5 Key Digital Shifts to Enhance

In a world where technology has revolutionized industries, the US healthcare system is still grappling with challenges that hinder its efficiency and efficacy. With an urgent need for transformative changes, it’s time to reimagine healthcare and embrace innovative solutions.

Here are the five game-changing shifts vital to unlocking a more streamlined, accessible, and patient-centric system. From simplifying care journeys with network-less experiences to harnessing telehealth, virtual-first products, and automation, these changes can redefine the future of healthcare in the United States.

1. Simplifying Care Journeys

"Member-centric health plan designs and streamlined medical management are crucial for simplifying care journeys. Companies like Sidecar Health and Oscar Health have emerged as innovative health insurance models. They offer frictionless user experiences, blurring the lines of in-network providers to create a network-less consumer experience."

Sidecar Health is an example of an ACA-compliant plan that transcends the traditional in-network concept by offering a 'network-less consumer experience.’ A study shows that 60% of insured Americans would prefer a health plan with no network restrictions, emphasizing the importance of this innovative approach (HBR, 2019). With Sidecar Health, consumers can visit any doctor to receive care without dealing with the complexities of network limitations.

In comparison, Oscar Health leverages technology to simplify healthcare processes, such as telemedicine and personalized care plans. By embracing digitalization, Oscar Health ensures a frictionless experience for its users, in line with evolving consumer preferences.

Virtual-First Products: UHG, Humana, and Oscar

UnitedHealth Group (UHG), Humana, and Oscar have embraced the virtual-first approach, offering a mobile-first member experience with on-demand care options. These companies also enable patients with access to healthcare services through asynchronous methods, such as secure messaging and chatbots, and synchronous methods, like tele or video visits.

Remote Patient Monitoring: TytoCare and Beyond

Remote patient monitoring suites like TytoCare are another critical piece of the telehealth puzzle. These platforms allow healthcare providers to monitor patient’s health data in real-time, at a distance, enabling them to make informed care decisions without needing in-person appointments. By utilizing devices such as wearable sensors and at-home medical equipment, remote patient monitoring can help detect potential health issues early on and allow for timely interventions.

4. Quality Care Transparency

It involves linking physicians’ compensation to their performance using value-based agreements based on outcome metrics. However, many providers have resisted adopting value-based care models.

"Although the benefits are evident, many providers have resisted adopting value-based care models, arguing that they ration critical care to patients using medical management guidelines that are too broad and miss the mark."

Value-based care is a reimbursement model that rewards healthcare providers for delivering high-quality, efficient care. It aims to shift the focus from the traditional fee-for-service model, which incentivizes quantity over quality, to a system that emphasizes patient outcomes and overall well-being (based on a recent report). This improves healthcare outcomes by 20%. Intermountain Healthcare is an Integrated Delivery System in Utah. According to a review report, Intermountain Healthcare has saved significantly over the past two decades by implementing value-based care initiatives, including electronic health records, standardized care processes, and a focus on continuous improvement.

5. Care Personalization

Traditional approaches to healthcare often employ a one-size-fits-all mentality, which fails to account for the unique needs, preferences, and circumstances of individual patients. As healthcare leaders, we must recognize that each patient’s socioeconomics, biology, living conditions, and other factors play an important role in determining the most effective treatments and care strategies.

The transition to personalized care is greatly facilitated by Electronic Medical Records (EMRs), which enable healthcare providers to capture and analyze vast amounts of patient data. According to a report, EMR adoption is around 35% in the United States, facilitating a reduction in adverse events, re-admissions, and overall treatment costs. EMRs can assist healthcare providers in identifying patterns and trends in specific patient cohorts , allowing for the development of targeted interventions and clinical pathways. This democratization of health data allows for more informed decision-making and collaboration between patients and their healthcare providers, fostering a more personalized and effective approach to care.