The success and feasibility of Affordable Care Act hinges on the industry’s ability to mine and manage data.
In the United States, the potential impact of The Affordable Care Act (Obamacare) is in many respects still poorly understood and hotly debated by political pundits, healthcare professionals and armchair policy analysts alike. One matter, however, is quite clear: it has already and will continue to profoundly change the healthcare delivery business model toward a consumer-centric focus. Information technologies play a central role in this outcomes-based, consumer-driven transformational journey, and the demands and incentives will push the boundaries of technological innovation.
Connected Patients, Empowered Patients
Empowered with data and knowledge, individuals will gradually take greater ownership in the maintenance of their own health, and there are powerful incentives for payers and providers to support that. In the recent past, information, equipment and other resources resided largely within the four walls of the hospital- in electronics records and in some countries still on paper. Now, because of advances in technology access to health information is available and can be made ubiquitous and shared in creative and astounding ways. Providers and payers can now share data with patients who, more than ever, are able participate in their healthcare and lifestyle improvements.
In fact, consumers are quite prepared for this connectivity. Cell phones are everywhere and proliferating at a phenomenal pace, nowhere more than in developing countries. Here are some stunning facts that was published about adoption and use. PC Magazine stated that mobile phones between 2000-2012 have multiplied the world over, growing from less than 1 billion in use, to 6 billion this year – a pace that is unmatched in the history of technology.The World Bank projects that by roughly 2015, the number of mobile subscriptions to actually overtake the world’s population.
Today consumers use their smart phones and other devices to connect directly with cab drivers in their vicinity, shuttle funds around their bank and retirement accounts, bid in real time on goods they need and desire, and check in on their parents and kids through in-home surveillance systems, they are perhaps unwittingly being trained to become better patients and more likely to take an active role in their wellness. Consider that forward thinking weight loss enterprises are already helping their customers hold true to their regimens through apps, alerts and other communications. There is a burgeoning opportunity for innovative healthcare IT companies provide the healthcare industry with more sophisticated tools to mine and share data and knowledge.
What is driving this is a greater focus on improved care and wellness, and this is expected to yield major costs savings. The delivery system is transforming to align economics incentives toward these ends that are likely to bring health plans, health systems (hospitals) and proactive care management under one roof into Accountable Care Organizations (ACOs). These organizations are designed and incented to keep their patient populations as healthy as possible. Their success will depend partly on how it shares data at the point of care and use of longitudinal data to manage their population’s health. There remain challenges of accessing integrating patient data from a range of records that reside on multiple databases.
Today some 80 percent of all health data is unstructured. The majority of this data is comprised of images and multimedia and though Picture Archiving Systems (PACS) continue to evolve and provide more value to providers, technology to mine this unstructured data is not fully developed, whereas textual data from medical transcripts, physician notes, various EHR field and other data is and can be mined, and analyzed.What to mine, share and get into the hands of consumers is the big question and challenge, and therein is thegreat opportunity for IT entrepreneurs to apply their knowledge and talents to drive healthcare enterprises forward in this new consumer-centric paradigm.
Indeed accessing, organizing and using patient data will be the holy grail of most healthcare enterprises in one way or another. The entire healthcare ecosystem will be affected by this bringing challenges and great opportunities- a great healthcare cybershift is underway where data and analytics will the take center stage at the pivotal and essential elements. Across the healthcare continuum and at every level there is an acute need for new and adept strategies to mine data, change behavior for the optimum patient compliance and make evidence-based research more effective at a lower cost.
Cases in Point: Payers, Hospitals and Pharmaceuticals
The consumer-centric shift will change the business models and incentives of those industries who operate in healthcare generally and in specific ways. Payers will clearly have to reorganize and reinvent themselves to evolve quickly from B2B to B2C businesses. This new orientation will see insurance companies offering customized policies that take into account specific patient health conditions and incent certain behaviors. As care management changes, payers will offer incentives for members to go through wellness programs and adopt more healthy diets, rewarding compliance with premium reductions.Care teams will connect to their “members” to monitor drug compliance, exercise and physical therapy programs, and a myriad of other health maintenance regimens. It is a brave new world made possible by data and connectivity.
Hospitals will be more proactive to ensure that patients are better cared for and outcomes improve significantly. With powerful incentives put in place avoid re-admittance within 30 days of discharge or hospitals are paying more attention to developing and delivering patient education. Success will require collaborating closely with families and communities so that health programs are followed after discharge. An extension of this will include home healthcare where hospitals are connected to patient monitoring devices in real time, and compiling historical data in ways that just a decade ago seemed quite futuristic. All of this requires intelligent information access, flow and connectivity to interact in a larger, more comprehensive healthcare ecosystem.
The improvement of information technologies enabling better and rapidaccess to patient data is also expected to have major impact on the development of drugs. Broad and deep patient information will help drug manufacturers better focus their R&D and make clinical trials more efficient clinically and financially. In the past random sampling of more random/generalized populations for clinical trials would yield success on perhaps 5 percent of the population. Better targeting for drug trials using information about genomic information, disease history and other factors can make the research more rapid, less costly and enable more tailored therapies. Drug therapies for diseases that might otherwise never receive funding because of cost factors and market potential might now see the light of day and help patients in need.
There are a large number of other participants and stakeholders who will play important roles in the new healthcare ecosystem and who must adapt to its new consumer centric imperatives. Medical device companies, home health enterprises, employers, and many others will need to be connected and exchanging data seamlessly. The success of this massive new undertaking, as well as the function of viability of Affordable Care Act’s itself, will clearly hinge on continuous advances in data intelligence. Much is riding on the backbone of advanced information technology, not the least of which is better health for people today, and for generations to come.
Bipin Thomas, president, UST Global Health Group
