CTI Healthcare blog series: A Prescription for Improving Patient and Institutional Financial Wellbeing

The “Now” Healthcare Innovation Part 3 of 5.

The business of healthcare is a mess. Observe the deep-rooted dual challenges of escalating costs coupled with deteriorating health – it’s an unsustainable paradox not only for the healthcare industry but for society in general.  This is counter-intuitive! Fundamentally this is a structural problem.  First you have the insurers (Payers) that exert power over health decisions despite being far removed from the “point of care”;  the reach and influence of the life sciences industry (hello opioid crisis), and finally the absurd penalties of the legal tort system that cause Providers to think twice rather than think sensibly — quite a potent brew.

However, one significant change is flipping some of these monsters: and it has been triggered by the Affordable Care Act, it’s Value-Based Care.  It causes the financial business of healthcare to reward better health outcomes rather than pay for fee-for-service.  As a consequence, the continuous treatment of symptoms is less financially rewarding than preventing or moderating the disease, and sometimes there can be financially punitive actions if the illness escalates.

Let’s examine how this plays out using diabetes as an example.  As a clinical leader, you will want to identify across your patients those that may have a possible diabetic risk and initiate some intervention program.   To do this, you will need to analyze patient history and various clinical markers that portends diabetic risk, assess the efficacy of treatment programs using experience across other patients, evaluate the financial consequences of the value-based reimbursements that may result from improved health outcomes versus otherwise, and combine all of this across multiple scenarios.  Moreover, then you need to act and monitor, and adjust.

This is the world that everyone is scrambling to realize.

Can your clinical and financial analysts perform this kind of scenario? In this question, we hit the crux of one of the most crippling impediments within healthcare: the inability to readily leverage the abundance of health data in a meaningful way.  It’s reasonable to assert that the next major healthcare breakthrough won’t be new medical innovations — it will be new data innovations that inform how to change the trajectory of a patient’s wellbeing radically and where to reduce costs and waste dramatically.

We can identify key themes in healthcare as follows, all of which critically depend on an “accessible” data ecosystem

Health care data revolution

How, then, do we create such a data ecosystem? I’ll discuss that in my next Blog.

 

References:

Read part 1 and 2.

http://www.healthcareitnews.com/news/hospitals-use-business-intelligence-boost-patient-throughput

http://searchbusinessanalytics.techtarget.com/report/Business-intelligence-in-healthcare-Special-report

https://en.wikipedia.org/wiki/Electronic_health_record