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In evolving healthcare business model, tech plays vital role

Brian Eastwood | Sept. 24, 2014
The healthcare industry's shift from its dominant fee-for-service structure forces organizations to rethink the way they do business. Embracing a value-based, bundled payment model means doing more to connect patients to providers, providers to each other, providers to payers and patients to payers.

This, too, mirrors the banking industry, where "boutique," custom software vendors gave way to larger, more established firms. "Epic is the new SAP for hospitals," Hagood says.

Payers Need to Engage Customers Any Way They Can

For payers, meanwhile, today's increasingly consumer-centric healthcare business model means finding ways to "diversify how consumers are engaged," according to IDC's recent report, Perspective: Engaging Consumers in a Post-Health Reform Market.

This matters, as consumer-centric healthcare emphasizes wellness. Anything that encourages patients to engage in healthy behavior — portals, apps, wearable tech, alerts, games or social networks — will pay off for insurers, who will accordingly spend less on duplicative, unnecessary or avoidable medical treatment.

Payers have to be willing to try anything, says Deanne Kasim, research director with IDC Health Insights and author of the report, because consumer-centric healthcare also purports to make it easier for patients to switch insurers.

Ensuring that new and existing customers remains "happy captives" means taking a multifaceted approach to engagement. Some customers will be content to use the online portal, she says. Others will want the "higher touch" of a phone call. New customers, especially those insured for the first time, will need educational resources. All customers will expect price transparency and an embrace of mobile technology.

Analytics Will Push Healthcare Orgs to Success

Here, again, the experiences of another industry will help. In this case, the IDC report says, it's retail's mastery of relationship, relevance and reciprocity, which collectively create "customer intimacy."

Much of this comes down to analytics, Kasim says, whether it's determining click-through rate of a targeted email or studying usage patterns for mobile apps or even remote patient monitoring. It's time- and labor-intensive, she says, but payers who know the "touch points" of their customers better understand what they want.

Providers, too, can benefit from analytics. Many still aren't quite there — even early adopters struggle to apply technology beyond the time of visit — but the possibility to bring together analytics, risk management and population health management expertise puts healthcare "in a place to achieve what we couldn't pull off in the past," says Heather Lavoie, COO of clinical and analytics systems firm Geneia and president of Geneia Innovations. In this sense, she adds, providing an analytics overlay on top of an EHR system works in a similar fashion as adding ERP on top of a transactional system in a manufacturing plant.

Geneia's latest release, Theon, aims to bring together clinical, claims, psychographic, physiologic and patient data into a single dashboard for better clinical decision support, Lavoie says. Providers can identify who within the patient population presents the highest risk and deliver that information at the point of care. Physicians can use the data to, say, set vital sign thresholds for that particular patient or identify subsequent care opportunities.

 

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