Where are we today?
Healthcare is in the midst of a paradigm shift. Our system has evolved to a point where it is not sustainable. People, both in the general public and amongst elected officials, have now concluded we don’t get substantial returns on our healthcare spending. The general sentiment is that our system is too expensive and spending is not tied to the value of care delivered or to the outcomes of care delivered. Those are both very fair conclusions.
Our current system is built with providers at the center of care and payers as the financial instrument obscuring the cost of healthcare from both providers and patients. Because providers are at the center of care, care is delivered sporadically in episodes when patients are sitting in front of providers - in an office, ER, hospital room, etc.
How did we get here?
We evolved to our current predicament from a time when hospitals just collected what they billed for care. Then came DRGs and CPTs to level the playing field for care for each condition or encounter. Because payment for healthcare hasn’t been tied to efficiency for or collaboration around care, there has been very little incentive to accurately and completely document healthcare data and share it with other providers. For most of healthcare delivery, the main motivation in documenting care has been to bill more completely for certain CPTs and DRGs. In recent years, the main driver of digital care documentation has been HITECH and Meaningful Use.
Where do we need to get to in 5 years?
Obviously, healthcare needs to change and the systems, processes, and tools just are not in place to make that change. Over the next five years, the healthcare delivery system has to broadly shift from being paid for delivering more care to being paid to deliver better care. The current en vogue terminology is that the system is shifting from volume-based care delivery to value-based care delivery. Better care, in the definition of the triple aim, means better clinical outcomes, lower overall costs, and a better experience for patients accessing care.
The shift to better care mandates several broad brush changes:
- New partnerships between healthcare providers and payers;
- New partnerships between healthcare providers and healthcare providers;
- New partnerships between healthcare providers and community anchors;
- New level of collaboration between different kinds of providers (MDs, nutritionists, care navigators, etc), especially in ambulatory and primary care settings;
- Informed and engaged patients that can, if they choose, play an active role in their care;
- Care delivered in locations that are the least expensive (sometimes virtual, through consumer devices, or in retail locations).
As you can see from those shifts, there is a significant need for tools that improve communication and data exchange, something that has not been a focus in healthcare.
What will healthcare look like then?
The end-result, which is going to take longer than five years, is a health system centered on patients and not healthcare providers or payers. Patients will be at the center of care but will not be accountable for the majority of healthcare costs. The health delivery organizations will take on more risk, therefore “owning” patients when it comes to payment and risk; on the flip side, patients will have much more say in their care. In addition to shifting care by putting patients at the center, care will be more of a team effort between different types of providers.
These shifts require two things (and here is the exciting news for those interested in digital health):
- More data about patients, not just episodic data; and
- Better data flow between systems to improve team-based care and patient access to data.
As Bob Wachter, MD, mentioned in our soon-to-be published Innovation Series Interview, the shift from volume-based care to value-based care will eventually enable the full digitization of healthcare. With the digitization of healthcare, the secondary benefits of EHRs will be realized and new digital health services will emerge that can radically shift the way we view health and healthcare.