The future of digital health and health informatics in a post-Covid world

The Covid-19 outbreak was a “black swan” event that dramatically accelerated the evolution and acceptance of digital health and information technology (IT) in healthcare – likely by more than five years. It also permanently changed Americans’ expectations of health care providers and patient care. However, the focus on Covid-19 belies three other underlying and interrelated trends that will continue to drive new use cases for digital health and healthcare IT applications.

Refund based on value

The ongoing shift towards “value-based reimbursement” continues to be a major catalyst for the adoption of digital health and health IT. Under value-based reimbursement, hospitals and physicians are compensated based on their ability to deliver high-quality care, drive positive real-world patient outcomes, and manage health and the well-being of people in the communities they serve. This contrasts with the old “fee for service” reimbursement model where providers are paid based on volume without regard to quality, outcomes or population health.

At the end of 2021, the Medicare and Medicaid Service Centers (CMS) announced an ambitious goal of moving the majority of beneficiaries to a value-based reimbursement model. A value-based reimbursement environment requires an interoperable IT infrastructure to coordinate and track patient data across disparate care settings. To support this, CMS has recently proposed significant reforms to the Medicare Shared Savings Program Provide upfront funding for digital health information and health technologies to providers to operate more effectively in these new value-based reimbursement models.

A major challenge to succeeding in value-based reimbursement is that the healthcare software ecosystem has evolved to be heavily client-server and on-premises, with each implementation being its own instance and customized for each user. This has led to fragmented and siled software systems that cannot communicate with each other. The good news is that legislative and regulatory measures are helping to address these interoperability challenges. The 21st Century Cures Act, for example, helps to open up closed software systems and allow artificial intelligence and machine learning applications to access larger data sets. This improved access to data, in turn, could elucidate new and unexpected predictive insights into how clinical, social, and environmental variables can positively impact patient outcomes and population health.

Healthcare consumerism

“Healthcare consumerism” is a second major macroeconomic factor behind the digitalization of healthcare. The growing prevalence of high-deductible health plans is placing a greater burden on Americans, which has led to more patients shopping around for medical care. Hospitals and doctors, in turn, compete for patients by creating modern and efficient consumer experiences. One area of ​​focus is digitizing the manual patient intake process, reducing paperwork for patients and improving operations for providers.

For example, physicians are adopting AI software to reduce patient no-show rates, which can be as high as 15-30%. AI-powered software can proactively flag patients who are more likely to miss their appointments and proactively initiate reminders. And, in the event of a patient cancellation, the AI ​​software automatically fills appointments from pre-existing lists of patients who have indicated they are ready to book appointments on short notice. Finally, physicians are using AI to conduct low-cost digital marketing and education campaigns to educate patients about new or additional services tailored to their personal healthcare needs.

Contributing to the movement towards health care consumerism is the implementation of the law without surprise, which has been one of the most underrated pieces of legislation to impact providers in recent years. This legislation materially contributes to an environment of greater price transparency between hospitals and physicians to allow Americans to better compare their care. Among other things, the law without surprise requires healthcare providers to disclose “good faith price” estimates to patients in advance for their services. Initially, this is limited to self-paying patients, but could provide a framework for additional legislation or regulation on price transparency over time. Here we see the need for new technologies to help providers generate and communicate real-time price estimates to patients. This can be especially challenging for care that involves multiple providers and multiple encounters over time.

Complexity of care

Finally, a third driver of digital health and health informatics is the growing scientific complexity of medical care, including advances in genomics and the use of precision therapeutics, which is driving the need for AI-based decision support.

This is particularly the case for complex specialties such as oncology. In oncology, for example, science is advancing so rapidly that a single doctor would need to read more than 40 hours a week to keep abreast of the latest research. In addition, doctors often have to choose between more than 7 therapeutic alternatives for the same diagnosis. The range of treatment alternatives will likely increase over time with the availability of low cost biosimilars. The use of low-cost biosimilar medicines represents an opportunity to generate hundreds of billions in annual savings over the next decade. However, one of the main obstacles to the use of biosimilars is awareness and education of providers and patients. Here, the software can help physicians proactively screen patients who might benefit from a lower-cost biosimilar alternative and provide tailored educational content.

Considerations for the future of innovative and hybrid care

Implementing and pursuing innovation in digital health and healthcare informatics should be a priority for all US healthcare providers and payers, especially as the lessons and the response to the Covid-19 pandemic are definitely part of our daily lives. That said, it should be remembered that advances in health informatics and digital health should be seen as a complement to in-person care, rather than a substitute for it. Relying exclusively on health informatics and digital health could have the unintended consequence of creating even greater fragmentation and duplication of care. Finally, if there is one lesson to be learned from recent years, it is to expect the unexpected.

Photo: Dina Mariani, MedCity News

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