To foster innovation, the Trump administration, regulatory agencies and other healthcare players should place more emphasis on value-based care, prioritize the user experience, foster nontraditional and local partnerships, remove unnecessary regulations and protect consumer data, a panel of industry experts said Wednesday.
The panel, hosted by Politico and CVS Health, argued that meaningful change will come from traditional players fixing their gaze on value-based care, not from any major advances in technology or novel business models.
Amazon was noticeably absent from the discussion. The e-commerce colossus, which usually crops up at one point or another in these conversations on the changing healthcare landscape, was brushed aside. The payer point of view was also not discussed.
The first step to long-term, lasting innovation is aligning financial incentives, followed up by a cultural and behavioral shift within traditional healthcare players, the four panel experts argued. New models prioritizing value-based payment are putting some onus on the healthcare system and causing some pain points.
"Healthcare is in this really awkward place where we have one foot in the value-based payment model and the other in fee-for-service. And those are two canoes going in two completely different directions," Ann Hwang, director of Community Catalyst's Center for Consumer Engagement in Health Innovation, said.
Mona Siddiqui, chief data officer at HHS, agreed that fee-for-service and value-based care are diametrically opposed and that moving payment models toward the latter is only the first step. "To say automatically that [value-based payment models are] going to transfer into an amazing patient care experience is to conflate the two," she said.
So, although the panelists agreed that the Trump administration is making important headway in initiatives to prioritize quality over quantity of care, that's not enough on its own.
"If we were to start with a clean slate and think about how we would redesign the system," Siddiqui said, "it would not be centered around a brick-and-mortar place" — the hospital. "Eighty percent of what we do in the hospital does not need to be done in the hospital," she said.
In the facility-centered system found today, "a lot of the burden falls on the patient," Hwang said, and Jay Desai, CEO and co-founder of national care coordination network PatientPing, agreed.
"There's a war that’s being waged around the patient, between the community" (local points of care like CVS MinuteClinics) "and the health system," Desai said.
But change will likely come from traditional players that are already well-positioned within the healthcare space — "people who understand the basic problems in healthcare," Siddiqui said. It's a hard road for startups given the lack of wiggle room (financial or regulatory) on the path to success.
Healthcare companies likely to withstand painful industry headwinds are those that will put the patient at the center. A hospital that sees itself as the center of the healthcare system "will not be around for a very long time," said Peter Basch, senior director for health IT quality and safety at nonprofit health system MedStar.
Another key to success is careful treatment of patients' health data.
Patients want control and access of their personal health information, but it has to be disseminated in a clear and actionable way. Simply turning over reams of confusing medical records, many from different systems with formatting in different styles, is the wrong paradigm for both the patient and provider, Siddiqui said.
Hospitals posting pricing data online per a new CMS requirement is the perfect example of what not to do, Hwang said, calling the chargemasters "Nordstrom Rack prices." It just confuses the average consumer more because "you know that's not the real price," she said.
The root of this issue, and its greatest potential solution, is interoperability. Three years after the 21st Century Cures Act, the industry is still waiting on concrete guidelines or standardization from the Office of the National Coordinator for Health IT.
"The internet connected computers,” Desai said wryly. It shouldn't be "that big of a deal to move medical records from one system to another."
The bedrock of the technology is already there, panel members said. Any more meaningful steps forward won't be based on groundbreaking new science or hardware, and will go far toward shrinking the disparities in quality of care between the different rungs of the socioeconomic ladder.
"Our devices now allow for more connectivity without necessarily getting special health devices," Brasch said. "A lot of what we're talking about could be done with tech that's already in hand" and relatively inexpensive, such as the use of smartphones to help with care access, remote monitoring and more.