Value-Based Care Relies on Healthcare-as-a-Platform

David Nickelson

David Nickelson

VP of Client Growth, Healthcare

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Beyond what it owns, the modern enterprise will now also be valued on what it can connect.

In transportation for example, smart mobility platforms let users access a wealth of options, such as ride sharing, buses, public bicycles or rented vehicles, through a single unified experience. As new technologies mature, such as autonomous vehicles or hoverboards, they will simply be integrated into the ecosystem with minimum disruption to the experience.

It’s a scenario that has captured the attention of healthcare leaders across the industry. Moreover, as savvy, digital platform giants such as Google and Apple enter the space, pressures to adopt collaborative, integrative platform models will only accelerate.

How is the platform movement taking shape in healthcare?

In healthcare, business and technology leaders are using connectivity, the ubiquity of information (and recent phenomena such as the burgeoning health and fitness market) to help consumers take a far more active role in their quest to achieve a healthier life. As this unstoppable transformation evolves, new healthcare platforms must evolve with it. But there’s an important distinction between healthcare platforms and healthcare-as-a-platform.

  • Healthcare platforms are modular, software-based collections of related functions. For example, electronic health record (EHR) platforms intake patients, aggregate their healthcare information and transactions and generate invoices. As stand-alone systems, healthcare platforms typically use proprietary methods, tools and techniques that rely on data input from medical professionals, which is often the source of their lack of interoperability.
  • Healthcare-as-a-Platform (HaaP) is a market-network business model, representing what we believe is the most significant transformation to occur in the U.S. health system’s history. Like platform models such as Uber and Amazon, the HaaP market-network business model uses data, technology and connectivity to co-create value by building long-term relationships through increased transaction/interaction velocity, higher user satisfaction, and better long-term health outcomes.

How does HaaP add business value?

Today, consumers expect the same digital devices they use to manage their lives to be front-and-center when managing healthcare services. By collecting data at the right places, analyzing it in near real-time and generating suggestions for the next-best course of actions, the HaaP approach helps you adapt to the consumer health movement.

Consumers have also become more demanding when it comes to making informed decisions about their health — with data, wherever it comes from. Hence, HaaP models draw on data from many sources outside a healthcare system to make services more relevant. Examples include data and insight from Patient Reported Outcomes (PROs), Social-Determinants of Health (SDH), and potentially even family/caregiver data.

As learnings and feedback are analyzed and prioritized, leaders can adapt and adjust the platform quickly. For example, though Amazon never anticipated occupying the data hosting space, it constructed a business case for helping and selling the service to others. Healthcare leaders in all segments are seeing similar opportunities.

How does HaaP help you exploit connectivity?

HaaP helps your organization move from old architectures (centered around core administrative processing systems) to those that focus on the delivery of better health outcomes in several ways.

Use platforms to influence next-best-actions. Digital juggernauts (Amazon, Apple and Google) pose more than just an existential threat to the industry. These digital natives are intimately familiar with building platforms that use behavioral data and algorithms to recommend highly tuned, next-best actions, a model that has proven effective at deepening relationships and encouraging loyalty. Such models could contribute to solving an age-old healthcare problem: encouraging the positive behavior required to achieve better health results.

Research shows that only 10 percent of an individual’s health is achieved through the delivery of healthcare services. 30 percent is a function of the individual’s genetic background and environment, with the remaining 60 percent dependent upon the consumer’s behavior, social and environmental factors, and level of commitment to better health. A HaaP approach aligns organizational levers in ways to deliver better outcomes.

