Healthcare uncertainty is an opportunity for health IT
There is much uncertainty regarding the future of healthcare and health insurance in the U.S. But despite all the headlines and handwringing about the repeal of the Affordable Care Act, there remain clear trends and momentum that provide astute industry leaders and innovators with opportunities to advance their agendas.
America's shift to values-based care and reimbursement models is undeniable. While the ACA or a possible replacement will address insurance and payer models, the underlying emphasis on patient engagement, satisfaction and outcomes is here to stay. That shift has placed an incredible amount of pressure on providers of all sizes – from the biggest health systems to the smallest physician-owned practices. And where there is pressure, there is opportunity.
Here are three ways health leaders and innovators can grow now by turning industry uncertainty into marketplace advantage.
Focus On the Pain Points
In any industry, the winners are those that focus on the most pressing and the biggest problems. For healthcare veterans, those opportunities are numerous. One of the biggest may be chronic care treatment, a massive sector in which chronic medical care accounts for 86% of all healthcare expenditures. In 2012, just 1% of the patient population with chronic disease conditions accounted for 22.7% of healthcare spending, while 5% accounted for 50% of total spending.
Chronic care management aims to manage these costs through early, proactive patient interventions and more effective patient engagement. From a business perspective, it offers a low-risk opportunity for medical providers to prepare for the future. It also creates an opening for innovators to help providers gain confidence and capitalize on the Centers for Medicare & Medicaid Services (CMS) value-based reimbursement system. And with two thirds of Medicare beneficiaries having two or more chronic conditions, this opportunity will only grow bigger.
Products + Services = Success
The demands of modern healthcare are creating a marketplace where truly scalable health IT solutions are those that blend services and product. Providers must embrace the automation and efficiency afforded by technology, but not at the expense of human interaction and guidance. Innovators that can offer both within a business model that delivers efficiency, growth and better care outcomes will be far ahead of the game.
One example of this model can be seen in chronic care management company Orb Health. The company combines a technology platform integrating multiple facets of chronic care management with its extensive team of nurses and practitioners to offer a full service solution for its clients. Users of the solution have been enamored by the efficiency and advantage this dual-pronged approach offers.
Remember the Bottom Line
There are many shiny objects in healthcare – the latest wearable fitness monitors, at home testing kits, and more. But true value and scale will come when innovators focus on solutions that enhance the bottom line for providers and deliver efficiency to the industry overall. Of course, nothing is more bottom line than patient revenue, as evidenced by a number of companies in the sector like SwervePay and Simplee that focus on facilitating patient payments for health systems.
This mirrors the CMS shift towards a payment model that improves delivery of care, earlier. Through better management of medical conditions – especially the aforementioned chronic illnesses – the industry can improve patient quality of life, reduce emergency room visits and late stage interventions, and lower programmatic costs.
Brian is a long-time healthcare technology and services veteran focusing on revenue enhancement for large health systems and providers. Disclaimer: He currently advises Orb Health.
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