By Abhinav Shashank

Have you ever come across the story of Dr. Reed of MS Family Medicine Health care? The story where her consistent efforts to stay connected with her patients had helped them achieve not just their personal health goals but also improve their overall health status. The impact she created on her patient population was so huge that patients with chronic conditions have been able to reduce or stop the regular medications.

However, there is a glitch that many need to fix. Care teams had been delivering care for centuries, but was it this complex back then? Or was it even complex at all? Wasn't it as simple as the patient visiting the physician and then taking the prescribed medication with other medical procedures that doctor would suggest. As healthcare evolved from era to era to the point where we are today, the more complicated it has become- which is why there is a sense of urgency to find a workaround these problems.

The current state of US healthcare isn't what one would've imagined 30 years ago. The healthcare was simple back then, but somehow gradually it kept on getting more and more complex. Today, the scenario is that US spends most on healthcare, which is north of $3 trillion annually with the US having least life expectancy rate among the OECD nations.

Is it a rocket science problem?

In the last 50 years, we have seen humankind on Moon, rovers on Mars, images from Pluto, and so much more. Data and analytics have driven other industries so well, connecting millions across the globe, but why can't we do it for healthcare? Then why do we keep scratching our heads like we are working on a problem related to rocket science?

What do we know? What have we learned?

There are so many things we can learn from others. People have innovated to deliver better care efficiently. The only requirement is that one should be open to adapt to changes. As in the case of Dr. Reed, who managed to reduce the cholesterol levels of her patients from 15-50 points and huge reductions in hbA1c levels. What she did for her 400 patients is something anyone could have easily done with the simplest of technological aid.

We want to bring down utilization costs but can't improve on utilization measures. We want to bring health care costs down, but the outlandishly high unit costs just keep on soaring high! What can we learn from mistakes?

Healthcare is a people business, and people make mistakes - though mistakes are precisely what healthcare technology is designed to minimize.

What does the past tell us about the future?

The past trends reflect that inpatient and outpatient utilizations in the US have grown exponentially over the years. The associated unit cost is very high, in fact, it's the highest in the world, surpassing countries like Argentina, Canada, France, Germany, Switzerland, and others. One reason could be that the healthcare industry lacks the means to track quality metrics and data.

We cannot improve what we cannot measure.

In a little more than a decade, the rate of emergency visits has gone way over the rate of outpatient utilization. High unit cost, rising utilization, and skewed demographics are the uncontrolled drivers that are sucking the life out of the healthcare system. For example, consider the case of high-risk patients for cardiac arrest. If regular tests and monitoring is done, it could be conveyed to these patients that their vitals are off the charts, they could then be given the right care at the right time.

Routing patients to high-quality service locations by connecting with timely is a major prerequisite to this.

Electronic health records (EHRs) because of their prevalence and point of care influence can bring down the variation in cost significantly. For this to unfold, organizations need to adopt a strategic approach to population health management (PHM) so that they are able to stratify patients according to their distinct risk scores. Engaging in comprehensive risk stratification requires familiarization to an analytic IT infrastructure in order to rapidly identify trends and pinpoint opportunities for improvement. Even then, it can be difficult for organizations to expand their influence beyond the four walls with limited budgets. This is where care coordination strategies come into the picture for better care management of the entire population. Physicians cannot talk to
every patient and deliver care to them, but health coaches can do that for them. This is the future of preventive care.

Preventive care is the future

What's needed is for data science to be the ideal assistants to our care teams. Patient Engagement is another important aspect because it ensures that the care center is not negligent. It ensures that patients are satisfied and are not seeking care out of the network. For this to work, a well-implemented care coordination program needs to be undertaken. This is to be done because the staff needs to know risk factors or errors if any, and which patients they have to reach out to.

Assessing and analyzing social determinants is crucial and should perhaps be the first step before any sort of diagnoses, treatment, etc. For what doesn't make up the fabric of healthcare but impacts it needs to be equally addressed and social determinants qualify under that category.

Using data analytics to understand, identify and revise programs to achieve better outcomes. The root causes as mentioned above should be understood in the way that they can be identified. Resolving network leakages through analytics which can help refer physicians within the network is another coherent step in the direction.

Abhinav Shashank, Co-Founder & CEO at Innovaccer, is an expert in population health management and robust technologies. For the better part of the decade he has been working to revolutionize healthcare delivery with 25+ value-focused organization and making over 10 million lives better. Visit www.innovaccer.com