Bringing a complex health care system into alignment

Ask the chief medical officer of a major health system about the issues that keep them up at night and he or she will talk about the need to understand outcomes in complex populations, the need to engage in new business models, novel collaborations with other stakeholders, and engaging “customers” i.e. patients in new ways, all while addressing increasing cost pressures and safety concerns.

Sit down with a franchise leader in oncology at a pharmaceutical or biotech innovator and ask the same questions, and the response will pretty much be the same.

The convergence of business imperatives is largely driven by two factors: 1) the shift to value based healthcare reimbursement from volume, and 2) our rapidly advancing understanding of the causes of disease and health that holds promise to accelerate further because of the proliferation of electronic health information coupled with continued scientific innovation.  

These two factors are driving nearly all healthcare stakeholders – health systems, health plans, governments, and life science manufacturers – to struggle to answer the “hard questions” in healthcare - what works, for whom, why and at what cost? That’s the connection that aligns all segments of the health care and life sciences sectors in this emerging era of new financing, rapid knowledge expansion, increasing consumer expectations and care delivery strategies.

And the good news is that science and technology are advancing at a pace that will enable this to occur as long as policy, public sentiment and the right business models can be found to support rather than thwart the shift to value based, personalized healthcare.

For all participants, the shift towards value-based reimbursement and personalized healthcare poses challenges that will test the core of their business and operating models, as well as the technology and systems strategies to support these new models.

When Deloitte launched ConvergeHealth in 2014, we recognized that bringing different and critical elements of the healthcare ecosystem into alignment based on insights from health information had enormous transformative potential and was in fact becoming an imperative for our clients to survive and thrive in this new era of healthcare.

Our North Star goal is to help the healthcare system become a learning healthcare system, where all relevant information can help to drive higher quality, more efficient care while also enabling breakthrough insights that will lead to the next wave of medical innovation. The ultimate objective is better outcomes, delivered in a cost-efficient manner, with value based, more personalized care as the end result.

Since we launched ConvergeHEALTH, the shift towards value based care has only accelerated. Recently, the Catalyst for Payment Reform (CPR) reported that 42 percent of Medicare’s $360 billion in payments are now tied to value, the rest being made through more traditional fee-for-services. The Administration has set forth aggressive goals to significantly increase this percentage over time. The momentum from volume to value is growing.

At the same time, movement towards personalized care also is growing. The President announced a major Precision Medicine Initiative as part of this year’s State of the Union, the House of Representatives passed the 21st Century Cures Act, and the number of targeted, personalized therapies across therapeutic areas continues to grow. The long promised era of personalized medicine appears to be close.

A powerful engine available for winning this market shift is insights derived from data analytics. Important factors that will determine how smoothly that engine can eventually operate include:

• Major redirection in reimbursement. The push towards payments that actually reward outcomes, as noted, is gaining steam and requires new analytics approaches that allow us to understand financial and clinical outcomes in complex populations.
• Massive advances in science and technology. Game-changing advances in genomics, proteomics, imaging and other aspects of scientific research and development are leading to an explosion of data, laying a path towards broader and more effective application of personalized medicine. Again, interpretation of massive amounts of complex data can hold the key to success.
• The digital health wave. Electronic medical records, wearables and patient self-reported data via social media and other patient engagement technologies – are generating another tsunami of health information that could have a significant impact on health care and life sciences and fill critical gaps in our understanding of health and disease.

If data and analytics are the engine driving this shift, the vehicle for winning the market shift is new, increasingly collaborative business models.

Said another way, technology innovation is a necessary but wholly insufficient piece of supporting this shift. Business model and operating model innovation are just as critical. Deloitte is committed to innovating here as well, as our ongoing collaboration with pharmaceutical company Allergan and our frequent teammate in innovation and collaborator Intermountain Healthcare demonstrates. This is one of a number of joint ventures that enable us to leverage our ConvergeHEALTH analytics platform to support insights into what medical interventions work optimally in certain populations. (See HealthcareIT News Story - 3 heavyweights harness analytics for women's health)

These types of next generation collaborations underscore a push toward enhanced clinical and operational excellence, value-based care to improve population health management and reliance on evidence-based medicine, and establishing excellence in research by leveraging real-world evidence and comparative analysis.

The writer and futurist William Gibson put it well: “The future is already here – it's just not evenly distributed.”

That’s where health care and the life sciences stand. It’s our role to bring innovative yet pragmatic, workable strategies to ensure the future that is already here extends evenly to all industry stakeholders, and most importantly the patient.

www.converge-health.com