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A less expensive, broader-based healthcare system?

Rama Juturu, March 23, 2017

New care delivery model that has a big potential: It’s going to be an excitingly different healthcare system in 15 years. It’s up to us to try to make sure that it goes in the right direction and gets there quickly enough. A less expensive, broader-based healthcare system?

I believe we can have an easy fix for healthcare costs and medical errors that is alarming: Simplicity with convenience is the ultimate sophistication.

Major Issues:

  1. The US Healthcare system is historically designed and medicine is practiced with an emphasis on:
  • Institutional care
  • Fragmented care
  • Sick care
  1. The coding system (ICD and CPT) for reimbursement of services by multiple commercial and government health plans is complex and unique to US that the citizens barley understand it.
  1. The citizens have been incurring exorbitant cost that isn’t sustainable.
  1. Diagnostic errors are a top concern in the patient safety field.
  1. The EMR that is now in place in most of the care settings are foundationally designed for billing services, this added further complexity and frustration across the care continuum that is disconnected.

Physician market dynamics empowering patient-consumer in the coming years:

  1. The control is moving from physician to patient positioning as a consumer – the millennials will crack it, baby boomers will get assistance from caregivers.
  2. Regulations are igniting a torch, the private sector will carry the torch promoting innovation benefiting the community offering: SIMPLICITY, CONVENIENCE, ACCESSIBILITY, AFFORDABILITY.
  3. Independent vs employed physician make a difference in care management.
  4. Health management requires patient-centric, holistic, nonclinical as well as clinical, data driven approach as opposed to current clinical (say 20% of health) approach promoting fragmented care.
  5. There will be a very tight integrated system among: payer, provider, patient ensuring information sharing across the care continuum by leveraging smart data, smart algorithms, smart insights at the point of care and the moment of decision.
  6. There will be emphasis on leveraging patient generated data (say 90% of whole health data) for managing health by patient-consumer.

Recommended Solution:

It is time to place an emphasis on: leveraging retail industry experience, retail convenience and data-driven algorithms.

It’s going to be an excitingly different healthcare system in 15 years. It’s up to us to try to make sure that it goes in the right direction and gets there quickly enough.

Supported by artificial intelligence-based algorithms, CVS’s pharmacists and nurse practitioners are working at the top of their licenses to provide acute and chronic care management. In the transition to value-based care, has CVS found a path to a less expensive, broader-based healthcare system?