Tuesday, February 18, 2014

Monetizing Wellness, to Drive Value-Driven, Outcomes-Based #Healthcare Transformation in the U.S. #NVTC #NVTCBEA

Thanks very much go to John Teeter - Managing Director, Federal Advisory at KPMG, Global Center of Excellence for Health and former HHS CIO - for his presentation and discussion leadership at today's #nvtc joint committee meeting (Health Technology and Business & Enterprise Architecture #nvtcbea ).

The dialogue revolved around a principle challenge and opportunity in the Global and particularly the US healthcare transformation debate - bending the cost curve of US healthcare through better health outcomes - driven in part by use of the rapidly-growing and effective availability of health performance data analytics. Decreasing costs, by focusing on quality - upfront and often.


Also, overall costs and payments can (now with advanced analytics technology) be more accurately and effectively "bundled" by integrated outcomes that cross provider boundaries - not just by service, by episode, by event, by facility.  The better outcomes are dependent on care investment at every stage, particularly at the Primary Care level.

By focusing attention on and funding regulatory, technology and organizational process improvement initiatives in the primary care/wellness phase of the healthcare services continuum (vs. so much in the secondary/tertiary phases, i.e. the "reactive" phases), outcome quality measures (by person, by population, by case segment) can be dramatically improved, thereby lowering "fee for services" costs and also lowering the overall expense of patient-centered health delivery.

This is "optimization of the gatekeeper function" of the Primary Care provider. The patient becomes the unit of measurement - i.e. their overall status, their engagement metrics, their behaviors. The patient, and the provider, also are more likely to participate in a "value-based benefits" system - where cost-effective (healthwise) behavior is rewarded with better health outcomes and opportunities for the patient, and more business for the provider, in essence "monetizing" the wellness activities.

This is in stark contrast to the status quo, which as Mr. Teeter put it, is usually a "perpetual revenue stream", from specialist visit, to referral/consult, to lab, to pharmacy - and repeated, the more cycles, the more revenue, but each cycle focused only on a particular condition and associated services.

Actual outcome quality initiatives the transformed healthcare industry require, would need to be built on foundations (already underway) aligned with standard Enterprise Architecture models.  The base includes informed, applied regulatory enablers (i.e. legislative mandate and governance); on top of which transformed healthcare payment and delivery business operating models would rest (i.e. the "Business Architecture"); run on modernized information technology platforms (including robust, big data-aware analytics and "Internet of Things" - IoT - platforms); ultimately enabling interoperable, standards-based health data services ecosystems.

The Big Data/IoT platforms are particularly promising, as regulators and healthcare IT professionals wrestle with the question of how, when and why to insert additional data attributes (from everything from social media to ingestible sensors) into personal health records - in a safe, secure, standard manner.

This dialogue will obviously continue in government and industry - and also within the NVTC Business & Enterprise Architecture and Healthcare Technology upcoming committee meetings and presentations.  Check NVTC.org for the next events...

No comments: