5 Ways Technology Will Enable Value-Based Care in 2020 and Beyond
Healthcare in the United States is changing rapidly, and within the next few years, it will look very different than it does today.
If your first thought while reading that statement was, “I’ve heard that before – and nothing actually ever changes,” your skepticism is well founded, as industry experts have been purporting significant transformation for at least a decade. However, I truly believe we’ve reached a tipping point, and that consumers will see real healthcare change in the near future. It’s a bold statement to make, but there are a few forces at work that I believe will make it true — namely, the intersection of value-based care and technological innovation.
We’ll cover technology below, but first, let’s spend some time talking about value-based care.
What is Value-Based Care? And Why Should I Care?
Value-based care is a “new” healthcare payment model that shifts medical providers reimbursement from fee-for-service to fee-for-value, with value defined as care quality, cost, efficiency and effectiveness (you can read more about it here). Put simply, this means physicians’ salaries will be tied directly to care quality, patient outcomes and overall cost efficiency, rather than to the act of performing a test or procedures — i.e. physicians will only receive full reimbursement from insurers for effective care. As a patient, this means you should experience improved quality of care with lower costs.
This is a seismic shift in our healthcare model, and yet, many consumers aren’t even aware that it’s taking place. Value-based care models have, in fact, been a topic of discussion as far back as 2008 and were a part of the Obama Administration’s Health Information Technology for Economic and Clinical Health Act, or HITECH Act, of 2009. However, significant implementation of the model did not occur until late last year when, with the Centers for Medicare and Medicaid Services (CMS) leading the way, key payer and provider organizations announced that 48% of their business was finally tied to value-based reimbursement models. As we head into 2020, this number is forecasted to grow as high as 75% and will likely reach 100% in the not-too-distant future. Keeping this in mind, it’s fair to say we’re going to finally see true healthcare change in 2020.
Technology plays a big role in this shift for the simple reason that benchmarking and reporting on patient outcomes and care quality necessitates unprecedented health data and analytics, increased patient engagement and heightened visibility into the patient journey. Patients are beginning to demand more from their medical providers, such as the ability to book appointments online and access medical records via smartphone. These services are commonplace in other industries, yet pointedly absent from many aspects of care. Known as the consumerization of healthcare, physician practices that offer quality and convenience are poised to succeed in this new value-based marketplace. Additionally, there is more responsibility on physicians — especially primary care providers (PCPs) — to act as care coordination liaisons and to balance quality care with cost control. As we head into 2020, here are some of the changes speeding down the pipeline that consumers can expect to see in the months to come.
1. Digital Therapeutics: Engaging With Patients During Recovery
As a nation, we’re increasingly recognizing that healthcare doesn’t take place solely in a hospital or physician office setting. If the ultimate goal of value-based care is to improve a patient’s well-being, this means consumers must take their health into their own hands, acting on prescribed dietary or lifestyle changes and following through on physician referrals. New app-based digital patient engagement tools are poised to play a key role, helping patients to stay focused on health goals and giving them a place to turn for questions that come up between visits.
One area proving particularly promising is the adoption of physical therapy exercise apps for home rehab post operatively. According to Elana M. Oberstein, MD, MPH•, “Patients can now have an Avatar to do their exercises with who helps encourage and remind them what they’re supposed to be doing and when. Such an app could also come with a brace device to give the surgeon real-time feedback regarding joint range of motion, number of steps, activity level, etc., and help the physician assign additional exercises to be taught by the Avatar.”
A recent survey of patients who had participated in physical or language therapy found that 90% reported challenges with their current course of traditional treatment, ranging from cost to transport to insurance. As we move toward value-based care models, providers may soon be graded on the types of post-operative recovery options they offer. While in-person visits certainly aren’t going away anytime soon, providing at-home monitoring and exercise options, especially for elderly patients or those in remote areas, is exactly the type of quality care that value-based initiatives promote.
According to WebPT, adherence to home exercise programs is a major factor in overall patient outcomes, and telehealth has massive potential for widespread application in rehab therapy. However, many therapists feel their hands are tied with payer and government regulations, so there are still changes that need to take place before virtual therapy becomes a care standard.
2. Promoting Patient Wellness With Wearables
Sticking with the app theme, wearable technologies and associated apps will likely have a larger role to play in the general healthcare landscape as well, guiding and supporting patients with chronic conditions and those with personal health goals. While wearables are already ubiquitous for tracking fitness, in the future, they’ll help measure health objectively, identifying changes in habits that may be indicative of a developing condition and relaying this information to providers.
In fact, wearable devices and associated apps already exist to help manage type 2 diabetes, asthma, arrhythmias, clinical depression and other disorders. For example, several existing wearables have been shown to help obese, at-risk populations avoid full-blown diabetes by tracking blood glucose measurements and reporting changes to providers. Wearable EKG sensors like those in the popular Apple Watch have helped catch irregular heart rhythms in wearers, alerting them (and their doctors) of a possible health condition — and even saving lives. They can even act as a modern day life alert system with fall detection capabilities.
