Electronic Health Reporter

By Dr. Giovanni Colella, CEO and co-founder, OODA Health.

2018 was another year of rapid changes in the healthcare industry. Over the past twelve months, I’ve had fascinating conversations with executives in the provider and payer community and they have described the challenges they face and their visions for the future. One thing has become clear among everyone in the healthcare ecosystem: expectations are changing.

Patients are looking for a retail-like experience for their treatment, and sure enough, a number of new, innovative providers are gaining traction by leading with convenience and patient-centricity. Patients are embracing alternatives to the traditional doctor’s office or the local hospital. Unwilling to wait for an appointment, patients are eager for more responsive, high-quality treatment options.

Healthcare providers are becoming more innovative in an effort to improve the quality and efficiency of patient care while continuing to look for ways to reduce costs. Payers are exploring new approaches to improve their back-office systems and are willing to partner with third-party vendors to accelerate this improvement, rather than trying to develop everything in-house.

I am confident that this year will be full of important change in the industry and that these changes will touch the lives of millions. Of course, there is still a long way to go since the healthcare industry is historically slow to embrace change – it is often difficult to break through a culture that normally stays with the status quo. However, the desire for change is definitely there. If I were to list my top three predictions for trends in healthcare in 2019, they would include the following:

1) Health plans will get much more serious about improving member experience and predictability.

Health plans are eager to improve their member experience, partially because of the emergence of new consumer-centric plan models. As the market becomes more competitive with new entrants, traditional health plans will continue to partner with agile startups to deliver an improved member experience. These partnerships will enable health plans and startups to pilot projects and scale them quickly, leveraging the strengths of both organizations.

2) Employers are focusing on providing access to targeted healthcare solutions that meet specific therapeutic needs.

As of 2018, 83 percent of employees say healthcare is very or extremely important to/for staying in a job or changing a job. Given the importance of healthcare to their employees, and that the average company spends $10,000 on healthcare annually for each worker, employers will recognize the need to invest in specific solutions in areas where traditional networks fall short. These include programs for infertility, women’s health and behavioral health.

3) AI will play a large role in overhauling the healthcare payment system.

According to a recent study published in JAMA, of the $3.4 trillion of healthcare spend in the US, about $500 billion is spent on administrative and oversight activities that are generally conducted with either manual processing, antiquated technology, or brittle automation that requires manual intervention/adjustment. The study estimates that about 80 percent of this overhead, or $400 billion is actually wasted cost that can be recovered by applying automation, digitization, and AI. In 2019, AI will be used to overhaul the current healthcare administrative experience and to modernize current legacy technology systems by automating manual processes. This will lead to cost savings for payers and providers and an easy to understand and consumer-centric experience for patients.

AI techniques will also help model and understand what is happening during an encounter. This includes automation being used to reduce the time spent entering data into EHRs and coding/billing activities, clinical data needed for claims processing, and producing understandable explanations of benefits and bills to patients.

One of the best parts about making predictions is circling back and reflecting. I look forward to revisiting these over the next twelve months and charting the landscapes evolution. Tweet us at @OODAHealth and let me know your thoughts or if you have some predictions of your own.

I am excited to see how things develop!