Chronic inefficiencies in the U.S. healthcare system are largely the product of fragmentation within the industry’s clinical, administrative and financial systems. Platform-enabled system integration has proven to be an essential remedy for providers determined to compete in the new healthcare economy.
According to an analysis published by Oxford University, the U.S. Healthcare System’s defining characteristic is fragmentation. Fragmentation exists within every function of the system. From insurance coverage to care to administration, fragmentation in our system of care has led to unnecessarily high costs. Costs that are attributable to inefficiencies the industry now must address.
Experts have agreed for years that improved integration would do much to address systemic inefficiencies, thereby reducing costs and improving patient outcomes. Many of the same experts point to the importance of innovation to achieve that integration. Yet, innovation in the healthcare industry continues to be painfully slow despite increasing costs and growing patient bad debt, stemming in part from the industry’s persistent lack of pricing transparency and poor patient financial engagement.
For the last decade or so, efforts to correct these deficiencies to improve the quality of care and patient experience have often focused on local interventions – or point solutions – designed to improve a single element within the episode of patient care. This incremental approach has resulted in modest improvements and an inability to manage the entire patient revenue cycle due to the complexity of the individual point solution components.
While most quality improvement efforts to date have missed the larger opportunity to redesign the fabric of health care, some encouraging signs are appearing on the horizon. Old and new companies alike are embracing a systems-integration or platform approach, incorporating the fundamental building blocks of health care - from equipment and technology to clinical insight, patient revenue cycle and all associated workflow processes. Proving the merits of the integrated approach, innovative networks such as HCA Healthcare consistently demonstrate superior financial performance.
These evolving and innovative companies aim to transform healthcare by enabling integrated service delivery that meets the World Health Organization’s working definition: “The management and delivery of health services so that clients receive a continuum of preventative and curative services, according to their needs over time and across different levels of the health system.” To that definition we would add providing a financial experience as good as, or better than, a patient’s clinical experience.
How Powerful is a Platform based strategy?
One need only to look at the largest technology companies to answer this question. These companies’ revolutionary application of the technology platform business model has driven performance and market valuations never before thought possible as many approach or exceed $1 Trillion. These well-known companies include:
Healthcare Platform Leverage – The Difference between Thriving and Struggling to Survive
For many healthcare providers, transformation is a matter of survival. Here’s why:
· Increasing demand of healthcare services from a growing and aging population
· With rising costs and rapidly growing employer adoption of high deductible health plans (HDHPs) the patient is now directly concerned with the cost of their treatments. In a recent TransUnion (TU) study, patient costs were up 12% in 2018 vs 2017. Even outpatient costs have broken through the $1,000 per encounter barrier. TU estimates that eventually 40% or more of all Health System revenue will be paid by patients.
· Decreasing availability of coverage through Affordable Care Act (ACA) exchanges and declining, unpredictable Medicare and Medicaid reimbursement rates.
· Increasing epidemics and sudden health emergencies such as Ebola, HIV, and reappearing diseases from our past including measles and tuberculosis
· Increasing nutrition-related problems, metabolic diseases and spikes in complex and costly diagnoses such as autism spectrum disorder.
If the industry attempts to address these issues with a “business as usual” approach, these phenomena will continue to drive up healthcare costs in the U.S., which are already the highest in the world. The need for integrated technology to deliver better care and deliver it more efficiently for the patient and the provider is now much more acute. Meeting the challenge has become an operating imperative.
A Day in the Life... Inefficiency is the Norm
According to a study from the American College of Physicians, “during the office day physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work.” This administrative burden aggravates the growing problem of physician burnout and can have deleterious impacts on patient care. The proof? In a recent Commonwealth Fund study of patients around the world, 52% of American said they couldn’t get a same- or next-day appointment with their provider when they were sick.
Similarly, healthcare’s approach to the financial dimension of the patient experience has not kept pace with patients’ increasing financial burdens and patient expectations for much more retail-like interactions. Instead, healthcare tends to rely on manual processes and a kaleidoscope of point solutions, outsourcers and large human labor pools. The industry is in a perfect position to solve the challenge of patient consumerism. But a fundamental change must occur that only a platform technology strategy can accomplish.
The Benefits of an Integrated Platform
By integrating systems on a platform, providers and insurers can overcome the intrinsic inefficiencies presented by multiple standalone systems and disconnected heath interventions. In one study, West Health Institute estimated that integration and interoperability could save the industry as much as $36 billion.
Key considerations in creating an integrated Health Services Platform, designed to achieve these savings include:
- Identifying the key entities in the ecosystem and their considering each entity’s objectives relative to the delivery of an integrated whole
- Exploring and defining multiple value propositions in the platform
- Understanding the key exchanges/transactions between ecosystem entities and the appropriate channels for flawless transactions
- Understanding how the platform supports and empowers participants (patients, clinicians and staff) to facilitate better performances and better results
Technology Platforms, like Loyale’s Patient Financial Manager™ integrate various financial, diagnostic, record and documents systems, making them easy to use by the patient, the provider and the insurer so that all parties have a common, helpful frame of reference. Further, platform technology is capable of mining data across disciplines throughout the patient care cycle, informing more productive workflows and generating business intelligence to drive continual improvement.
Advancing Integrated Delivery through Platform Expansion
Integration empowers healthcare providers to deliver services through a common platform. One that is seamless, smooth and easy to navigate. Patients and the people who care for them want a coordinated, platform-enabled experience of linked services. Such a platform “minimizes both the number of stages in an appointment and the number of separate visits required to a health facility.” To providers such as hospitals and doctors, integration means that separate technical services (and their management support systems) are provided, managed, financed and evaluated either together, or in a closely coordinated way.
To achieve the level of integration needed to meet both patient and provider expectations, the industry is experiencing a high number of mergers, partnerships and alliances, some conventional and some unconventional. Thus, the current trend of mega mergers such as JP Morgan and Instamed, CVS and Aetna and the newly created Haven, a joint venture of Amazon, JP Morgan and Berkshire Hathaway, are just some examples of the developing effort to create technology and service platforms to improve patient care and reduce the costs and inefficiencies.
Within Revenue Cycle alone we are seeing platform companies emerge with designs on holistic services capabilities. As with most industries at, or nearing, maturity - players such as Waystar, NThrive and Change Healthcare represent the beginning of a large-scale consolidation where platform leverage is the essential approach for any healthcare company that expects to survive.
Loyale Healthcare is an active proponent for integration to cure the fragmentation that hobbles healthcare in the U.S. Our patient financial engagement platform was built from the ground up for seamless integration in the most complex healthcare ecosystems. With it, providers deliver their personnel and patients transparency and continuity that improves financial outcomes and overall staff and patient satisfaction. Loyale is proving every day that by delivering more consumer-friendly experiences to their patients, providers are seeing improved efficiencies and better financial outcomes.