These technologies are getting smaller and more economically accessible (just check out this electronic tattoo that can measure vital signs) and are bringing continuous health monitoring to a level previously seen only in an intensive care unit. This additional data is coming to be known as the personal health record (PHR), and when combined with the electronic medical record (EMR), can help physicians and patients make even more informed care decisions.
3. Price Transparency: What’s The Cost Of My Care?
I doubt there are many readers here who haven’t heard of the fierce cost of care debates playing out at the national level, as healthcare is probably one of the only industries where consumers opt for a service before knowing the price. What may not be immediately apparent is that not only do patients not know the cost of their care, but providers also don’t know how they will be compensated before carrying out a service. Prices are heavily dictated by government regulations and increased transparency for both patients and providers has been a major topic of discussion. For example, check out the current administration’s new price disclosure rules. Keeping all of this in mind, it’s fair to say the cost of care will remain top of mind for some time to come.
We are, however, making progress when it comes to price transparency, and technology is playing a big role in bringing relief to consumers. Tools exist that can show patients the out-of-pocket medication costs while in the exam room, where they’re able to determine alternative drug options that fit their wallet with their provider. Price comparison technologies are becoming more common, and there’s a good chance you’ll encounter it in the coming months.
In 2020 and beyond, these technologies will go further, alerting patients and providers about in-network options for care referrals and preventing out-of-network visits to keep costs down. According to a recent study, physicians send about 25% of their patients to out-of-network specialists for procedures and surgeries, even though they recognize that this incurs a higher cost of care. But why? Nearly half of providers say they have difficulty determining whether a provider is in network. However, the technology to give providers insight about in-network options for specialist referrals already exists, and the roll-out of these platforms will continue to increase in the coming months.
4. Healthcare, Personalized: Precision Medicine and Genetics
More and more consumers have had their genetic profile tested by companies like 23&Me and AncestryDNA, the result of which are better-informed consumers who know more about the diseases they have and are susceptible to (plus uncovering some family secrets like a cousin they didn’t know existed). This allows patients to act as a partner in their own care, coming to the table with a sense of their overall health, screening plans and treatment. Because precision medicine has been shown to lead to better patient outcomes, organizations like the American Medical Association have spoken out strongly about the need for genetic testing to be a part of the value-based care model.
Combining a patient’s genetic data with that available from wearable devices will open even more avenues toward understanding disease. Databases tracking medication performance of patients with similar genetic profiles will allow physicians to prescribe patient-specific treatments. This sophistication will allow us to move beyond episodic and reactive care – the kind that happens after a disease is discovered – toward even more proactive and preventative care.
5. Dr. A.I. Will See You Now
It seems these days that you can’t discuss the future of technology without mentioning artificial intelligence (A.I.), but truth be told, true A.I. in healthcare is still in its infancy — so, no you’re not going to be booking an appointment with Dr. A.I. in 2020. However, we are on the cusp of using A.I. and deep learning technology to help physicians make more even more informed care decisions for their patients by helping to scan test results and identify anomalies.
Ophthalmology is one area where AI-guided decision support is proving to be highly beneficial, as it can provide a cost-effective and easy way to scan for retinal diseases. Many Americans today skip their yearly eye check, thinking that unless they notice any irregularities, it’s not necessary. However, that couldn’t be further from the truth. This is true especially for diabetic patients who are at risk of developing diabetic retinopathy, a debilitating disease that causes blindness, and which can’t be reversed once it’s begun.
Studies have shown that A.I. is effective at scanning high-resolution images of a patient’s retina to detect for signs of retinopathy, signaling when it’s time to see the eye doctor. A recent study found that 73% of adults aged 40 and over with diabetic retinopathy were unaware of their condition, so performing tests such as this in the primary care setting could help prevent the disease from progressing before it’s too late. A.I-guided image analysis has the potential to scan for a whole host of eye diseases, and will also be important for glaucoma screening in the near future.
Value-Based Care is Bringing Real Change
There’s no doubt that we’re at an exciting juncture in the healthcare field. Changes that have been happening over the past decade are finally reaching critical mass and our technological innovations are poised to enable true connected care.
Still not convinced? Keep an eye on industry news and the political debates surrounding value-based care, interoperability and price transparency to keep pulse on where we stand in the months to come. And better yet, see what changes you experience the next time you visit your physician’s office.
*Dr. Elana Oberstein is an on-staff physician at Modernizing Medicine.
President and Chief Operating Officer
Joe Harpaz serves as President and Chief Operating Officer of Modernizing Medicine. In his role, Joe leads growth and scale at Modernizing Medicine as the company aims to deliver best in class product and customer experience to make a true difference in healthcare tech.
Joe has over 20 years of experience in building and leading high growth B2B software businesses that operate in complex and regulated industries. He’s known for his ability to lead and inspire large organizations while driving innovation and growth at scale. Learn more about Joe here.