5 Key Digital Shifts to Enhance
The US Healthcare System
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John Squeo
SVP - Provider and Healthcare Services, CitiusTech
June 23
Article
Insights
- US healthcare system is still grappling with challenges and is calling for transformative changes; that will redefine patient care.
- Member-centric health plan designs and streamlined medical management are crucial for simplifying care journeys. The widespread adoption of telehealth and virtual-first products can significantly improve the US healthcare system. According to a McKinsey report, the use of telehealth in the US skyrocketed from 11% of consumers in 2019 to 46% of consumers in 2020, and it is predicted to continue growing.
- Implementation of intelligent automation and robotics can ensure that the right level of care is provided where it’s needed most.
- Value-based care is a reimbursement model that rewards healthcare providers for delivering high-quality, efficient care. It aims to shift the focus from the traditional fee-for-service model, which incentivizes quantity over quality, to a system that emphasizes patient outcomes and overall well-being.
In a world where technology has revolutionized industries, the US healthcare system is still grappling with challenges that hinder its efficiency and efficacy. With an urgent need for transformative changes, it’s time to reimagine healthcare and embrace innovative solutions.
Here are the five game-changing shifts vital to unlocking a more streamlined, accessible, and patient-centric system. From simplifying care journeys with network-less experiences to harnessing telehealth, virtual-first products, and automation, these changes can redefine the future of healthcare in the United States.
1. Simplifying Care Journeys
"Member-centric health plan designs and streamlined medical management are crucial for simplifying care journeys. Companies like Sidecar Health and Oscar Health have emerged as innovative health insurance models. They offer frictionless user experiences, blurring the lines of in-network providers to create a network-less consumer experience."
Sidecar Health is an example of an ACA-compliant plan that transcends the traditional in-network concept by offering a 'network-less consumer experience.’ A study shows that 60% of insured Americans would prefer a health plan with no network restrictions, emphasizing the importance of this innovative approach (HBR, 2019). With Sidecar Health, consumers can visit any doctor to receive care without dealing with the complexities of network limitations.
In comparison, Oscar Health leverages technology to simplify healthcare processes, such as telemedicine and personalized care plans. By embracing digitalization, Oscar Health ensures a frictionless experience for its users, in line with evolving consumer preferences.
2. Embracing Telehealth and Virtual-First Products
The widespread adoption of telehealth and virtual-first products can significantly improve the US healthcare system. It eliminates the need for long wait times, reduces the risk of infection from in-person visits, and helps address the shortage of healthcare professionals in rural areas.
By embracing technology and leveraging innovative solutions, we can create a more accessible, efficient, and affordable healthcare experience for all Americans.
According to a recent report, the use of telehealth in the US skyrocketed from 11% of consumers in 2019 to 46% of consumers in 2020, and it is predicted to continue growing. In fact, 84% of physicians offering virtual visits during the pandemic would prefer to continue offering virtual care.
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By embracing technology and leveraging innovative solutions, we can create a more accessible, efficient, and affordable healthcare experience for all Americans.
Virtual-First Products: UHG, Humana, and Oscar
UnitedHealth Group (UHG), Humana, and Oscar have embraced the virtual-first approach, offering a mobile-first member experience with on-demand care options. These companies also enable patients with access to healthcare services through asynchronous methods, such as secure messaging and chatbots, and synchronous methods, like tele or video visits.
Remote Patient Monitoring: TytoCare and Beyond
Remote patient monitoring suites like TytoCare are another critical piece of the telehealth puzzle. These platforms allow healthcare providers to monitor patient’s health data in real-time, at a distance, enabling them to make informed care decisions without needing in-person appointments. By utilizing devices such as wearable sensors and at-home medical equipment, remote patient monitoring can help detect potential health issues early on and allow for timely interventions.
3. Reducing Labor Intensity with Automation and Robotics
Another critical area that requires transformation is the current care models, which are often labor-intensive and have experienced declining productivity.
According to data from 1980 to 2004, nursing care hours per patient per day have increased by a factor of 2.3, highlighting the growing inefficiency within the healthcare system and the increased amount of utilization and patient interaction. This decline in productivity contrasts sharply with other industries that have embraced automation, such as the automotive sector. By leveraging, automation, team productivity, and skill optimization, companies like Ford increased car production per person-hour by a factor of 30 between 1913 and 1927. The efficiencies are continuing to increase via the use of robotics, visual sensors, and artificial intelligence (AI), all of which can be used in healthcare to drive productivity and improve safety.
