Using Technology to Re-Shape Health Care
Currently the U.S. spends more on health care than any other country, but the highest rate of preventable deaths. Leveraging technology can fundamentally improve these outcomes with the appropriate approach.
Summary
The current U.S. health care delivery system is costly with less than optimal outcomes.
Technology can be leveraged to alter the landscape of healthcare
Big data, new care models and risk stratification to identify the sickest, most resource heavy use patients can help improve outcomes and costs.
Background
The U.S. spends more on health care than any other country, but is lagging in achieving comparable performance.
The U.S. has poorer:
Life expectancy
Suicide rates
Mortality amenable to health care
Although a higher number of adults in the U.S. have multiple chronic conditions and obesity which can contribute to the poorer outcomes, the U.S. health care system can also be improved to provide timely, higher quality care.
The quick and widespread dissemination of technology in health care has already transformed care delivery. Application of information technology across the entire health system can help deliver quality care more affordably.
It’s time for a fundamentally new strategy. This involves multiple steps, but can be leveraged by technology changing the way clinicians deliver care.
REVIEW:
DATA DRIVEN HEALTH CARE THAT MATTER TO PATIENTS:
A mountain of data which currently exists and is continuously growing within healthcare.
However, adoption of big data in healthcare has lagged other industries.
Most hospitals and health organizations have little or no accurate information on their actual costs.
Technology will enable big data to more quickly move from pay-for-service models to value based care.
Healthcare data analytics from numerous big data sources will enable measurement and tracking of large pools of patients, to be reimbursed on outcomes.
Mehrotra et al. The Commonwealth Fund. June 25, 2020
Technology will provide clinicians with big data analysis to drive evidence-based patient-centered information.
Data should be tied to quality and efficiency metrics which matter to patients, by medical condition, not specialty.
Outcomes which matter to patients are at 3 levels:
Level 1: Health (functional) status achieved by the patient
Level 2: Care cycle and recovery (readmissions, discomfort during care, etc)
Level 3: Sustainability of health – measure full set of outcomes
NEW CARE MODEL – Medical Homes:
Looking beyond preventable complications, disease prevention, population health improvement and care coordination are important focus areas to improve outcomes and control costs.
Improving health care outcomes need to address overuse, underuse and misuse.
Overuse results when benefits of care are absent or negligible due to unnecessary test, laboratories or procedures.
The patient centered medical home has the potential to achieve these goals.
Although models and tactics differ, Patient centered Medical Home model typically involves:
Team structured care with specific responsibilities
Standards for data collection, evidence-based decision support, Convenient patient access,
Management protocols to identify patients needing close monitoring and care
These new delivery models of a patient centered approach correlates with fewer:
Hospitalizations,
Diagnostic tests,
Specialty referrals
Lower overall medical costs
Improved patient retention and continuity of care
Medical home models attention to the whole person with integration of all aspects of health care will:
Improve management of the whole patient
Management of chronic conditions
Improve access to community services
FOCUS ON SICKEST PATIENTS:
We tend to focus on averages when discussing health spending, but few people spend the average.
A small share of the population incurs most of the costs.
The top 5% of patients account for 50% of the nation’s health care expenditures in 2016.
Powers et al JAMA Health Forum 2021;2(7):e211597
70% of the top 10 cases of death in the U.S. are preventable conditions.
Heart disease; stroke; cancer; diabetes; obesity
Identification of the sickest patients requires a mix of objective and subjective data.
The healthcare team can systematically use patient risk levels to make care management decisions
Risk Stratification Approach
Conclusions
The U.S health system faces a number of challenges including inefficiencies, variability of care and high costs.
Various authors, government and regulatory agencies have proposed areas for improvement.
Technology, if used properly, can play an important role in helping the health care team drive evidence based, patient centered improved outcomes.