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How Obamacare will usher in a consumerization of healthcare

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By

Contributing Writer,

CITEworld |


PT

In less than two weeks, the majority of the provisions in the Affordable Care Act (a.k.a. Obamacare) are slated to go into effect, including the start of coverage for health insurance plans purchased from online exchanges (despite the flawed rollout of healthcare.gov). While the exchanges and the potential to expand coverage to individuals and families that previously couldn’t afford health insurance is the most public-facing part of the law, they represent only a portion of the law’s efforts to reform healthcare in America.

The American healthcare paradox

Expanding coverage to the millions of Americans without health insurance and improving the overall quality of coverage are noble goals in their own right, but they’re also practical steps towards tackling a bigger problem — the rising costs of healthcare in America. The U.S. has poorer healthcare outcomes across most major metrics for measuring care compared to other industrialized countries despite spending much money on average than other countries — a phenomenon known in medical circles as the American healthcare paradox.

Extending coverage can lower costs by providing better access to primary care, so patients don’t wait to get really sick and end up in more expensive emergency rooms, and better preventive care. But extending coverage can only lower costs by so much. That’s where other provisions of the law come into play. These provisions are designed to shift the basic economic model of healthcare in America away from the fee-for-service model, in which hospitals or providers are reimbursed solely on the number of procedures or tests performed regardless of the ultimate outcome. Instead, the law is trying to move to the accountable care principle, in which hospitals, medical groups, and practitioners are rewarded for keeping a patient healthy and penalized for poor outcomes that are considered preventable.

One of these provisions that has been in effect since 2012 penalizes hospitals with high rates of re-admission, meaning someone was discharged after being treated but later needs to be admitted again for the same issue or complications related to treatment — a common metric for hospital performance. The federal government penalizes hospitals with excessive re-admission rates by lowering their rate of Medicare reimbursement by one or two percent (depending on the number of re-admissions) for the upcoming year. In 2013, about two thirds of U.S. hospitals were penalized, most at the higher two percent rate cut.

As a result of these penalties, many hospitals are examining their discharge policies and processes. During most hospital discharges, a patient is given a packet that includes reference material about his or her condition(s), follow up instructions, prescriptions for any medications they need to continue, and the names and contact information for any doctors or other healthcare professionals that they need to see for post-discharge care. Patients are often left to fill the prescriptions and schedule follow up appointments (and to arrange transportation to them) on their own. To reduce re-admissions, many hospitals are now revising their discharge processes and devising ways to coordinate ongoing care and to ensure that patients adhere to treatment plans so that they don’t need to be re-admitted.

Along with hospitals, many medical groups and healthcare practices are also facing similar shifts, in part because of the influx of new patients expected to occur over the next year as a result of expanded access to health insurance and Medicaid (in states that have chosen to expand Medicaid in accordance with the new health law).

A buzzword in the healthcare community that has been gaining traction is team-based medicine, a concept that places the responsibility for a patient’s health and wellness in a team of professionals — doctors, nurse practitioners, physicians’ assistants, nutritionists, physical therapists, and so on — rather than in an individual primary care physician. This approach allows for better allocation of time and skills — a nurse practitioner, who costs less to hire than a physician, can still perform many evaluations and treatments while a nutritionist may be both less costly and better suited to working with a patient on issues of weight or food-related chronic conditions. 

But accountable care requires a different set of resources. Post-discharge care for a hospital — particularly for older patients, patients with multiple chronic health issues, or patients without strong family support and caregivers — can mean hospital staff must not only ensure that patients make follow-up appointments, but also ensure that they have transportation and that patients understand and adhere to treatment regiments discussed during those appointments.

This changing focus requires more outreach to patients, and often that outreach is assigned to a health coach. These folks coordinate activities that support wellness but that aren’t strictly medical in nature, like maintaining an exercise practice, using stress management tools, and connecting patients with chronic conditions to support groups.

All of this also requires much tighter integration and discussion among physician and non-physician members of the practice.

