Unfortunately, I can't disagree with anything you wrote. It is important that they get this right for so many reasons,…
Faster Horses? Let’s Think Different
By Stuart Hanson
Stuart Hanson, MBA is CEO of Avaneer Health of Chicago, IL.
American industrialist and business magnate Henry Ford is purported to have said, “If I had asked people what they wanted, they would have said faster horses.” The same could be said when it comes to what it’s going to take to transform the US healthcare system, one of the most administratively complex in the world.
When compared to other high-income nations, we spend the most, yet have poorer outcomes. While we have many initiatives in place to fix our current administrative inefficiencies, what we really need is an entirely new way for healthcare stakeholders to connect, collaborate, and conduct business. That requires the industry to put aside “faster horses” thinking and move beyond more API connections, HIEs, or revenue cycle management bolt-on technologies.
Our healthcare system was designed around payer and provider processes. But at its core, healthcare is human. At the center of every procedure, every diagnosis, every transaction is a human being — a real person with expectations of being treated with dignity at a moment when they are most vulnerable. Yet our back-office processes aren’t built around the patient; they are designed around transactions. Those transactions move across disparate data silos, point solutions, aged technology infrastructure, and manual processes. Many of us can share experiences of how we have been personally impacted by our current systems.
It’s time to create a new way of working together that puts the patient first, restoring the humanity of healthcare. That requires a level of data fluidity that we currently lack, fluidity that enables the sharing of data and seamless collaboration for more effective back-end processes and better patient experiences.
While APIs are great at establishing point-to-point connectivity, they aren’t the answer for achieving true, seamless interoperability that puts the patient first. APIs are still focused on the transaction and the transaction type. We need a digital ecosystem built on a highly secure, decentralized peer-to-peer network that leverages common infrastructure, as well as tools that enable collaboration and trust — a data superhighway. This approach puts the patient, patient identity and all needed data at the center.
With the type of interoperability delivered in a decentralized network:
- Participants retain ownership of their data while giving access (with permission) to the data needed.
- Instead of sending files back and forth, there is automatic access to data and the data owner can revoke rights at any time.
- A single person identity (for the patient/member/provider) and intelligent matching creates confidence in the accuracy of the information exchange.
- FHIR standardizes the data.
- Solutions on the network enable participants to interact, transforming administrative and clinical processes.
One of the most significant benefits of a decentralized network is its ability to provide an unprecedented level of transparency and accountability, which supports greater integrity and personal responsibility among participants. With a decentralized network built upon innovative technologies, the data becomes immutable and is always refreshed and current, eliminating the need for third-party validation. This type of data fluidity would enable real-time risk adjustment, simplified quality reviews, and more proactive process improvements.
Another benefit of this type of network is that payers, providers, and solution vendors can connect to any other network participant without having to build or maintain another API. It’s a completely new way of doing business.
From a patient’s perspective, greater data fluidity via a decentralized network can eliminate much of the complexity that inhibits seamless, timely access to care. Prior authorizations can be completed in minutes instead of days or weeks, reducing delays in care. Referrals take seconds, helping to eliminate gaps in care. Accurate patient financial responsibility can be determined in real time so patients know with 100% certainty what they will owe prior to their service. Patient medical records are accessible in real time no matter where the patient has been seen in the past, giving the provider a complete view of the patient’s medical history without having to request, email, fax, or send records through the mail.
Leveraging a peer-to-peer network, developers and innovators could connect on a single platform and use common tools to collaborate with other stakeholders. Connecting innovators and stakeholders across the ecosystem on a single platform would enable co-creation, which would allow much needed innovations to reach the market faster. Payers win, providers win, vendors win, and most importantly, patients win.
Interoperability is a term that invokes thoughts of payer-provider processes. While that’s true, we need to rethink what it means in terms of the patient. We need to take a step outside of the interoperability solutions around us and rethink how the business of healthcare could work. Instead of trying to fix a broken system, we should reimagine a completely new system, one unencumbered by layers of inefficiencies that inhibit patient care and one that reinvents the patient experience for good.