The COVID-19 outbreak was a “black swan” event that dramatically accelerated the development and acceptance of digital health and health care information technology (IT) – possibly by more than five years. It has also permanently changed Americans’ expectations of healthcare providers and patient care. However, the focus on COVID-19 belies three additional underlying and interrelated trends that will continue to drive new use cases for digital health and healthcare IT applications.
cost based reimbursement
The ongoing shift towards “value-based reimbursement” remains a major catalyst for digital health and healthcare IT adoption. Under value-based reimbursement, hospitals and physicians are compensated based on their ability to demonstrate high quality of care, generate positive real-world patient outcomes, and manage the health and well-being of the populations in the communities they serve. Let’s do service. This contrasts with legacy, “fee for service” reimbursement models, under which providers are paid with little regard for quality, outcomes, or population health.
At the end of 2021, the Centers for Medicare and Medicaid Services (CMS) announced an ambitious goal of moving the majority of beneficiaries to a value-based reimbursement model. A value-based reimbursement environment requires an interoperable IT infrastructure to coordinate and track data on patients across disparate settings of care. To support this, CMS has recently proposed significant improvements. Medicare Shared Savings Program Advance funding for healthcare IT and digital health technologies for providers to operate more effectively in these new value-based reimbursement models.
A major challenge to success in value-based reimbursement is that the software ecosystem in healthcare has evolved to be heavily client-server and on-premises, with each implementation having its own instance and customized for each user. This has led to fragmented and siloed software systems that cannot talk to each other. The good news is that legislative and regulatory actions are helping to address these interoperability challenges. 21st Century Cures Act, for example, is helping to open up closed software systems and give artificial intelligence and machine learning applications access to large data sets. This improved data access could, in turn, elucidate new and unexpected predictive insights into how clinical, social and environmental variables can positively influence patient outcomes and population health.
“Healthcare consumerism” is another major macro driver behind the digitization of healthcare. The increasing prevalence of high deductible health plans resulting in higher out-of-pocket burdens for Americans has led more patients to comparison shop for their medical care. In turn, hospitals and physicians are competing for patients by creating modern and efficient consumer experiences. One area of focus is the digitization of the manual patient intake process – reducing paperwork for patients and improving operations for providers.
For example, physicians are adopting AI software to reduce patient no-show rates, which can range from 15 to 30 percent. AI-based software can proactively flag patients who are more likely to miss appointments and proactively initiate reminders. And, if there is a patient cancellation, the AI software automatically fills the appointment from a pre-existing list of patients who have indicated they are open to taking short-notice appointments. Finally, physicians are using AI to run low-cost digital marketing and educational campaigns to make patients aware of new or incremental services relevant to their individual health care needs.
Contributing to the movement towards healthcare consumerism is the implementation of no surprise act, which has been one of the more under-appreciated pieces of legislation affecting providers in recent years. This law is making a significant contribution to an environment of greater price transparency between hospitals and physicians to enable Americans to better comparison shop for the care they need. among other things, no surprise act Healthcare providers are required to disclose to patients “good faith value” estimates for their services. Initially, this is limited to self-paying patients, but it could provide a framework for additional price transparency legislation or regulation over time. Here, we see a need for new technologies to help providers generate and communicate real-time value estimates to patients. This can be especially difficult for care that involves multiple providers and multiple encounters over time.
complexity of care
Finally, a third driver of digital health and healthcare IT is the increasing scientific complexity of medical care, including advances in genomics and the use of precision therapeutics, which is driving the need for AI-based decision support software.
This is especially the case with complex specialties such as oncology. In oncology, for example, science is advancing so rapidly that a physician would need to read 40+ hours per week to stay current on the latest research. Furthermore, physicians must often decide between 7+ therapeutic options for any one diagnosis. With the availability of low-cost biosimilars, the range of treatment options is likely to increase over time. The use of low-cost biosimilar drugs represents an opportunity to generate hundreds of billions in annual savings over the next decade. However, one of the major barriers to the use of biosimilars is provider and patient awareness and education. Here, the software can help clinicians proactively screen for patients who may benefit from a lower-cost biosimilar option and provide tailored educational materials.
Ideas for the future of innovative, hybrid care
Implementing and pursuing innovation in digital health and healthcare IT should be a priority for all US healthcare providers and payers – especially as the lessons and response to the COVID-19 pandemic become permanently a part of our daily lives . That said, we should not forget that advances in healthcare IT and digital health should be considered as a complement to in-person care rather than a replacement for it. Reliance on healthcare IT and digital health in particular may have the unintended consequence of creating even greater fragmentation and duplication of care. Ultimately, if there’s one lesson learned from the past few years, it’s to expect the unexpected.
Photo: Dina Mariani, Medcity News