Of the nation’s $3.5 trillion in annual healthcare spending, 90 percent is for people with chronic and mental health conditions. Can healthcare institutes afford not to engage in the 2020 wave of preventative care healthcare disruption? While healers are not prognosticators, savvy healthcare CEOs have their eye on 2020.
For those riding the disruption wave, the answer is simple. CMS alone is providing more than $80 billion in reimbursements for preventive care initiatives. This calculation alone does not count on complex chronic care conditions and other follow-ups from preventive care engagements.
Also, CMS aims at containing the growth of acute care reimbursement. It has almost the same “carrot and stick” model used for the evolution from paper to electronic. Stay on the paper train and get penalized or get on the preventative care train and receive financial incentives.
Earthquake or Hurricane?
Both natural disasters are simply disasters. We do not use this analogy from a disaster standpoint, but from our ability to monitor the progress towards controlling the impact. Earthquakes cannot be foreseen. A hurricane cannot be monitored to the exact point of where it will hit, but at least it can be monitored to approximately when it will hit and its potential impact.
The paper evolution is like an earthquake to healthcare with its aftershocks still being felt today without the ability to plan much upfront. The preventive care evolution is more like an imminent hurricane. We know it is coming, we know when it lands, but we don’t know where it is going. We need to deal with it and manage where it will take us. Those unprepared will suffer the most negative impacts. Would your healthcare facility take this risk?
Most healthcare institutes have deployed an EHR system, almost completing the evolution from paper to electronic medical records. This was the first wave of healthcare disruption. However, we are now realizing that this was much more of a disruptive process in healthcare than anyone realized, as its impact has gone way beyond how patient medical data is recorded.
Power vs. Paper
It began with requirements for care providers to use an electronic system in place of the traditional paper approach, opening for a potential patient medical information exchange, improving care quality and efficiency. CMS rolled out preventive care reimbursements starting with the Annual Wellness Visit (AWV) in 2015.
CMS then continued to invest in preventive care through additional reimbursements, such as chronic care management, remote patient monitoring, behavioral health integration and transitional care management.
Every year, CMS has either expanding current reimbursements or deployed new preventive care services. This strategy is based on the patient centered medical home with the objective to curb healthcare cost with preventive care measures, a 6:1 ROI versus acute care.
Reimbursements as incentives led to the next wave of healthcare disruption in which care providers’ workflows were impacted on how to record patient medical records. These preventive care initiatives created fundamental changes impacting almost every operational aspect of a care provider’s workflow.
Preventive Care
Today, it is all about preventive care: simply put, the patient is not yet a patient until he or she encounters pain. The patient is not yet sick. The operational model is not reactive. The demand is to anticipate and monitor conditions so care providers can act before the patient encounters a serious medical problem. This causes changes in the operational workflows for healthcare institutes and their workflow.
In the patient engagement model, there is the acute care model in which it is the patient who makes an appointment or visit. For preventive care, it is care providers and healthcare institutes conducting the outreach. However, without the patient outreach model, healthcare institutes cannot realize the full financial incentives offered by CMS.
In non-face-to-face engagements, patients contact their primary care providers for consultation, but that model is different from the preventive care one. In the acute care environment, care providers cannot bill for the engagements, but can bill for visits and appointments. In the preventive care environment, care providers can bill for services, but it is up to care providers (and their staff) to reach out, monitor patient conditions and meet the time required for billing.
Healthcare is one sector where information technology is yet to be exploited to its fullest. Medical science has gained a lot from computers and information technology but healthcare is still being run mostly without it. The basic healthcare process entail the patient thinking something is wrong with them and going to a doctor. It depends too much on people’s own observances and not enough on science. Our medical equipment has gotten better and we are able to cure and manage more diseases than before but the basic healthcare regimen is still the same. That will not be true for many more years because healthcare is slowly starting to embrace information technology.
