Although the impact of potential changes to the Affordable Care Act and other healthcare regulations are a top focus, IT leaders in the healthcare sector are looking at other forms of friction in how their organizations operate and serve patients and providers. Adam Nelson, chief operating officer for life sciences and healthcare technologies at NTT Data Services, offers insights about how these factors are affecting IT investments by US healthcare providers, insurance companies, and life sciences firms.
How have patient expectations around healthcare services changed?
When patients interact with the healthcare system, they expect the same level of technology and customer service that they find when they interact with retailers. But healthcare providers are still operating at a much less sophisticated level. For example, the patient will ask, “If I can use my health plan app to find a provider, why can’t the app schedule the appointment?” Patients also expect clear information about costs, but they seldom get it, because of the multiplicity of contract arrangements between providers and payers. And patients are frustrated by the lack of information sharing among providers in an era of electronic medical records.
In addition to uncertainty about legislative and regulatory changes, what other friction factors exist in the US healthcare environment?
For all healthcare providers, processes for making appointments and responding to patient questions create friction for both staff and patients, as do claims coding and processing. Technology exists that could greatly reduce all of that friction. For hospitals, lack of support for patients after discharge is another source of friction. Often, patients get readmitted to the hospital within 30 days of discharge (with huge impact to the hospital’s bottom line) because they don’t understand what they need to do after discharge and have no one to call to get their questions answered in real time. Telehealth and remote monitoring could reduce that friction.
For payer organizations, contracting with employers and providers requires flexibility, which results in complex internal processes that their systems are ill-equipped to handle. Customer service and a lack of transparency is also a source of friction for both staff and members. Payers often underestimate the cost of this friction, in the form of lower member trust and satisfaction. Care management can also be a source of friction if the health plan has inadequate systems for ensuring quality and cost-effectiveness of care, which are important to profitability.
For the life sciences, staff members encounter friction in serving customers. How easy is it for an employee to post a contract, negotiate a price, find the right products and ship them? For medical product companies, new competition from commodity suppliers like Amazon is breaking the traditional link between high-end devices and commodity products, a link that has been key to profitability. They will need to understand buyers’ attitudes toward their companies and create a good omni-channel experience for buyers to combat this new competition. For pharmaceutical companies, enrolling participants in drug trials and ensuring they remain active and adhere to instructions is paramount. Trials have significant friction, with a multitude of devices and participants, and data collection that depends on in-person interviews and manual data entry. Removing friction here is a time and money saver, and a strong factor in chronic care management and precision medicine.
How can healthcare organizations address these factors with new IT investments?
The best IT investment is often a consultant who can give an objective assessment of friction points, help prioritize needs based on business goals and design a systems architecture that integrates data from a wide array of sources and blends existing technology with new capabilities. Cloud-based applications and storage can be a smarter choice than buying new hardware and software, especially if your systems architecture is flexible, agile and ready to integrate disparate data. One of the most critical constructs in an architecture is balance: shifting from a large ERP or legacy system that has become costly to support and difficult to upgrade toward dozens of XaaS platforms that provide focused business outcomes can be almost as costly and difficult to maintain from a data integration perspective. Balance in an IT architecture is paramount, and selecting platforms that support the majority of a firm’s business units and that can be governed is key.
What results and benefits do US healthcare organizations expect from IT?
For providers, key benefits are to improve patient outcomes through improved teamwork and data sharing, because future competitiveness and business growth will depend on proving value to payers. Payers expect to see higher levels of employer acquisition and retention, reduced administrative costs through automation and lower medical costs through better care coordination. Life sciences companies expect ROI from increased volume and profit margin for sales or decreased cost and time associated with business processes. These organizations seek technology with the flexibility to adapt to ongoing change in the industry and with an experience that plays toward the actual consumer, be it a patient, an employer (buying benefits), a provider system, or a clinical research organization.
As value-based care becomes more pervasive, these organizations will look to IT for help, certainly in patient engagement, yet even more so in collaboration between payers, providers, and life sciences companies. The B2B collaboration and experience, and the reduction of friction among shared processes across the ecosystem, is essential before the patient will truly experience uplift and be able to translate that into positive behavior change.
Thank you, Adam, for offering these useful insights into the American healthcare environment today. It’s clear that technology will play a vital role in helping all parties deliver continued improvements, even in a time of uncertain change.
Healthcare IT Investments Around the Globe
Healthcare organizations worldwide are using new technology investments to drive digital business, reduce costs, and make improvements in patient care and safety. Learn more by reading the other articles in this series: