Patient Over Profit: How Healthcare Providers Can Collaborate Better to Improve Care

Healthcare in the US is at a major crossroads. The recent COVID-19 pandemic exposed plenty of cracks in the current system, especially in terms of health equity and value-based care. This was further corroborated in a recent study, which revealed that 80% of Americans are unhappy with the way the healthcare system is currently being run. What is the problem with the healthcare system today, and how can it be fixed?

Unfortunately, patients are perceived by many health plans and providers as a means of revenue. As a result, actions that are taken (by payers and providers) are not necessarily for the patient’s benefit, or in the patient’s interest, but rather for the bottom line of the other interested parties. 

While there are good reasons for healthcare providers to attempt to keep patients within their system, especially with integrated delivery financing systems, ACOs, etc., a fragmented patient experience is still far too common. 

A corollary problem is information blocking, which occurs when healthcare providers unnecessarily keep electronic health information (EHI) from other clinicians or sometimes even the patients themselves. In both cases, patients are the “object of my revenue” desires.

Disruption is coming

To improve the patient experience by preventing such practices, the Department of Health and Human Services (HHS) implemented the Cures Act. This new rule is designed to empower patients by allowing seamless and secure access, exchange, and use of EHI. It is also meant to foster increased competition and innovation among healthcare organizations.

One of the ways that all this is meant to be achieved is through greater use of interoperability. By forcing the healthcare industry to use more standardized application programming interfaces (APIs), the Cures Act hopes to create an ecosystem of new, user-friendly applications to provide patients with more options when it comes to accessing and using their own health data.

When this takes full effect, the world of healthcare will be changed forever. As health data becomes more shareable and available, many new independent third-party developers will be able to create apps that are more patient centric. 

One perceived advantage of this from a patient’s perspective is a better consumer experience. The ease with which they will be able to quickly get care delivered from local pharmacies that have an embedded clinic, or to get a telehealth visit from a provider that doesn’t know them, may become commonplace.

The implication of this newfound patient/consumer experience is that it could turn providers into more of a commodity in the healthcare marketplace than they have ever been. Without the gatekeepers of decades past, user experience will be king. The early statistics of dramatically shorter wait times for a PCP visit are very attractive and will drive a change in patient behavior patterns.  

All of this will increase pressure on healthcare providers and health plans to step up and improve how they treat patients. The discussion won’t be about payments, coverage, or primary care networks anymore. Instead, it will be more focused on care delivery and doing what’s best for the patient. 

It will also be more important than ever that consumer convenience does not jeopardize the need for longitudinal care, particularly with chronic illnesses.  

Increased collaboration leads to better outcomes

As the new data sharing rules lead to more competition from third-party apps, both healthcare providers and payers must see that collaboration and a drive to value-based care are THE way to navigate through the fast-changing healthcare landscape. The opportunity is there, but if neither providers or health plans will grab the bull by the horns and drive this, then the window will be wide open for third-party developers to gain the competitive edge.

However, these newcomers don’t know healthcare as well as providers or payers, so while they may deliver a friendly consumer experience, they won’t necessarily achieve high patient outcomes. If the holy grail is value-based care through lower costs and better outcomes, then it should be driven by those with the greatest stake in the game.

Health plans and providers have the opportunity in front of them to come up with truly innovative collaborations. Whether it is through more efficient and widespread geographic partnerships and networks, easier patient access to their health data, or improved digital user experiences, it all boils down to doing something truly patient centric. 

A greater focus on data analytics to support AI and data-driven intelligence to deliver optimal patient experiences should also be a goal. Even when everyone has access to the same data, how it is used by healthcare providers and payers will determine the success of their value-based care.

Of course, becoming more data-driven and improving efficiency and results is easier said than done. Technology accelerators and innovation are aspirational for most organizations. It’s time to stop worrying about getting the last dollar of revenue out of our patients, our members, and begin figuring out 1) how to work together, and 2) how to become patient centric in our care delivery models. Our patients are waiting on us.