The consumerization of care

Today, moves to accountable care models require lots of staff, and hospitals and medical groups adopting such models are hiring ranks of health coaches and care coordinators to provide such umbrellas of care. These newly minted healthcare professionals must have access to a range of tools and interventions that encourage patients to work as active partners in their own care. That may be a challenge, but the good news is that many consumer-oriented technologies can be leveraged to help patients stay healthy. The consumerization trends in IT actually provide a good model for healthcare organizations.

Mobile devices can play a vital role in accountable care models. Studies show that simple solutions like push notifications or text messages reminding patients of appointments, needed prescription refills, and similar tasks can be very effective. Research has shown that seniors, typically considered the least likely demographic to embrace technology, are embracing digital and mobile tools for managing their care.

Smartphones and tablets can also be used for remote consultations and telehealth visits, like those supported by the new Doctor on Demand service, allow users to record symptoms as they occur so that they can provide a more complete picture on visiting with their doctor using apps like AskMD, serve as an easy to access and portable data store for drug and treatment details, record data from smart medical devices like blood pressure or glucose monitors, and encourage fitness and wellness with a range of publicly available apps. Mobile device users can also rely on both built-in and third party apps for reminders to take medication, perform physical therapy exercises, or record data to examine later with members of their care team. Solutions that leverage mobile devices like to ensure medication and treatment adherence are also coming into the market that range from reminder apps to smart pill bottles

For organizations that do extensive patient outreach and offer at home services like visiting nurses or home health aids, tablets and smartphones offer a powerful tool in that they allow practitioners to  access to access detailed patient and treatment information via electronic health records. They also allow for immediate data entry that can include photos, videos, and location information. Much as they do in hospitals, tablets can help illustrate conditions or injuries and demonstrate how to do physical therapy or other medical tasks using still images and videos.

Consumer wearable devices are also beginning to be adopted in medicine, despite the fact that most device manufacturers are focusing their marketing efforts on young healthy patients looking to stay in shape or lose weight. Activity trackers have begun to be seen as much as a status symbol as a fitness tool in some communities. Although not designed specifically for medicine, many activity trackers can provide a wealth of information both in the hospital and at home.

A recent study at the Mayo Clinic tested the efficacy of trackers from Fitbit to improve care of patients following heart surgery and found that their activity data could alert a care team to potential issues as well as allowing for faster interventions by doctors, nursing staff, and physical therapists. Since many of these devices can sync data with a smartphone using Bluetooth LE and transmit that data to a repository, there is also the potential for syncing that data with a hospital or medical group systems and allowing specific signs of inactivity to alert a health coach without requiring coaches to study every patient’s activity data on a daily basis.

Virtually all activity trackers and related fitness apps include a social component that allows users to compare their fitness achievements with friends and strangers alike. Integrating such tools into an accountable care model can help patients stay healthy. Creating a social environment of patients within one app is one great example. Helping patients to choose a tracker and a fitness community that provides ongoing encouragement is another.

Social solutions can play a bigger role for people with specific chronic conditions. Several communities already exist online as either dedicated sites for patients with a particular disease or as communities on broader social networks like Facebook, Google+, or Twitter. Those groups can function as a support and information resource, and many patients find that environment more comfortable and familiar that a traditional support group. Such groups also help patients exchange strategies about managing their conditions as well as encouragement to stick with a treatment regimen.

The biggest lesson for accountable care organizations from IT. The role of the health coach is something very new that will evolve over time. The biggest lesson that health coaches and accountable care organizations can take from the consumerization of IT is the importance of understanding user behavior and motivations. Much as IT professionals confronted with a user illicitly sharing confidential data using Dropbox need to understand why the user is doing so — what problem Dropbox is solving that existing enterprise solutions don’t — in order to offer a solution that’s secure and meets the user’s needs, health coaches and their organizations need to discover why a patient isn’t adhering to treatment or wellness regiments in order to find an appropriate technology or non-technical solution that keeps him or her on track and healthy.

This story, “How Obamacare will usher in a consumerization of healthcare” was originally published by

CITEworld.

Ryan Faas, a contributing writer for Computerworld, is a technology journalist and author who has been writing about Apple, business and enterprise IT topics, and the mobile industry for over a decade.

Copyright © 2019 IDG Communications, Inc.

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