The past decade has been one of significant evolution for the healthcare industry, shifting from a disparate and transactional environment to a more value-based model where patients are at the center. With untold amounts of health and medical information at their fingertips, patients now are in the driver’s seat as a consumer — playing a more active role in selecting their provider, demanding better quality of care, and requiring greater transparency for healthcare costs.
With the emergence of innovative technologies, including artificial intelligence, more than ever patients are being empowered to make better, informed decisions regarding their healthcare. This new power shift requires a new framework, data-driven technological solutions and a greater focus on and ongoing commitment to advancing patient-centered care.
While reforms such as the Patient Protection and Affordable Care Act of 2010 (ACA) have helped patients gain access to better healthcare — for instance, enabling patients with pre-existing conditions to secure previously hard to obtain health insurance coverage — nothing has empowered patients as consumers more than the technological advancements that have been made within the past decade. Artificial intelligence has redefined the healthcare experience, enabling patients to be informed consumers and allowing them “to optimize the things they couldn’t in the past, such as choosing care based on quality or making decisions about price.” As a result of this real-time access, patients are approaching their health — and more specifically, their healthcare — with more of a consumer mindset regarding the services and quality they expect from their providers. As healthcare costs have increased, so too has the amount patients are paying out of pocket. Since they are paying higher deductibles, patients expect to receive greater value. As the “retailer,” the healthcare system is now incentivized to provide higher quality healthcare to meet patient demands, or as with any business, risk losing revenue.
Artificial intelligence and other machine learning technologies have impacted every facet of the healthcare ecosystem – with significant improvement occurring in recent years — proving to be a pivotal tool for both patients and physicians. With its ability to analyze and combine data from disparate sources, and deliver actionable insights, artificial intelligence provides data-driven, predictive analytics that physicians can leverage to create more insightful patient care plans, better diagnose diseases, conduct research and detect patient risk. While the technology will never replace the role of physicians, it has arguably created a data-driven environment to dramatically improve patient outcomes.
Traditionally, patients have relied on referrals and recommendations from their social networks and primary care physicians when selecting a new healthcare provider or specialist. However, with the emergence of health information sites, such as WebMD, Mayo Clinic, Healthline, Drugs.com, and many others, patients now have a vast array of resources to choose from in their search for a physician or for information on symptoms or about a certain medical condition. These sites are all working toward one goal: bridging the gap between the healthcare system and patients. Whether it is breaking down complex medical terminology or providing reviews of a physician, their goal is to help ensure patients are informed every step of the way in their healthcare journey.
Providers have also taken an active role in providing patients with more transparency in their healthcare journey. Patient portals have become increasingly popular as a way to provide access to various kinds of healthcare information allowing patients to view healthcare benefits, gain insight into Star Rating scores, access tools that predict out-of-pocket costs for physicians in and out of network, view health savings account balances (HSAs), and much more — all allowing patients to plan and budget for costly health services and choose the best physician that meets their needs.
Patients as consumers are taking bold steps forward and making demands for higher-quality care with greater value. In a recent study conducted by the global brand and marketing consulting firm Prophet on the effort’s healthcare organizations are making to become more consumer centric, the firm found that many healthcare organizations are lagging in the shift toward consumer centricity. After interviewing more than 60 executives from top healthcare organizations, such as Mayo Clinic, Novartis, and Aetna, they outlined five shifts that healthcare organizations will have to make to meet the patient demands as a consumer. The five key shifts identified by Prophet are:
The report goes into greater detail on the work that needs to be done for healthcare organizations to meet the evolving needs of their target market — in short, consumer centricity is no longer an option of healthcare organizations but a requirement. Strategies need to be developed from a holistic standpoint with the patient as the consumer in mind. Continued care and resources need to be provided for patients even after a product or service is provided. Patients must be actively engaged in the conversation and asked about the changes they would like to see in the healthcare industry. As patients become more informed, empowered and educated consumers, healthcare organizations can no longer rely on the old mantra of “there will always be sick people who need healthcare” as leeway to lag.
Although the healthcare industry has made great progress toward providing better patient care with greater value, gaps remain. A 2017 study conducted by the Urban Institute’s Health Policy Center found that most patients would feel comfortable talking to their primary care physician (PCP) about sensitive issues that are relevant to their healthcare, but their providers do not ask about these issues often, so the conversation never happens. In one survey, 88.1 percent of patients reported feeling comfortable speaking to their physician about their health and healthcare challenges, but of that 88.1 percent, only 41.6 percent reported that their PCP asked about these issues. That leaves an alarming 46.5 percent of physicians who are not inquiring about healthcare challenges their patients may be facing. These results are representative of how patient care has — at times — been minimized to impersonal, routine “care.”
Technology has been instrumental in the advancement of medicine and in improvements made across the healthcare ecosystem; however, technology is only as good as the person using it. To ensure the best quality of care and improve patient experiences, a deeper focus on patient engagement and care, beyond understanding what is contained in EHR records, is required. Both payers and providers stand to benefit from improved patient care — because better patient care reduces the risk of malpractice, undiagnosed diseases and hospitalizations.
To ensure physicians are providing the highest level of care, the Food and Drug Administration (FDA) created patient reported outcome measures (PRO). These measures serve as a guideline for physicians on how to use patient-reported outcomes for clinical research and other assessments. According to the FDA, high-quality information from PRO measures can provide valuable evidence for benefit-risk assessments and can be used in medical device labeling to communicate the treatment effect on patient symptoms, functioning and quality of life. Data collected from PRO measures can also be useful in helping key healthcare stakeholders work collaboratively to create an improved, value-based framework assessment to deliver better patient-centered care.
Although a relatively new term, precision medicine — an “approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person” — has been in practice for some time now. This approach allows healthcare providers to take a more curated approach to developing treatment and prevention strategies for patients. Leveraging artificial intelligence technology, Inovalon has created a Future Encounters Prediction Framework that analyzes more than 70,000 ICD codes and more than 100,000 claims codes to determine — in real time — the predicted outcome of a patient’s adverse event. With the successful application of this tool, healthcare professionals can predict the likelihood of fall risk, stroke, emergency admission and other events. Inovalon’s Population Health Insights tool provides payers and providers a data-driven approach for care coordination to support, for example, morbidity management of a specific patient as well as the overall health of a patient population. Utilizing artificial intelligence technology, the tool provides real-time insights into patients and their risk levels relative to broader populations, allowing providers and payers to focus on key population health outcomes.
As the healthcare industry becomes more consumer centric and patients become more informed consumers, the question of “What’s next?” for the ever-evolving world of healthcare remains — in hospitals, board rooms, and on the minds of patients and law makers. How can we continue to improve and push the envelope to ensure physicians have the tools they need to provide the best possible care to patients?
Although the answers to these questions remain a topic of debate across the industry, it is safe to say that healthcare will only continue to become more patient centric. And, as with any industry, when your consumers are at the forefront of your business strategy, you have positioned yourself for success.