The biggest roadblock for technology in healthcare is that failure is unacceptable. In most other areas you can afford some mistakes or errors. Sometimes your Netflix doesn’t load, sometimes your phone may drop a few calls, perfectly acceptable. The same cannot be afforded when it comes to healthcare. So while we are not happy that IT is not being full used in healthcare right, we are happy that we are focusing on ensuring everything works perfectly before implementing it in a medical setting.
Health monitoring will save lives and change how we communicate with doctors
The diseases that most people die of are perfectly curable or manageable. Even most cancers are curable – as long as they are caught in time. That is why so many people still die from cancers. You can have cancerous growths in your body and not show any symptoms. By the time people get in front of an oncologist it is often too late to fully cure their issues. This is also why the deadliest cancers are also the ones that are the hardest to detect. There’s a special type of gallbladder cancer which doesn’t exhibit any symptoms until it metastases. Aside from cancers there are many other diseases which can be reversed in the beginning. Many forms of diabetes as well as heart problems can be reversed if caught early simply through diet and exercise.
Another problem is that people do not know what symptoms to be worried about and often do not go to doctors because they don’t realize what is wrong with them. We can’t blame people either; only doctors know what symptoms to be worried about and it takes them a decade worth of education to reach that level. We cannot expect people who did not pursue a medical education to instantly realize that something is wrong with them. There are many simple things which indicate big problems as well. Things like fatigue and a lack of desire to eat seem like just one of those things that happen to everyone sometimes, but they can be symptoms of serious illnesses as well.
Sensors and trackers will capture medical information in real time
All this is about to be changed thanks to information technology. Medical sensors are already a consumer product but they are limited. Products like Fitbit have been available in the market for years but they only measure basic vital signs such as pulse and the amount of exercise you are getting. As we get better at making sensors smaller we will soon begin seeing similar devices which can monitor many other things in our bodies and let us know if anything is wrong. These devices are proving to be quite popular as well; in this year’s Consumer Electronics Expo there were 32 new health monitoring products unveiled by companies like HTC, Philips, Samsung, and Intel.
Another huge application of such devices is providing vital information to doctors. Doctors need your medical history in order to make the correct diagnoses. Since most of us do not know what is medically significant we aren’t very good at self reporting what is wrong with us. Medical sensors, trackers and mHealth apps will be able to tell doctors exactly what has changed in our bodies and when the changes started. Doctors will have more information about our bodies than ever before which will allow them to make more accurate diagnosis than ever before. The devices will also be connected to the internet and will be able to contact emergency services when needed. Heart attacks, seizures, accidents, anything that requires immediate medical attention will automatically hail an ambulance to your location. This is huge because a big problem is ensuring that people who live alone get the medical help which they need without needing there to be someone else in the room with them to call 911.
Preventive care will get the focus it deserves
There’s a big problem with the way we treat the healthcare system in the world. We focus a lot on curing diseases but do not focus on preventing diseases. We came to this system not because we are stupid – it was just the most viable way to do things. We only begin fighting diseases when people come to the doctor because that was the only way we had to detect a problem. Now, thanks to the developments in information technology, we will soon have the means to focus on preventive care properly. There are already sensors which can tell you if there are any harmful gases or particles in your home.
Such monitoring devices will get more advanced and become a great way to detect diseases earlier and will allow us to prevent them completely. Imagine getting a notification on your phone that goes “You have consumed 10 tablespoons of sugar and 500 grams of fats per day for the past month. Continuing this pattern will cause many diseases and medical problems. Would you like to switch to a healthier diet?”. Information technology will give us the ability to detect problems as they are being formed and fix them. This will also substantially lower our medical expenses. The effects of such monitoring and its aid for preventive care are mind boggling. Ever year more than 3 million skin cancer cases are diagnosed; most of these could be prevented just by ensuring that people do not spend too much time out in the sun. Cardiovascular diseases are the leading cause of death in the developed world, more than all the cancers combined. Yet, most cardiovascular diseases can be prevented entirely through diet and proper exercise.
