“The mandates to improve care, advance quality and share information, combined with the constant pressure to reduce costs within the healthcare ecosystem, demand far greater collaboration and coordination than ever before in U.S. healthcare.”
President, Healthcare and Life Sciences
In the United States, the healthcare ecosystem is moving briskly toward a patient-centric model in response to pressures to enhance patient care and drive cost out of the system. Without question, data is finding itself at the heart of this convergence.
Our healthcare ecosystem, operating as a series of silos, captures and stores huge amounts of data from healthcare providers, pharmaceutical companies and payers (health insurers). This volume of data is dubbed “healthcare information,” and should be fully analyzed and interpreted by healthcare professionals to draw meaningful conclusions that create actionable events in the form of treatment protocols. Once a protocol is selected and implemented, the results can be studied and the movement from data to information to knowledge and ultimately wisdom (the knowledge management continuum) would be in place in our healthcare system, producing better outcomes and improved patient care.
Are we there yet?
A number of factors are driving this transition to a patient-centric model. They include:
- HITECH, part of 2009’s American Recovery and Reinvestment Act, which expanded the use of health information technology and mandated that patients have certain rights regarding their healthcare data
- The Affordable Care Act of 2010
- An influx of younger caregivers intent on achieving better healthcare outcomes
Although the transition is still evolving, it’s clear that this is the most significant paradigm shift in the way healthcare is delivered in the United States since the advent of managed care.
So, who are the stakeholders in this historically—and some would say, hopelessly—silo-intensive ecosystem? According to a recent report from The Office of the National Coordinator for Health Information Technology entitled Connecting Health and Care for the Nation: Shared Nationwide Interoperability Roadmap, stakeholders include many constituencies like “public health services among governmental agencies such as state and local health departments, emergency responders and public safety; hospitals; health care professionals; diagnostic laboratories; researchers; non-governmental human services; advocacy and community based organizations.”
That’s a lot of silos.
The long and winding road to patient centricity
The migration to an environment that ensures the secure sharing of data among the stakeholders in question is fraught with complexities, and this requisite data sharing is not without a high level of risk. That is why it is crucial to entrust this new cultural shift to an IT service provider with demonstrable experience within each of the healthcare sectors involved. Ideally, a service provider will be deeply experienced with large organizations in the hospital, pharmaceutical and payer arenas and recognize that each sector tends to view cost cutting and care delivery through its own prisms.
Understanding these diverse perspectives is just as important as having the ability to deliver the necessary infrastructure, technology, applications and digital experience, along with the critical structure and expertise to assure data security and protection.
“Today, healthcare providers and payers are realizing they must not only manage the risk associated with the converging healthcare ecosystem, but also learn to ascribe fees across all of the providers involved in an end-to-end care episode. This can create severe technological challenges for IT systems,” Ralph Burns, President, Healthcare and Life Sciences, NTT DATA, notes. “The era is upon us when these systems must accommodate implementation and support of many new systems including electronic medical records, tele-health and patient mobility platforms,” he adds.
Since all constituents of the ecosystem are being challenged to work more closely together and share information to support the ultimate goal of creating lower costs and better patient outcomes, expertise in healthcare processes and data management within each sector is vital. Burns stresses that the IT service provider who wins client confidence will know how to take advantage of data across the healthcare ecosystem and implement the technology platforms that can create efficiencies at every level. “Buyers should also be alert for any experience with driving innovation in areas like mobility, digital business and secure data exchange,” he adds.
Expertise in the integration of electronic health records, care management, core claim systems, clinical research, medical supply chain and devices is key. They are the bedrock of the data and digital convergence that is making this new, consumer-centric world possible. The right IT service provider can present creative ideas that enable constituents to contribute to a holistic system encompassing payers, providers and pharmaceutical or medical device manufacturers across the entire technology stack, which includes data, digital, applications, cloud, security and infrastructure.
Increasingly, patients are in the driver’s seat
Fostering an environment with patients squarely at the center and attracting and retaining members over the long term demands that health plans adopt a top-of-wallet financial services mindset. The health plans must change their marketing strategy to retain members, particularly as we evolve to an era of specialized treatment plans and individualized medications. A personal retail touch will take on a whole new meaning in healthcare.
It’s quickly becoming commonplace to measure member satisfaction by real-time feedback at the time of care management calls, online chats and video/tele-health interactions, and new benefit products, treatments and medicines are even now being built from claims, clinical, pharmaceutical and home health data. However, a patient-centric model requires more than new products and treatments. It also demands that the partners in the ecosystem provide patients with painless interactions. Interactions in this digital marketplace have got to be easy. They have to put the patient, who is the customer, at the center, just like the retail omni-channel shopping experience evolved to serve customers via their preferred channel—phone, mail, chat, text or video.
It must also be possible for information to be instantly shared, so the patient only has to provide it once; thereafter, it simply becomes a matter of quick, easy validation. Finally, it has to be usable, and it is the complex task of the IT service provider to facilitate the realization of these goals.
Buyers should look for service providers with passionate opinions about a better or more accelerated approach and not settle for maintenance of the status quo. In fact, they would be well advised to select an IT provider that forces them out of their comfort zones. Shifting an organization is definitely difficult, given the natural human tendency to resist change. Hospital systems, health plans and big pharmaceutical companies are no exception—changing human behavior across any organizational culture is a slow process at best.
Finally, Burns reflects that buyers should also be alert for IT service providers who blend high-value solutions and technologies with a genuinely humanistic focus. “While our own conversations with customers are certainly about technology, we must keep at the forefront of our thinking that healthcare is personal, emotional and impacts all of us. These systems and technologies exist to help people. So ultimately a technology solution must enable not only improvements in the U.S. healthcare system, but also enhancement of human life.”
Ralph Burns, President, Healthcare and Life Sciences, NTT DATA
Anthony McCarley, Vice President, Healthcare Convergence, NTT DATA
Adam Nelson, Vice President, Industry Solutions, HealthCare and Life Sciences, NTT DATA
Michael Ragan, Senior Vice President, Healthcare and Life Sciences, NTT DATA