CEO of Bamboo Health. Over 20 years of healthcare/tech experience with leadership roles at McKinsey and Company, Anthem, and Healthways.
Today's healthcare landscape faces a multitude of challenges driven by fragmented care. According to an international survey by The Commonwealth Fund, primary care doctors in the U.S. more frequently struggle to coordinate patient care and communicate with other healthcare providers when compared to providers in the other high-income countries surveyed.
Furthermore, a JAMA article on waste in the U.S. healthcare system estimates that poorly executed care, waste from poor care coordination, and overtreatment driven by fee-for-service roughly total between $205.3 billion and $345 billion per year.
Beyond these staggering costs, the effects of fragmented care can ultimately lead to uncoordinated care and poor patient outcomes—especially for those who struggle to access care in the first place. This can only further the ever-widening gap in health disparity and inhibit our country from helping patients, regardless of their economic and social conditions, receive the care they need when they need it most.
The Government Response
To address these health disparities, the current administration has implemented a strong focus on health equity. President Joe Biden signed an executive order on advancing racial equity and support for underserved communities through the federal government, featuring health equity as one of the order's areas of interest. Since then, the Department of Health and Human Services (HHS) and its Centers for Medicare & Medicaid Services (CMS) have followed suit, making health equity a main component of many new health plan requirements and value-based care payment models—such as the impending ACO Realizing Equity, Access, and Community Health (REACH) Model that goes into effect in 2023.
While this push toward more equitable healthcare holds great promise, actual change can only be realized when we have the proper technological infrastructure in place to:
• More readily and quickly identify high-risk patients.
• Better manage their care and costs in real-time without adding administrative burdens for healthcare providers and care managers.
Leveraging Technology To Address Health Inequities
Achieving these objectives will involve a mix of foundational, legislative, and organizational changes in addition to the healthcare industry leveraging technology to deliver more equitable, streamlined healthcare that benefits providers, patients, health plans, and the system overall.
For example, consider that many providers still rely primarily on claims data that is 60 to 120 days old to assist with care management. Unfortunately, this outdated information can result in lost opportunities to assess and impact care for today's ever-changing patient population. Commonly, this can lead to reactive healthcare practices, as providers do not have adequate time and resources to focus on preventive care and ensure proper continuity of care—furthering care and treatment gaps.
Technology can offer the ability to not only deliver actionable, real-time insights to inform and drive better care decisions, but it can also hold the key to connecting disparate stakeholders across the care continuum so they can work collectively toward achieving health equity.
Overcoming Fragmentation For More Equitable Care
The good news is that providers have already made strides toward alleviating healthcare fragmentation through the use of real-time admission, discharge, and transfer (ADT) data. However, to go one step further in pursuit of better care and outcomes, the healthcare industry must move toward technology that enables more efficient identification and treatment of high-risk patients who are often missed through traditional stratification models.
This is especially impactful for patients with rapidly rising care needs such as those diagnosed with mental health and substance use disorders, those with social determinants of health (SDoH) challenges, and those with chronic diseases. According to CDC data, this at-risk patient population drives "90% of the nation's $4.1 trillion in annual healthcare expenditures." Access to proactive intelligence can help healthcare organizations reduce risk and lower the cost of care associated with these high-utilizer patients to increase financial performance and accelerate the adoption of value-based care.
Steps that healthcare organizations can take internally to help prepare their technological infrastructure for the delivery of more equitable care include:
• Setting up the proper technology systems and networks to ensure that information is being freely shared in real-time throughout an individual health system and across other care facilities and settings. This is especially critical for the most vulnerable patients who commonly have more providers across care settings and healthcare entities. For these patients, an interoperable technology infrastructure can arm their healthcare providers with clear visibility into their care journey so that they can facilitate better care management, improve care access and prevent unnecessary readmissions.
• For improved clinical efficiency, it is essential to integrate real-time insights directly within clinicians' workflows. Doing so can enable a comprehensive patient view and make it easier for providers to identify and treat patients with rapidly rising care needs at the point of care. It can also offer critical context that can be used across providers and care settings so that all care team members are working from the same page.
• Lastly, it is crucial to employ efficient patient engagement practices that incorporate care events as well as SDoH. This will require a focus on investing in and using care coordination strategies and approaches that can help providers support proactive patient engagement and care interventions—particularly for the high-risk, high-utilization population. Such an approach can streamline follow-up workflows to improve patient experiences and outcomes as well as lessen the administrative burden.
While the elements for changing our fragmented healthcare system and policies are complex, streamlining care management processes can play a critical role in improving patient outcomes and reducing costs of care. The result can help to further equitable healthcare by connecting patients and communities to a network of providers, government agencies, health plans, and health resources that can work collaboratively to drive health equity and enrich public health and societal well-being.
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