Year-Over-Year In Healthcare: What Have We Learned?

By Dinesh Sheth, founder and CEO, Green Circle Health

What has changed in healthcare within the past year? While preparing for and winding down from HIMSS16, I asked myself that very question. The industry’s most important event is not only a gathering of the leading organizations, powerful minds, and emerging technologies, it is also an opportunity for us to benchmark our progress and see where we are compared to where we were. The changes that have occurred since 2015 highlight some significant transformations in the structure and focus of the industry. They also provide a glimpse into areas where we fell short and where we succeeded.

Consolidation: there are now three major insurers who have more buying power, thanks to some significant mergers. The shift to three big players is not going to be a radical departure from the norm for the insurance industry and some might say it was an inevitable step in healthcare’s overall transformation. Some also might say the mergers provide an unfair amount of leverage to insurers in negotiating rates with providers, but I think by consolidating operations, these organizations will increase their profitability and will place less pressure to raise premiums and prices. This could be a good thing for consumers of healthcare, as a December 2015 poll conducted by Reuters and Ipsos found 62 percent of Americans ranked affordability as their second-highest concern (behind national security). Similar to insurers, there is consolidation taking place in healthcare IT industry and that trend will continue to accelerate in the next year.

Meaningful Use became meaningless: for the past few years, the discussion has been focused on how providers need to maintain compliance with meaningful use (MU) requirements. And despite the government delaying the timeline of the three stages of deployment and significant provider investment in the technologies to stay within the parameters, the goal of getting patients to use online digital health records and increase interoperability never came to fruition. Deadlines have been pushed back because the industry is still attempting to engage patients in their healthcare data and establish a viable solution in terms of sharing care responsibility by making patient data more widely accessible. It may have been a right idea on paper, but in practice it was simply not a viable pursuit, given the tools the industry had to work with. The whole notion of MU has slowly become meaningless in the past 12 months as the CMS is realizing and adjusting its goals.

At HIMSS, Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services (CMS) said if everyone does their jobs right, the industry’s next phase will see a wider adoption of tools that support patients instead of worrying about EHRs or MU.

Promises with remote monitoring and telehealth: effective remote monitoring and care management facilitates the timely and transparent exchange of vitals and health records and keeps patients out of expensive treatment centers. The HIMSS exhibit floor was full of telehealth, remote health, and connected health technology providers, perhaps giving the impression that we have achieved effective monitoring. However, despite the incredible potential and promises of success, the industry has yet to fully leverage remote monitoring and fulfill this generation’s promise to enable telemedicine services to provide better care to a greater segment of the population. The reality is that telehealth and remote monitoring are still in the infancy stage. Consumer-facing health devices seems to make a big splash, but soon the novelty fades and reality sets in (Fitbit’s stock has fallen more than 60 percent in the past six months and more than 50 percent year-over-year). Adopting a healthy lifestyle requires more than a few cool new gadgets.

While more and more states make new rules and regulations, there did not seem to be enough traction beyond some cool trials and results with telehealth and remote monitoring. However showing a renewed focus on bringing patients to the center of healthcare, Sylvia Burwell, the Secretary of Health and Human Services, emphasized the importance of making data more available to patients, interpreting the data more effectively among providers and using the data to strengthen population health. The future will arrive on this wave, but it may take more than another year to see greater adoption and newer platforms.

A shift to performance-based healthcare: since last year, the focus on moving from episodic care to improving outcomes by keeping patients healthy has intensified. A determining factor in the success or failure of a performance based healthcare plan is the communication between patients and providers. However, even in a fully capacitated model, the physicians are still overwhelmingly paid per-visit per-person. The industry has to recognize efficiencies in remote monitoring and telehealth to develop different payment models based on care delivery models. This will allow us to move away from annual and semi-annual in-person appointments to for early detection and treatment to ongoing monitoring and interactions when most appropriate. This will creates a greater demand for stronger communication tools and technologies that change the paradigm of healthcare from treatment to prevention and improve outcomes. By maximizing the exchange of relevant health information, performance-based healthcare will begin to become reality in 2016, but may take years for patients and providers to adjust.

So what comes next? CMS’ announcement to have pledges from health technology providers and health systems to work together to free up patient data and use common open standards provides us a new hope and shows maturing of digital health record management. In addition, CMS offering seed funding to encourage new patient- and provider-facing application development, as well as a place to share such applications indicates that we will see a renewed push for standardization and interoperability. Based on what I saw from many of the more than 1,300 vendors at HIMSS, we can expect to see data accessibility, communication and analysis to accelerate and have greater impact on patient care.

There was no shortage of innovative technologies that focused on engagement, but the technology available for interoperability and patient control was limited. In that respect, I think that the industry still has a lot to learn before it truly become patient centric with focus on family health. Overall, we have started the dialogue and leaders are seeing a departure from traditionally closed systems and failed approaches to a changing healthcare paradigm, but it will be several years before the industry realizes the benefits of the changes we hope to make today.