"Though human beings are much more complex than cars, many tasks and workflows in healthcare are repetitive yet simple. By focusing on the implementation of intelligent automation and robotics, we can significantly impact the labor intensity of current care models and administrative activities to ensure that the right level of care is provided where it’s needed most."
According to a research, automation offers a projected $150 billion potential for enhancing operational efficiency, which encompasses decreasing administrative expenses, boosting quality management, and fortifying insights to accomplish strategic goals. Furthermore, US healthcare payers benefit most from automation initiatives, considering the significant proportion of their tasks that involve data gathering and processing. This would enable healthcare professionals to focus on more complex and high-value tasks, ultimately improving patient outcomes and satisfaction.
- Intelligent Automation: Intelligent Automation can streamline administrative tasks such as appointment scheduling, billing, and data entry, reducing the burden on healthcare staff and improving overall efficiency.
- AI-driven diagnostics: Machine learning algorithms can analyze medical images and data, assisting doctors in making more accurate and faster diagnoses. This can lead to earlier interventions and improved patient outcomes.
- Telemedicine and remote monitoring: By leveraging AI-powered chatbots and telemedicine platforms, healthcare providers can offer more accessible care to patients in remote locations or with limited mobility. Remote monitoring devices can also help manage chronic conditions more effectively.
4. Quality Care Transparency
It involves linking physicians’ compensation to their performance using value-based agreements based on outcome metrics. However, many providers have resisted adopting value-based care models.
"Although the benefits are evident, many providers have resisted adopting value-based care models, arguing that they ration critical care to patients using medical management guidelines that are too broad and miss the mark."
Value-based care is a reimbursement model that rewards healthcare providers for delivering high-quality, efficient care. It aims to shift the focus from the traditional fee-for-service model, which incentivizes quantity over quality, to a system that emphasizes patient outcomes and overall well-being (based on a recent report). This improves healthcare outcomes by 20%. Intermountain Healthcare is an Integrated Delivery System in Utah. According to a review report, Intermountain Healthcare has saved significantly over the past two decades by implementing value-based care initiatives, including electronic health records, standardized care processes, and a focus on continuous improvement.
5. Care Personalization
Traditional approaches to healthcare often employ a one-size-fits-all mentality, which fails to account for the unique needs, preferences, and circumstances of individual patients. As healthcare leaders, we must recognize that each patient’s socioeconomics, biology, living conditions, and other factors play an important role in determining the most effective treatments and care strategies.
The transition to personalized care is greatly facilitated by Electronic Medical Records (EMRs), which enable healthcare providers to capture and analyze vast amounts of patient data. According to a report, EMR adoption is around 35% in the United States, facilitating a reduction in adverse events, re-admissions, and overall treatment costs. EMRs can assist healthcare providers in identifying patterns and trends in specific patient cohorts , allowing for the development of targeted interventions and clinical pathways. This democratization of health data allows for more informed decision-making and collaboration between patients and their healthcare providers, fostering a more personalized and effective approach to care.
Conclusion
The US healthcare system stands at a pivotal crossroads, with the potential for transformative change within reach. By simplifying care journeys, embracing telehealth, harnessing the power of automation and robotics, promoting quality care transparency, and personalizing care delivery, we can create a more efficient, accessible, and patient-centered system.
"Innovative companies such as Sidecar Health, Oscar Health, UnitedHealth Group, and Intermountain Healthcare exemplify the possibilities of a reimagined healthcare landscape, showcasing the benefits of adopting these forward-thinking strategies."
As we venture into the future, our collective responsibility is to foster a healthcare system that prioritizes patient well-being and outcomes above all, shaping a healthier and more equitable America for generations to come.
References
- https://newsroom.accenture.com/news/patients-want-to-continue-to-use-virtual-care-even-after-the-pandemic-ends-accenture-survey-finds.htm
- https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
- https://www.mckinsey.com/capabilities/operations/our-insights/making-healthcare-more-affordable-through-scalable-automation
- https://www.mckinsey.com/industries/healthcare/our-insights/investing-in-the-new-era-of-value-based-care
- https://hbr.org/2019/10/a-5-point-model-for-value-based-health-care
- https://www.mckinsey.com/industries/healthcare/our-insights/promoting-an-overdue-digital-transformation-in-healthcare
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