Many technological and infrastructure investments may seem enticing these days, but healthcare leaders should evaluate which are worthwhile by considering whether they will benefit patients and enhance the value of care.
With so many new developments in data analytics, technology, and artificial intelligence competing for limited resources, resource allocation decisions are more challenging than ever in an era of disruptive innovation. And champions of various innovations can often make a compelling case for their projects.
In health care, we are all susceptible to shiny-object syndrome, which occurs when a new idea captures our imagination and distracts us from the big picture. We then risk going off on expensive tangents that don’t necessarily improve healthcare value.
Envisioning the Ideal Healthcare System
At HFMA’s Thought Leadership Retreat in October, leaders from all sectors of health care gathered to discuss the effect of innovation on the patient experience of care. When the discussion turned to defining the attributes of the ideal healthcare system as a means of guiding resource allocation decisions related to innovation, the following key points emerged.
The ideal healthcare system will reward high-value care. It will be a well-care system rather than a sick-care system. It will pay for all services that providers consider essential to achieving the desired health outcomes. These, of course, are the concepts underlying value-based payment. Continued innovation in value-based payment models is needed because early experimentation has not resulted in definitive winners. Complete interoperability across the continuum of care is a prerequisite for a high-value health system.
The ideal healthcare system will be personalized on a mass scale. It will be genomics-based, meaning precision medicine will become the standard of care. Patients will no longer experience care that’s all downside, i.e., treatment that causes side effects but has little or no chance of benefiting a patient, given his or her genetic profile.
The ideal healthcare system will value engagement with patients and communities. It will recognize that price transparency, along with clear and easy-to-understand financial communication, is integral to engagement. It will address social determinants of health, so it will be integrated with a wide array of community resources and will emphasize accessibility to a variety of care providers and services. Prevention and treatment of behavioral health and substance abuse issues will be on a par with those for other medical conditions. End-of-life discussions will be more socialized and acceptable than they are now.
Linking Innovation to the Pursuit of the Ideal Healthcare System
As healthcare leaders are faced with decisions about what types of innovations to encourage, pursue, or fund, maintaining a vision of the ideal healthcare system can point the way. Leaders should ask whether, and how, a specific investment of time, money, or other resources would:
- Directly or indirectly improve healthcare value to patients and other care purchasers
- Facilitate improved communication with patients or with other care providers within the health system or in the community
- Improve patient engagement
- Expand capabilities to address social determinants of health
- Enable the organization to improve personalization of care
- Help ensure that patients have all the information needed to make better healthcare decisions, including information about out-of-pocket costs
If a proposed innovation does not meet one or more of these criteria, chances are it’s just another shiny object.
Reimagining the Patient Experience of Care
Technological innovations have already transformed the patient’s experience of care in many ways—not always for the better, from the patient’s perspective. At first glance, it may be hard to see how innovations that bring us closer to an ideal healthcare system could do anything butimprove the patient’s experience of care. Yet we shouldn’t underestimate the potential for negative impacts associated with transformational change.
For example, wearables that continuously monitor health metrics and facilitate intervention, while a giant leap forward in many ways, may be experienced by patients as intrusive. Precision medicine may be welcomed by patients who learn they will benefit from certain care and distrusted by those who hear the difficult news that they will not.
In addition, it’s important to keep in mind that American consumers often equate procedures and medical interventions with health improvement. Overutilization is not just a supply-side phenomenon. Down the road, consumers may question whether value-based payment—by whatever name they eventually come to know it—is incentivizing providers to withhold what consumers consider to be necessary care.
To address these issues, leaders should seek ways of looking at proposed innovations through a patient’s eyes. Healthcare organizations typically fall far short of other service and consumer product organizations in having structures and processes designed to gather consumer input and feedback on a regular basis. Now is the time to remedy that.
Innovation in health care is bound to present challenges that we haven’t even identified yet. But with a patients-first and value-based perspective, leaders will be well-equipped to guide their organizations through the coming era of transformational innovation.
Joseph J. Fifer, FHFMA, CPA, is president and CEO, HFMA. Follow Joe Fifer on Twitter @HFMAFifer.