U.S. Healthcare: Converting Vision to Reality
Contributed by Patricia Birch
A combination of technologies and trends such as cloud computing, mobile access, virtualization, globalization, and the rise of millennials is driving a transformation in healthcare IT that promises improvements in access and cost savings.
The healthcare industry, one of the five major sectors of the U.S. economy and representing 17% of the GDP, has changed tremendously in the past decade and faces yet more momentous transformation ahead. A heady combination of legislative efforts, rapid evolution in medical science, and cost and quality issues will catalyze fundamental changes in the industry, in everything from administration to patient care.
Legislation such as the Patient Protection and Affordable Care Act (PPACA), provisions in the American Reinvestment and Recovery Act (ARRA), and incremental regulatory changes are governmental drivers of change. And the conversion from ICD-9 to the more granular-data-intensive ICD-10 coding structure will provide opportunities for the healthcare industry to use technology, globalization and virtualization to its advantage
Given increasing demand for services and the unwieldiness of the industry, the redesign of healthcare to reduce costs and improve access for all U.S. consumers will continue to be a large-scale transformation effort. Because the fundamental purpose of healthcare is caring for individuals – often at their most vulnerable moments – tackling this shift will require sensitive, well-designed and well-executed change management strategies.
Significant progress can be anticipated in four areas (See Figure 1):
- National/international healthcare IT (HIT) infrastructure.
- Integrated health management based on the concept of coordinated care and including patient-centered medical homes (PCMH) and accountable care organizations (ACO).
- Personalized care strategies based on more targeted diagnostic tests.
- Easier access to care through mass use of new applications such as e-visits and online appointment scheduling and access to test results.
Pieces of this vision exist today, but many changes are required to bring it to fruition. For example, the electronic, real-time exchange of healthcare information, whether clinical or administrative, requires an extensive base of content, transaction, interoperability, product and messaging standards. Many of these standards exist and are in various stages of adoption, but more are needed.
New Business Models
Intertwined with HIT are new and evolving models of care and reimbursement structures. PCMHs and ACOs are designed to provide coordinated comprehensive wellness and preventive care to individuals and thus reduce urgent and acute care episodes.
The increasingly sophisticated and information-rich diagnostic tests that will enable personalized medical care will also likely alter business models and workflows for delivering preventive care. It will be important for these new delivery models to continue emerging alongside more traditional approaches to prevent business disruption
In the long term, payment based on the quality of data collected and exchanged with other partners in the healthcare ecosystem will help sustain the industry's investment in IT. Achieving a positive return on investment should drive continued IT investment.
The Millennial Impact
Members of the millennial workforce now entering the profession have been raised using the Internet, mobile devices and social networking tools. Millennial workers may not be drawn to healthcare as readily if they perceive it as behind the technology curve. This will only exacerbate predicted shortages of qualified personnel. Furthermore, these same individuals will expand the ranks of healthcare consumers. They will want to interact with the healthcare ecosystem in the same way that they interact with all of their other service providers: through Web sites and portals, via e-mail, using smartphone and tablet PC apps.
In addition to the millennial impact, key trends shaping the future of healthcare today include technology advances, virtualization, and globalization (see Figure 2).
Figure 2: MegaTrends Driving Change
Technology:
Cloud computing and mobile tools such as smartphones and social networking applications offer real-time data collection, access and collaboration that can help solve healthcare challenges. Cloud solutions can support HIT deployment and benefits exchanges, as well as internal data sharing.
In addition, mobile and social technologies have rapidly become necessities for millennial consumers and employees. They expect to interact with all of their service providers virtually and in real time, and are increasingly frustrated by workplaces with technology lagging behind the tools they use at home. The healthcare industry will need to adopt cloud and mobility to meet baseline service expectations of the next generation of consumers, and to compete successfully for talent.
Fortunately, cloud and mobile solutions can be deployed without inflating capital budgets and can actually reduce costs and improve efficiency.
Globalization:
Using resources from the global marketplace, healthcare organizations can accomplish labor-intensive, repetitive tasks, such as physician credentialing, at lower costs. The global market is also able to manage complex tasks more cost effectively, from reading radiological scans, to analyzing population health data. In particular, globally sourced skills and processes – delivered via the cloud – can help reduce the costs of mission-critical but noncore operations.
Virtualization:
In healthcare, virtualization is already visible in the form of ACOs and PCMHs, where each member entity provides its core expertise while common administrative processes could be outsourced to a third party, giving patients and consumers the experience of dealing with only one organization.
The impact of virtualization will also be apparent as certain highly repetitive, redundant industry processes become commoditized and ripe for servicing by trusted third parties. These process-commodities are likely to range from claims administration to data analytics.
Finally, virtualization of knowledge will enable the healthcare ecosystem to use the most effective resources and services available, whether they are across town or on the other side of the globe.
Healthcare organizations need the benefits of technology, globalization and virtualization to help them flex, shift and evolve so they can succeed in delivering high-quality, lower-cost care for everyone.
Read the full white paper U.S. Healthcare: Converting Vision to Reality (PDF) or learn more about Cognizant's healthcare practice.
About the Author:
Patricia (Trish) Birch is a Cognizant Vice President and leads the company’s Healthcare Consulting Practice within Cognizant Business Consulting. She has 25 years of experience in healthcare operations and management consulting and serves on the board of directors of Franciscan Services Corp., which provides healthcare services in the midwest and south-central U.S. Trish is also a published author and speaker on issues facing the healthcare industry. She earned a BSBA in Finance from Boston University and an MBA from Jacksonville University.