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Changing the covenant of care: The data activation theory

  For a care delivery system to be called a value-based model, it has to fulfill three elementary criteria? patients should get the right care, at the right time, and at the right price. However, many organizations face challenges in one or more of these areas, and they end up being directly or indirectly responsible […]

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For a care delivery system to be called a value-based model, it has to fulfill three elementary criteria? patients should get the right care, at the right time, and at the right price. However, many organizations face challenges in one or more of these areas, and they end up being directly or indirectly responsible for most of the complexities that our healthcare systems face.

Challenges with conventional care systems
Unlike a personalized, consumer-first approach adopted by most other sectors, a patient-centric approach is a fairly new concept in healthcare. Traditionally, healthcare was oriented mainly around providers.

While this approach worked back in the day, healthcare needs to adapt to a different approach, especially as we are well into the value-based care era. Non-personalized care models can potentially sabotage the very essence of creating a model that focuses on ensuring wellness rather than curing diseases.

Practically, the value proposition attached to care procedures does not push providers to focus on preventive measures as much as on treating patients when they are ill. Therefore, conventional care procedures still take precedence over personalized care models. Not only are providers incentivized for those procedures, but they also lack the right support to think otherwise.

On top of it all, our healthcare has solely relied on addressing the problems rather than their causes for the better part of the last century and beyond. Organizations do not have detailed insights into patient preferences, nor do they have the right resources to capitalize on information that can improve the care paradigm. Healthcare is one of the last sectors to embrace coming-of-age technologies that can complement the medical wisdom of the care teams. Many organizations still rely entirely on outdated information in their systems and fax machines that they used a couple of decades back.

The inability to adopt a team-based approach to proactively manage patients is another grey area that we have not been able to address properly. Most providers are occupied with multiple tasks that may or may not benefit the prospect of patients getting healthier. They are often stuck with complex data files and redundant tasks that do not involve imparting care. For instance, there is no need for a physician to make manual data entries by themselves, or for a care coordinator to make dozens of calls to patients to follow up each week.

Giving a new dimension to provider-patient relationships
The number of patients expecting a consumer system-like care delivery model is increasing rapidly. They not only expect top-notch and personalized services but also want to be a part of decision-making processes. It has resulted in more and more organizations reflecting on their care delivery models and coming up with tailor-made innovations. While the initial trends seem promising, we are far from revamping our system entirely.

However, the needs of patients should never superimpose those of the care teams under any circumstance. In fact, one of the main reasons why we have struggled to make the much-needed transition a smooth affair has been the unavailability of supporting elements, including data insights and lesser administrative burden, to look after the needs of physicians and other care team members.

IHI Triple Aim- also expanded to become the Quadruple Aim- is a relatively new term coined to recognize the significance of physician engagement and perfectly sums up the argument. The foundation of a quality healthcare system is built on happy physicians who are ready to go the extra mile to ensure complete patient satisfaction.

Aligning payments with performance is an exciting concept as long as physicians get to choose the right path to achieve their objective. Physicians need to be on board for this journey since the process may get extremely complicated. We need to create more empathetic physician leaders who have a sound knowledge of payment models and meaningful use of data.

Empowering primary care providers with data activation technology
Primary care should be the cornerstone of a sustainable patient-centric healthcare system, and PCPs (along with their teams) should strive to improve the future of their patients. Organizations should activate their entire healthcare data to support their physicians with the right insights at the right time.

Excessive utilization and high costs associated with complex care processes are two facets of an inefficient healthcare system that only Primary Care Providers (PCPs) can eliminate. The policies and frameworks that are required to fulfill the aim of a patient-centric healthcare system can only be designed and implemented by the PCPs.

I have come across many examples where organizations have reduced ER visits by keeping a tab on vulnerable populations or minimized readmissions by increasing Annual Wellness Visits (AWVs). I personally believe that achieving better results has more to do with the vision and intent of the organizations rather than anything else. Once care teams have predefined targets and accurate data points, they can work in an aggressive manner to redirect more patients towards primary care facilities.

Healthcare leadership should invest in the right technologies to optimize care and quality outcomes. First, they need to identify the bottlenecks that hinder the path of healthcare efficiency, and second, they need to leverage solutions that can address them most effectively. Providers need insights to power clinical applications in the moment of care without looking for them anywhere else.

The need for stepping into the era of data activation and Artificial Intelligence (AI)
It is the perfect time to redefine the status quo with the power of data and Artificial Intelligence and make it appealing to deliver care the way we should in the 2020s. Physicians genuinely want to be a part of the solution rather than the problem, and AI is going to be instrumental equipment in that process.

One thing that I often discuss is how other sectors are leveraging AI to improve the customer experience. Food-chains across the states send us notifications based on our eating habits, airlines remember our favorite drinks every time we travel, and streaming websites recommend movies to us that are based on our past preferences. Healthcare professionals, on the contrary, go back to their EHRs every time they need to find relevant patient details. We are yet to witness that level of innovation in the healthcare space primarily because most organizations are unaware of the solutions to initiate such processes.

To continuously evolve and innovate, we need to capitalize on the power that “activated data” holds? Data that is specific, in real-time, and accurate. By aggregating together millions of data points, organizations can ensure a seamless patient-centric system. For instance, a patient suffering from a chronic disease should ideally be updated about his care plan in real-time and provided with a reminder system and an educational portal so that they can manage their own health more effectively. Such insights can also help in drastically reducing the overall number of care episodes. For this to occur, every patient needs a dedicated care plan. AI can help organizations significantly in this regard.

The best time to act is now
By choosing not to innovate, organizations essentially choose to leave the money on the table by not allowing their care teams to see more patients on a daily basis owing to the lack of time. In the age of intelligence, we need new solutions to combat new challenges. The earlier we innovate, the sooner we will achieve the Quadruple Aim of Healthcare.

Photo: from2015, Getty Images

Dr. Paul Grundy is the Chief Transformation Officer at Innovaccer. Affectionately known as the ‘Godfather’ of the Patient-Centered Medical Home model, he is the Founding President of the Patient-Centered Primary Care Collaborative (PCPCC) and a member of the National Academy of Medicine. Prior to Innovaccer Dr. Grundy enjoyed an esteemed career at IBM, as the Chief Medical Officer of the Healthcare Life Sciences division, and the Global Director of Healthcare Transformation. Previous to IBM he was the Minister Consular for the US Department of State. Dr. Grundy is a globally respected healthcare convener, storyteller, and visionary - a "Trusted Healer.” He holds numerous international honorary titles and awards, including an honorary lifetime member of the UK National Association of Primary Care, an Ambassador for Healthcare DENMARK and the first international member of the Irish National Association of General Practice. He was the recipient of the NCQA National Quality Award in 2012, and recipient of the prestigious Barbara Starfield Primary Care Leadership Award in 2016.

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