WHEN PEOPLE THINK about what medical care used to be, many have idealized memories of close doctor-patient relationships forged over many years. They remember a doctor who knew the patient’s medical history, acted as a steward of the patient’s best interests and was wholly invested in the patient’s health because of a shared history.
Now, because of the growing costs and complexity of today’s healthcare system, the primary care physician has been forced to share that traditional role with payers, who now are charged with balancing care and business concerns and managing a wide range of responsibilities, including provisioning appropriate treatment, processing multiple provider claims and integrating multiple points of service into seamless delivery of care for each patient.
Despite their best efforts, payers are ill-equipped for such a multifaceted role. In reality, no one could step into such large shoes.
As healthcare delivery has become more expensive, complex and fractured, there’s been a growing longing for a return to the years when the family doctor knew everything and always made a decision that yielded the seemingly best outcome with little cost consequence.
While that may be a bygone dream, cutting-edge information technology that aggregates population health information into a single platform – accessible by employers, payers and providers – increasingly is helping stakeholders manage risk profiles. As stakeholders collaborate more effectively, the system can re-establish the trust once reserved for the family physician.
For this to happen, all participants in the healthcare continuum must work to achieve uniform data standards that support the free flow of information. Because valuable and comprehensive information is embedded in claims, it is crucial that payers and employers make the information they gather available to those who need it.
The benefits of information sharing could be synergistic. For example, employers will benefit from productivity gains from healthier, better-treated employees; and hospitals will be in a better position to provide high-value, specialized care. Companies that better understand their employees’ health can optimize their benefits packages and take tangible steps to help consumers manage their own wellness and seek appropriate care when necessary.
In addition, hospitals must realign their businesses by leveraging comprehensive population health data. They need to maximize appropriate admissions to take full advantage of their resources, and reduce the risk to payers and employers. Hospitals that use information sharing to become smarter and more precise in treatment processes will greatly improve the value of their care and minimize the potential for error.
Creating uniform standards for data also will reduce the time providers and payers spend determining who has the best evidence, enabling them to focus on implementing action plans to drive population health improvements. For example, if a hospital and payer find a specific population being treated for diabetes-related episodes at an alarming rate, they can work together to create a targeted community outreach program that involves ongoing dialogue, fitness opportunities and education, delivered in the population’s primary language and in line with its cultural sensibilities.
In the long term, the country will have healthier populations, lower usage and lower operational costs, which providers and payers can pass back through the system.
All stakeholders have much to gain by embracing a universal data platform and everything to lose if they stick to the status quo. By working together to use aggregated patient information more effectively, they can replicate the “high touch” healthcare environment of yesteryear, and ultimately ensure a healthier and more productive population.
In the past 12 months, the industry has begun to move in this direction. But it’s still the exception; it needs to be the norm. n
Shahir Kassam-Adams is executive vice president of Thomson Healthcare in charge of clinical decision support solutions.