In today’s digital world, people handle the majority of their business and personal needs online. Increasingly, people expect to handle healthcare needs digitally as well. Spurred by new public demand, healthcare is rapidly moving into the digital age by applying the same advanced analytics, Big Data, machine learning and consumer applications that retailers have used successfully for years.
As is often the case, the federal government–led by the Department of Defense, Veterans Affairs, Health and Human Services, and others–has been at the forefront as a catalyst or user of these techniques.
During my service as the National Coordinator for Health IT in the past administration, we focused on improving healthcare by making it better (using technology to measure and emphasize evidence-based care delivery), smarter (reimbursing providers based on the value they bring), and healthier (focusing on overall health and health status, not just treating patients when they’re sick). Technology is a foundational element of support in this work. Our goal was to help the country meet societal expectations of 21st century healthcare.
Changing Payment Models
Healthcare payers are moving to alternative payment models. These programs are not burdened with counterproductive incentives within legacy fee-for-service models; rather, providers are rewarded for keeping patients well. Payers are incenting patients to choose healthier behaviors that contribute to overall wellness and hold them accountable for poor health choices.
This shift to alternative payment models and value-based reimbursement was spurred by the U.S. Department of Health and Human Services, with the U.S. Centers for Medicare and Medicaid Services (CMS) adopting these approaches for the Medicare program. CMS estimates that by 2018, up to 70 percent of all Medicare reimbursements will be based on value, not merely volume. Many private payers and state Medicaid programs have implemented similar programs. Partnerships between healthcare providers and payers allow more successful value-based care paradigms to flourish, providing the best results for members and patients.
Population Health Approach
For too many years, the healthcare system focused almost solely on illness and treatments. Today, more healthcare providers are using a population health approach, assessing and addressing needs and issues preventing wellness. Many providers embrace the challenge of spurring patients and their families to action; they share information to help them reach their best health, no longer content with the assessment that patients are not properly motivated or simply “non-compliant.” This financial alignment helps ensure providers are reimbursed and incented to care for patients in new and innovative ways.
Enhanced Information Technology
The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed in 2009, led a majority of healthcare providers to implement electronic health records (EHRs) and digital data sharing. Nearly all hospitals and 75 percent of doctors’ offices now use EHRs.
To fully capitalize on this advancement, healthcare providers and payers should support development of universal data standards and a consistent governance model. This would facilitate information flow, empowering patients, supporting better decision-making and improving outcomes. Activity has begun, but much is yet to be achieved.
Blue Cross and Blue Shield of Louisiana’s as Example
Blue Cross and Blue Shield of Louisiana’s is an example of a payer interested in leveraging technology to achieve its core mission — to improve the health and lives of Louisianians.
The digital platform created by the HITECH act provides a basis for innovation, care coordination and transparency that did not exist before the delivery system was digitized.
The digital platform created by the HITECH act provides a basis for innovation, care coordination and transparency that did not exist before
One major effort has been to facilitate, in partnership with providers, a learning health ecosystem. In this model, data from claims, provider systems, patients, state registries and the best-available research evidence is used to tailor solutions and innovations to support high-quality, personalized care across the state. The data models are powered by the flow of information. And, they have allowed Blue Cross to foster health maintenance activities as well as identify effective interventions for motivating members and improving the quality of care they receive.
A second major effort is a digital excellence program, based on combining and analyzing digital information from providers, government, community resources, publicly available sources and Blue Cross information to not only promote high-quality, evidence-based care, but, more importantly, to predict members’ needs in advance of illnesses or catastrophes. This is done through the deployment of predictive analytics and care management teams that reach out to members before there is a crisis.
Blue Cross also uses more traditional technologies to empower and engage members like online tools, mobile apps and personal health risk tools. They also empower members at home with digital monitors and wearables; members can then focus on staying healthy. And, if well members become patients or develop chronic conditions, Blue Cross can use these additional tools to better support them. The newly deployed advanced learning systems and analytics platforms make these interventions and tools more effective and relevant. This allows for cost-effective deployment.
New Partnerships/New Approaches
Blue Cross focuses on initiatives to innovatively engage with network providers and customers using technology. The plan recently established a unique partnership with Ochsner Health System, which is headquartered in New Orleans. The two organizations are offering an innovative product, Blue Connect, which provides their mutual customers with coordinated, focused care.
Value is gained by aligning incentives and taking advantage of home monitoring, advanced analytics to target care, and creating a learning health system. Early data shows that primary care doctors enrolled in our value programs have superior outcomes (improvement of perfect care measures by 40 percent) and have saved up to 6.25 percent of total health costs over the past 12 months. More improvements are expected as the program matures. Technology supports Blue Cross’ holistic approach to health and wellness by more efficiently targeting and matching resources in the community with members in need.
Moving Into the Future
Healthcare today is a high-cost, high-pressure environment, and future success will be facilitated by the free flow of information. While providers and payers alike have embraced new technologies and artificial intelligence tools, there is still much work ahead.
The digital health system provides a promise for driving better health, higher quality and lower costs. Collaboration among patients, providers, payers, community organizations, state and federal healthcare leaders and social advocates is necessary to realize the full promise of the new digital platform.
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