January 18, 2019
Healthcare providers are faced with a challenge: how to move into a digital era without losing focus on the patient and their care. Now, new players vying to enter the healthcare market are finding opportunities to own a piece of the industry. Large scale, customer-focused companies are demonstrating that they have the balance sheets to buy into healthcare in a big way, anything from a payer to a pharmacy benefit manager to a hospital. As patients choose to take a more active role in their care experience, this new model of the healthcare industry is built on an ecosystem with the patient and consumer at its core. So, what does this mean for industry incumbents? Just in time for HIMSS19, we caught up with Jason Gelsomino, Global Industry Solutions Lead for Healthcare and Life Sciences at Bluewolf, an IBM Company, to share his thoughts.
How would you describe a typical patient experience today?
Providers today don’t have a means of effectively reaching out or engaging with patients in a proactive and consistent manner. The experience is fragmented. The need for providers to reach out and be proactive with their patient care is really driven by the payment model and the transition from fee-for-service to value-based payment models. The focus in the past has always been on patient visits, submitting a claim, and getting paid. From a provider’s perspective, it made more sense to see patients more often but patients aren’t necessarily getting better and conditions might not be properly managed in that type of model. But in the new value-based model, providers benefit by not seeing their patients face-to-face as often. In order to facilitate that, providers need to move to a managed care environment and experience for their patients.
From a patient's perspective, they want more interaction with their providers as well as more ways to do so. One of the things that we introduced to the market was the digital contact center, which gives patients the ability to ask questions and receive answers through a virtual or live agent using their mobile phones, tablets or desktop computers. For people with chronic conditions who have to regularly meet with their doctor, it also makes more sense to have care options available to them virtually through telemedicine rather than having to make time to meet face-to-face every time.
What is an example of how the industry is adapting to meet this new patient experience model?
Accountable Care Organizations (ACO) are focused on the value-based payment models. They’re tracking and monitoring the activities of their patients proactively, and in return, they receive savings from the Shared Savings Program, which is a percentage of the savings they get in return for managing the patients and moving focus away from volume and towards value and outcomes.
What challenges do you see preventing providers from adoption?
One thing that providers and other healthcare organizations are still trying to figure out is interoperability or the ability to share patient information. The industry struggles with taking in all that information and aggregating it so that it can be used in an actionable way by multiple provider groups and/or organizations. Today providers collect information on their patients which is then stored in siloed databases. Interoperability is important because it allows providers to share information with others to help provide a better quality of care. Currently, when a patient walks into a doctor’s office, the current provider doesn’t have visibility into information that was collected by other providers, that prevents providers from understanding the patient and their conditions fully.
The other challenge is that the healthcare industry typically hasn’t been as progressive as some other industries. Providers have a way of doing things and are used to managing their patient population as they’ve always done, and in some cases are not open to change. In addition, patients are limited in the way they interact with their providers. Most patients only interact with their providers during office visits. Connected devices and things like telemedicine are now available to help connect patients and their providers. However, the patient challenge with that is the availability of such connected devices. Some people don't even have a computer or access to WiFi, so even if the industry transitions from a traditional paper-based approach to a digital solution, many of these people won’t be able to benefit from that.
What are the big focuses you see coming this year?
Data is king. The person with the data is going to be the person that can provide the most effective level of service to their patients. Salesforce has created some adapters and some hooks into these systems and is probably light years ahead of others who are attempting to do the same thing without using a platform. A big focus this year is probably going to be on population health and moving into care management and figuring out how to identify individuals, engage with them, and connect them to resources. We’re currently building a care management platform that identifies, engages, and connects patients to services and solution and resources, and if we can build it into a solution that’s repeatable across the market, it can help solve for interoperability. It would allow care management participants to collaborate and share information for the purposes of providing better quality care and getting a better end-to-end view of each individual patient. For example, a care provider could have access to labs, diagnoses, notes, and assessments from other providers, and the ability to interact with data and information to make more informed decisions. This allows providers to build dynamic care plans based on an individual’s specific conditions and achieve better patient outcomes.
Which emerging technologies do you expect will make a lasting impact?
Blockchain is a potential solution for healthcare; it’s been done for other industries but hasn’t really been approached in healthcare. The blockchain can connect resources in a decentralized way. It can solve for roadblocks from rules and regulations, while at the same time, sharing information in a systematic way that solves for the interoperability problem.
The other thing is AI. The idea behind AI is we're able to actually look at a database with information about a population of patients, and identify those who are in a similar situation to the individual being treated right now. A provider can compare and analyze thousands of other patient data to look for similarities, patterns, and trends, compare them to the individual’s case and come up with the best recommendation. It's really about augmented, not artificial, intelligence; the provider is going to make the decision on what the next step is, but they're using AI capabilities to help them make that decision.
Voice Assistants like Alexa or Google Assistant could also help with the data collection piece of the digital transformation and help providers get the information they need faster. For example, if a patient is monitoring their blood pressure at home, they don’t have to wait until the next appointment to share the readings with their doctor. Alexa could remind the patient to check their blood pressure, and if the numbers are outside the expected range, it can send a message to a provider, prompting the provider to reach out.
What are you most excited to see at HIMSS?
I know many people are still concerned with the reducing cost of healthcare, but in my opinion, a reduction in cost is a result of improvements in care. Instead, I'm interested in learning more about what are the cutting edge, innovative ways that companies are improving the quality of care, solutions for sharing information, and achieving a better means of interoperability.
HIMSS is happening February 11-15–and Bluewolf will be there. Want top takeaways and highlights? Get the best of the leading health information and technology conference delivered to your inbox.