In today’s digital world, people handle the majority of their business and personal needs online. Increasingly, people expect to handle healthcare needs digitally as well. Spurred by new public demand, healthcare is rapidly moving into the digital age by applying the same advanced analytics, Big Data, machine learning and consumer applications that retailers have used successfully for years.
As is often the case, the federal government—led by the Department of Defense, Veterans Affairs, Health and Human Services, and others—has been at the forefront as a catalyst or user of these techniques.
During my service as the National Coordinator for Health IT in the past administration, we focused on improving healthcare by making it better (using technology to measure and emphasize evidence-based care delivery), smarter (reimbursing providers based on the value they bring), and healthier (focusing on overall health and health status, not just treating patients when they’re sick). Technology is a foundational element of support in this work. Our goal was to help the country meet societal expectations of 21st century healthcare.
Changing Payment Models
Healthcare payers are moving to alternative payment models. These programs are not burdened with counterproductive incentives within legacy fee-for-service models; rather, providers are rewarded for keeping patients well. Payers are incenting patients to choose healthier behaviors that contribute to overall wellness and hold them accountable for poor health choices.
This shift to alternative payment models and value-based reimbursement was spurred by the U.S. Department of Health and Human Services, with the U.S. Centers for Medicare and Medicaid Services (CMS) adopting these approaches for the Medicare program. CMS estimates that by 2018, up to 70 percent of all Medicare reimbursements will be based on value, not merely volume. Many private payers and state Medicaid programs have implemented similar programs. Partnerships between healthcare providers and payers allow more successful value-based care paradigms to flourish, providing the best results for members and patients.
Population Health Approach
For too many years, the healthcare system focused almost solely on illness and treatments. Today, more healthcare providers are using a population health approach, assessing and addressing needs and issues preventing wellness. Many providers embrace the challenge of spurring patients and their families to action; they share information to help them reach their best health, no longer content with the assessment that patients are not properly motivated or simply “non-compliant.”