Technology: Changing the Delivery of Healthcare
The Affordable Care Act (ACA), and the broad initiative known as healthcare reform, seeks to ensure quality healthcare to all Americans while reducing or stabilizing costs. But the effort requires more than a simple mandate or new legislation that changes the way we conduct the business of healthcare. It also requires that patients assume greater personal responsibility for their health. Now, a surge in new technology development is helping them do just that.
The New Healthcare Model
Healthcare reform has brought profound changes in both healthcare delivery and the economic incentives for providers. One of the most important changes has been the gradual phasing out of the fee-for-service model, in which providers are paid for each visit and procedure. The problem with that model, experts say, is that it incentivizes the wrong behavior, reimbursing providers for service intensity rather than effectiveness. It encourages medical professionals to administer more tests, see patients more often, and perform more procedures, which is often economically wasteful and, as studies show, does not result in healthier individuals.
Indeed, the fee-for-service model means the provider is rewarded the sicker an individual becomes and the more care that is required. When provider payments are tethered to optimal patient outcomes, on the other hand, patient and provider interests are aligned and costs come down.
Healthcare reform also changes incentives for patients. The ACA makes healthcare insurance coverage mandatory. To reduce the costs of coverage, many plans provide discounts and other financial incentives for those who take more responsibility for their health. Preventive services, for example, are often provided at no or minimal charge.
Another profound change has been the level of interest patients are taking in their own care—and in the cost of that care. No longer are these individuals just patients. They have also become consumers. And, as such, they have begun to expect more from their healthcare providers.
The Rise of the Patient as Consumer
With healthcare reform we have entered a new era of patient-centric care and consumerism. The future of healthcare is in many ways tied to patient satisfaction.
Patients increasingly search for “value” in healthcare purchases—that optimal balance between quality and cost. The availability of electronic data makes it easier for prospective patients to “shop” for services using hospital rankings, physician grades, and other quality metrics.
Healthcare consumers and consumer advocacy groups are also demanding more transparency with regard to costs for medical tests and procedures. A recent poll estimated that 55% of Americans feel that providing more information to patients about the price of physician visits, tests, and treatments should be a top priority for the federal government.1
It has become evident that patients are willing to become more involved in their personal healthcare—at least from a financial perspective—but are they also willing to take an active role in improving their own health? Are they ready to share decision making with physicians, learn more about self-management, make healthier choices, make important lifestyle changes, and become less reliant on drugs or surgery while placing more emphasis on prevention?
Increasing patient involvement is desirable for 2 important reasons. First, awareness of one’s health status helps individuals make better and more cost-effective choices. Second, according to research, higher patient engagement levels result in greater compliance and, ultimately, healthier individuals.2 Highly engaged patients feel more in control and accept greater responsibility for their health.
There are many approaches aimed at increasing patient involvement, but we will focus on technology and “high touch” methods, currently in use by healthcare systems across the country. High-touch methods are an intervention or activity having high interpersonal value or connectivity (ie, a more personal way to engage another individual). These technologies enable patients to become engaged partners in their own care as well as the principal generators of data through such devices as wearable activity monitors, medical devices powered by microelectromechanical technology, or MEMS, and electronic communication with their healthcare provider.
When patients take advantage of these technological advances, they are more likely to follow treatment plans, reducing pain and other disease symptoms and possibly preventing other illnesses. Medical providers also benefit from improved patient relationships and reductions in costs.
Engagement Is Motivational
With the advent of email, texting, patient portals, and activity/medical trackers, the connection between patients and their physicians has changed profoundly. These technologies, which were initially only reluctantly adopted by the medical profession, have now become commonplace. Healthcare providers use them to monitor conditions and modify patient behavior, preventing illness or hospital readmissions, controlling or reversing chronic disease, and directing patients to appropriate treatment before their condition worsens.3
Electronic messaging can be an especially effective adjunct to face-to-face intervention in weight management and smoking cessation programs. Evidence suggests that an extra 3 minutes of talking to a patient makes a significant difference in cessation likelihood.4
An ongoing impact analysis at the Mayo Clinic is examining the use of text messaging to extend provider outreach. The analysis found that “smoking quit rates for the text messaging intervention groups were 36% higher compared to the control group quit rates. Results suggest that SMS text messaging may be a promising way to improve smoking cessation outcomes.”5
Smoking cessation is a high-priority program because of the proven downstream benefits that make this a highly cost-effective intervention.6 In addition to text messaging, mobile apps that sense when someone is entering a high-risk environment such as a bar, where others will be smoking and temptation may be greater, are also available.