  • Use platforms to deliver a more unified experience. The industry’s current, fragmented experience forces consumers to navigate a rich, yet often confusing set of diverse resources from Health Delivery Organizations (HDOs), physicians, drug companies, pharmacists, labs, insurers, web sites, mobile apps and call centers. HaaP models can be designed to orchestrate, simplify and optimize the experience across this diverse landscape to deliver better health outcomes and to achieve better results in less time. In the spirit of delivering on this vision, platforms can be designed for prevention and early detection (versus a dependence on reactive medicine), to achieve better outcomes and reduce costs.
  • Align platform architectures with emerging ecosystems. A platform approach helps providers and payers shift from their current position of simply covering healthcare costs, to actively encouraging and rewarding patients for their involvement in defining what it means to be healthy. This vision is achievable with the aid of a digital platform, optimized to adapt to change, versus those designed to adjudicate claims. Platform architectures are also better suited to capturing and continuously measuring the results of various patient-physician interactions.
  • Design platforms to support data-driven journeys and decisions. Shared Health Records (SHRs) contain subsets of normalized patient data across systems such as EMRs and Laboratory Information Management Systems (LIMS). When properly equipped with data management tools and analytics, HaaP turns shared health records into an operational, real-time transactional data source to paint a clear picture of the patient’s health from a sea of complexity (i.e., a typical patient-level clinical data set can include more than 800 data items. For comparison, a financial transaction may include 20-30 data points).

Factors to successful HaaP

Security and privacy become ultra critical as devices and corresponding softwares begin predicting patterns and providing users with insights and connectivity increases. These types of operational issues are addressable with emerging technology, including blockchain, Fast Healthcare Interoperability Resources (FHIR), the Health Insurance Portability and Accountability Act (HIPAA), the EU’s General Data Protection Regulation (GDPR) and the Hospital Consumer Assessment of Healthcare, Providers and Systems (HCAHPS). Then there are the larger “third rail” cultural hurdles such as ingrained finance functions and traditional models of medicine, nursing and hospital-centric work environments, which must be addressed with visionary leadership, collaborative service design and thoughtful culture change efforts.

Data-driven decisions have made enormous differences in all sectors, especially healthcare, where physicians supplement their expertise with data insights from dozens of disparate systems. However, the healthcare industry represents the fastest, most complex data-generating sector of all (according to a Stanford study). Healthcare leaders should fund advanced analytics initiatives to deal with big data in their delivery of a value-based platform. Without such tools, physicians and their teams are challenged with an unnecessary cognitive load.

Monetizing information and knowledge helps all healthcare industry participants organize and present data for clinical and diagnostic guidance, alerting them to patient-specific disorders while delivering continuous insights into optimal treatments. Whether you’re a healthcare provider, payer or life sciences firm, converting idle data into the type of actionable insight you need for business advantage lends itself to a platform approach.

Interoperability: While EHRs have delivered enormous benefits, they have also presented security and interoperability issues. Adding to the problem are physicians struggling to decipher data from the patient’s other providers. Healthcare leaders and their IT counterparts should secure and design their systems to interact with one another within time frames that can make a meaningful difference in the patient’s health.

Patient-centricity: While such a move appears natural and logical, it can be counterintuitive to organizations with hospital-centered, physician-centric histories. Business and technology leaders can empower cross-functional, multi-discipline teams to set their own goals and manage their own obstacles as they put patients front-and-center. Patient-centricity is moving fast as organizations such as Blue Cross Blue Shield partner with Walgreens, CVS and Lyft to offer consumers rides to drugstores near them to pick up their prescriptions. Similarly, Humana co-creates solutions with consumers to rethink the journey, equipping them with the type of support and trusted advice they need to confidently navigate and select the right insurance product for themselves.

As the economy grows more hyperconnected, new “Uber-experiences” aim to offer easier, more intuitive access to a market’s vast network of information and resources. The beauty of these networks lies in their flexibility and ability to adapt to change. When new technologies, business models and solution platforms are introduced, they are simply integrated into the ecosystem.

As digital giants enter the healthcare space with their savvy platform expertise, a tidal wave of innovation will disrupt the entire industry over the next decade. Getting from where you are now, to where you need to be to effectively compete, requires urgent management action.

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