The Healthcare industry whether payer, provider, pharma or medical device manufacturer finds itself at a very interesting crossroad: the patient is the center of attention and each entity now has an increased focus in achieving outcomes from delivered services.
For providers care coordination of at risk patients in particular accountable care, the threat that re-admissions pose, the need to move non critical patients from ER to more cost effective walk-in facilities; operational efficiencies in specialty access, nursing operations and a flattening of in-patient revenue and the need to build referrals for acute care are driving changes to existing business models.
Pharma is long past blockbuster drugs and the merger and acquisition spree to diversify its drug portfolio and is certainly not immune to an outcome centric approach. Pricing will be determined by outcomes and pricing erosion by generics. Pharma will look at ways and means to reach out to patients to manage adherence, making clinical trials more efficient and simultaneously collaborating with other organizations for research into newer drugs.
Medical device manufacturers are seeing new buying centers in the US as a result of the payment sunshine act and in Europe the muscle of a buying consortium. A significant portion of the portfolio is subject to commoditization from players from China and Turkey amongst others. These manufacturers are taking their case to emerging markets and are looking to services to protect their franchise in mature markets.
Finally payers are reacting to the changes brought in by the Accountable Care Act. The exchanges, (look what happened to the payers before and after the exchange became operational in Massachusetts), 50 million new enrollees will enter the system, some through the exchanges others through Medicaid expansion, limits on administrative expenses, no rescission just to name a few. Payers are experimenting with accountable care models, some consolidating managed care medicaid assets, info-medic technologies or simply acquiring hospitals to become payer providers.
This is a “services” moment for the healthcare industry, service that focuses outcomes.
Healthcare providers are responding to changes in the business needs, analyzing opportunities to drive operational efficiencies as well as delivering care through accountable care models. Accountable care requires access to patients wherever they are in the care continuum- in hospital, extended nursing, skilled nursing, hospice or home. Care needs to reach the patient in any care setting. This shifts the paradigm from patients walking in the door to receive care to care coordination and care being delivered to the patient anywhere. Technologies such as video and telehealth can bring access to the patient in any care setting, allowing borderless delivery of healthcare as a service.
As provider systems vie for patients, patient experience and outcomes will be key differentiators. Smart hospitals with technology can provide the creative edge as well as enable new ways to deliver care. In room videos that provide entertainment, education, physician rounding, EMR access for visiting physicians, patient access to families, surveillance and monitoring, connecting patients to nurses can significantly enhance care, experience and with collaborative multi specialty access from specialists anywhere impact even outcomes. Whether in-patient with acute conditions, outpatients in rehab or with chronic conditions payments will be tied to quality cost and access. As care transitions from one setting to another systems needs to integrate the delivery of healthcare and manage these transitions. Provider systems may see the need to share assets such as EMR, PACs, Quality management, analytics and deliver them as a service to the extended ecosystem.
With access and new business models such as accountable care the nature of healthcare will gradually change from prescription to participation. Care coordinators will draw in physicians and specialist to oversee patient examination. Immersive video and Telehealth will allow a group of specialists to examine and determine a treatment plan.
Collaboration across the care continuum is key and immersive collaboration with high definition video is centric to this change. Video in some form or the other has been around for over 25 years, but it existed in pockets or as some would like to call it science projects it never became mainstream. For collaboration video to become mainstream it has to address business problems and become part of the business architecture, in essence integrate into the IT architecture. Standalone video collaboration systems create islands of automation but do not integrate into hospital business assets the scheduling, EMR, ePACS, billing and quality management systems. Further they lack scalability.
As Healthcare operations integrate care pathways with collaboration and participation, home health, care coordination they need to work with various technologies video, wireless, the need to accommodate smart phone, smartPADs – location, context, security, content creation and distribution, delivery of smart Apps, contact centers and patient relationship management. Healthcare services have to be delivered using the network as a platform. This needs the business architecture to be integrated to the IT architecture and the IT architecture to the Network architecture. The network architecture can be built on a solid medical grade network that is smart, intelligent, extensible, sustainable, flexible, modular, scalable, interoperable, economical and future proof. This is complex and needs a strong architectural foundation with services and applications that use these services.
At the end of the day is there an ROI?
Over the past year we have worked on various models to define a potential ROI for the new healthcare needs. We took a business centric approach looking at the business problem and then identifying value drivers that either brings operational efficiencies or drive new revenue. We focused healthcare segment provider, pharma as well as medical device manufacturers. We built several models some for our customers and validated them:
- Accountable care - to what extent can collaboration, video and Telehealth solutions increase cost savings and improve quality metrics to increase the shared savings
- Corporate Campus Clinics – how can Telehealth extend the reach to satellite branches, increase uptake through specialties at the main campus and the spoke branches driving benefit both to the Company in increased savings as well as increased penetration and revenue to the medical service provider
- What is the business justification for Telehealth and video to assist in reducing readmissions
- What is the ROI in moving patients from ER to Urgent care and how could that change be managed
- The business justification for using collaboration technologies to increase referrals as well as build specialty networks for operational efficiencies
- Is there an ROI in Training and education?
Some of these models looked at problems that were not driven by reimbursement but had enough value drivers to deliver hard savings and justify the investment. Our models show there is a positive ROI in each of these settings.
As any model goes any change is multidimensional. Any new delivery model should become part of business strategy. A structure should be created to implement this new strategy; appropriate architecture approach and platform solutions should drive the strategy, processes need to change to implement the strategy, finally people should be trained with appropriate change management to make this work.
Is there an ROI, yes but the health of that ROI will depend on how well the organization manages this multidimensional change.