The 2 ingredients powering next generation community healthcare
It was 2011 and the readmission penalties were a year away. We were unsure of how exactly this would affect us but we knew that learning to reduce readmission would better prepare us for the evolving fee-for-value health system. One of our pilot initiatives involved the use of enterprise social networks to allow clinical and non-clinical personnel to collaborate in resolving emerging issues with high-risk patients. As the days went by, the news feeds revealed to me a very interesting pattern. Patients, eager as they may be to stay away from the hospital, often faced hurdles for which the healthcare system was not equipped to handle. One of our first patients brought home this point very clearly. She was facing an eviction notice and the nurse assigned to her knew that this would ultimately bring the patient back into the hospital. This nurse was so committed to making the program a success that she helped the patient submit paperwork to resolve the housing issue.
There is enough research linking the socioeconomic environment to the health of individuals. Doctors and nurses also know this from firsthand experience yet there is little that they can do about this. They do not have the resources for these activities nor are they trained for this kind of work. Notwithstanding these deficiencies, a health system trying to bring down the cost of care will find itself confronting these hurdles at some level. Until now, there was little incentive for clinical services to be proactive about working outside of its conventional boundaries but that has been changing. The shift has become even more clearly manifest with the recently announced CMS innovation model – the Accountable Health Communities. In this new model, organizations will test 5-year programs aimed at bringing down healthcare costs by addressing needs relating to housing, food insecurity, utility needs, interpersonal violence and transportation needs. This is a small initiative, a nudge in the right direction but this could be the first step toward redefining healthcare. Major structural change is however becoming possible due to two key ingredients that have the power to stretch, from an economic point of view, the operational boundaries of healthcare organizations.
- Open data: Over the last few years, government agencies have been making increasing amounts of data electronically accessible. From 911 calls to code violations, many datasets of relevance are now open for consumption. Widely available technologies can help make sense of these emerging streams of data and even derive synergistic value together with clinical data. A glimpse into the value of the confluence of such data sources becomes evident when trying to relate social infrastructure data to clinical events, a good example of which is a study (1) relating asthma-related ED visits to housing quality. Such data makes it possible to see how helping a patient with better living conditions can keep them from needing intense clinical care. Organizations can now tap into these data resources and see how taking preventive action beyond their traditional clinical services can sometimes be more cost effective.
- Partner APIs: Application-programming interfaces allow different applications to talk to each other; but beyond this technical function, APIs have in recent years, been demonstrating enormous economic value by powering innovative business models. This power comes from being able to deploy services across conventional organizational boundaries and allow the creation of new operational or business models. You can understand how this could work if you imagine how a medical transportation company can make more vehicles available to transport its Medicaid members by accessing the ride sharing services of a company such as Lyft or Uber. There is no longer a need to acquire new assets or have an organizational structure to do more; so testing new services and scaling activities outside of traditional boundaries become easier to execute and feasible. Similarly APIs accessing clinical data can help power the work of community health and social workers who traditionally have been weakly connected to clinical organizations.
Open data and partner APIs do not just provide technological capabilities but also act at a more fundamental level by bringing down the cost of transacting or executing services outside the normal boundaries of an organization. They can make healthcare transformation possible by helping extend care deep into the community.
References: Andrew F. Beck et al. Health Aff 2014;33:1993-2002