Services (CMS) to reduce payments to IPPS (Inpatient Prospective Payment Systems) hospitals with excess readmissions.
Due to the shift from volume to value-based care delivery model, the focus is on outcomes and the value delivered to the customer. This shift requires a significant change in strategy, operations, and processes of healthcare enterprises. Moreover, with the rise of Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), there is a lot of emphasis on ‘Care Coordination’.
With all of that, there are various challenges that healthcare systems are facing today. Care is frequently rushed, responsibility is fragmented, and often there is little communication between care settings and multiple providers. The ensuing confusion regarding a patient’s condition or needs, can cause inconsistent patient monitoring, duplicative tests, medication errors, delays in diagnosis, lack of follow through on referrals, and so on.
Some more data to support the statement:
- NEHI (New England Healthcare Institute) estimates that total potential savings from adherence and related disease management could be $290 billion annually — 13% of health spending.
- As per the study conducted in 2013, Medical errors was the third leading cause of death behind heart disease and cancer.
- 20% of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were re-hospitalized within 30 days, and 34% were re-hospitalized within 90 days; 67% of patients who had been discharged with medical conditions and 52% of those who had been discharged after surgical procedures were re-hospitalized or died within the first year after discharge.
- A number of studies show that hospitals can engage in several activities to lower their rate of readmissions, such as clarifying patient discharge instructions, coordinating with post-acute care providers and patients’ primary care physicians, and reducing medical complications during patients’ initial hospital stays.
- In the fourth year of federal readmission penalties, 2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital — readmitted or not.
Hence there is an imperative need for all healthcare enterprises to improve their operational efficiency and deliver quality care with better outcomes.
Apart from the huge amount of data available in the legacy systems, the emergence of ‘Internet of Things’ (IoT) will result in enormous rise of data every second through connected devices, wearables, mHealth tools and other systems. Astute use of this data will provide tremendous actionable insights. It will be a key driver for organizations to change the way in which healthcare can be delivered; driving better outcomes, increasing efficiency and providing quality care.
Some of the applications of IoT in healthcare can be Remote Patient Tracking & Monitoring, Care Coordination, Wellness, and others. IoT is a colossal area of discussion and hence I will park that for some other blog as of now.
This trend of ‘Outcome based Quality Care’ is giving rise to a buzz phrase in the healthcare world today: ‘Population Health Management’ (PHM). As far as I understand, it is nothing but a robust ecosystem with technology as the driving force to achieve the objectives mentioned so far.
Some of the significant technology components of PHM framework may include:
- Enterprise Data Warehouses with connectors to manage patient data from multiple sources
- Business Intelligence (insights and analytics, rules engine, predictive models, clinical evidence based guidelines, clinical decision support tools and more)
- Collaboration and care coordination platform
- Personalized care and wellness management for population at all levels along the continuum of care
- Enablers (in form of tools and resources) for all stakeholders to improve overall efficiency
In this world of digitization and IoT, technology will be a key catalyst for Healthcare Enterprises to transform their business models. It’s not about building a technology solution or software, but it’s about laying a foundation for a robust ecosystem which comprises of right blend of Digital and Healthcare interventions.
Thanks for reading this. Would like to hear your thoughts, views and comments on the topic.