The patient, payer, provider triangle is the key to success and ushering in change, writes Georges Chidiac.
The healthcare industry is experiencing a paradigm shift towards a patient-empowered d model. Technological advancements in the medical field and better access to information have allowed patients to take a more active role in their own healthcare plans, significantly altering the “collaboration triangle” between payers, providers and patients.
The provision of value-based care (VBC) for patients is no longer a luxury, it is a necessity.
Previously, healthcare models were disjointed, transactional, and complex with multiple barriers to a seamless, effective system. Today, advancements in medical technology, including digital health apps and e-medical records, have created an opportunity for a more integrated healthcare system. And insurance firms have a great opportunity ty to play an intermediary role in the ‘”collaboration triangle” between patients, payers and providers, driving value for all.
E-medical records allow for seamless information sharing between patients and providers. Combined with data analytics, it offers an opportunity for insurance companies to work closely with both parties to identify centers of excellence (healthcare institutions which supply exceptionally high concentrations of expertise and related resources centered on particular medical areas) that offer the best match, based on patients’ unique cases.
The process empowers patients by providing them with easy access to their health information and greater control over their healthcare needs. For providers, storing and transferring patient information digitally can significantly reduce clinical errors.
In addition to advanced electronic medical records, the industry has also witnessed a significant rise in patient assisted technology such as wearables and health applications. There are now more than 325,000 health related apps online. The internet has given patients unlimited access to conduct their own research and review their payers and providers. This is known as ‘medical consumerism’, a new era of healthcare which is taking hold across the full healthcare spectrum – from hospitals to practitioners. It is up to insurance companies to embrace this brave new world.
Successful healthcare partnerships also hinge on developing new payment models. The industry is shifting toward s mixed reimbursement models, which vary globally according to regulation, governments an d geography. Different healthcare reimbursement models utilize a variety of payment mechanisms with varying degrees of effectiveness. Industry stake holders must work closely together to agree upon mutually satisfactory, efficient and effective reimbursement models.
Common healthcare reimbursement mechanisms include capitation, fee-for-service (FFS), diagnosis-based payment (DRGs, diagnosis-related groups) and pay-for-performance (P4P). Most countries operate under a mixed reimbursement system and there are positives and negative points to all the methods, hence no single reimbursement system has emerged as universal, an d the mixed model works best in the current system
Combined, digitalisation of medical records, the rise of medical consumerism and the press in g need to provide better quality of care at a lower cost, will see a move to a ‘continuum of care’ where patients are tracked over time through a comprehensive array of health services. Rather than incentivizing people to over- utilize medical services, the focus will shift to keep in g patient’s health y. Medical team s will no longer only focus on a single episode of ca re but must look at outcomes across a continuum of care with.
How payers and providers can win over patients
Insurers (payers) and providers must harness technology to address key gaps in the health care ecosystem an d deliver the best value-based care for patients. Digital disruption plays a major role in the shift towards
Medical consumerism and the use of technology is enabling a customer-centric app roach, across three key areas:
Transparency – The healthcare industry has been traditionally opaque. Most patients never know the real cost of their treatment until after it is provided. Today, cost and quality transparency tools are becoming more widely available and used by medical practitioners to provide full transparency to patients.
Personalized treatment – Data analytics have mad e it possible to leverage patients’ family history, prior Jab tests an d claim s to c u s to mistreatment n t options. Treating patients base d o n their individual health profile can further revolutionize the health car e industry.
Continuity- Patients no longer visit just one primary health care provider. They often have multiple medical consultants, often across borders. Access to digital medical records enables medical practitioners to access a patients’ entire medical history before recommending a suitable treatment option.