Smart Metrics to Use for Improving Patient Access
Article Jun 03, 2022
Challenges are often catalysts for change, for individuals, organizations, even entire industries. Healthcare has faced its share of challenges in recent years: The industry took on a global pandemic, managing the largest vaccination distribution in history while keeping our health systems operational and learning much along the way. While these years have been tumultuous, they accelerated healthcare’s momentum toward a new era of improved access to care, information, and services referred to as the Patient Era.
The Digital Era marked the introduction of privacy and data standards and the adoption of the electronic health record (EHR). The Patient Era places the patient at the center of a new breed of digital solutions and ecosystems oriented around the individual. In this new world, patients have greater control of their health information. This changes how providers and payers share information, provide transparency, and better coordinate among healthcare’s many parts.
This is a welcome change for consumers. As patients continue to bear a greater share of out-of-pocket costs, healthcare simply hasn’t kept pace with changing consumer demands for convenience, transparency, or flexibility. Consumers spend $1,650 per person on out-of-pocket healthcare costs, and this spending is expected to increase by nearly 10 percent per year through 2026.
Change happens when consumer trends, emerging technology, industry demands, and regulation converge. In 2009, the HITECH Act ushered in the adoption of today’s health record systems (EHRs), demonstrating that, when necessary, rapid transformational change is possible. It just needs the right conditions. Today, the right combination of conditions has given rise to the Patient Era.
Consumers are demanding more from healthcare. From price transparency and shoppable services to more affordable and convenient care, patients’ wants and needs are shaping their healthcare choices. Emerging options like concierge care, retail healthcare services, and at-home diagnostic services are offering consumers options beyond the hospital or clinic setting.
Innovation continues to open new opportunities for technology to help us work smarter and faster, at a lower cost. From AI to blockchain to cloud computing, new tools and technologies are prompting organizations to rethink the processes and systems that defined the last era of healthcare. Leveraging technologies like verifiable credentials and decentralized identity, new tools are facilitating solutions for patients in ways that were never before possible.
The 21st Century Cures Act ushered in an unprecedented new wave of empowerment and control for patients. This changes the role that patients fundamentally play in the coordination and management of their healthcare. More recently, new regulations for healthcare price transparency (see below) aim to give patients more information about their healthcare costs to make more informed decisions.
The patient is at the center of the 21st Century Cures Act. Putting patients in charge of their health records is a key piece of patient control in health care, and patient control is at the center of HHS’ work toward a value-based health care system.
How can healthcare organizations resolve the patient access issues that make healthcare challenging for patients and providers? By putting better information in the hands of patients at the right time, so they can be more informed and make better decisions. This starts with greater cooperation between healthcare’s many players.
Until now, patients have not had access to the information they need in order to navigate their healthcare journeys as informed consumers. Technology has also not existed to adequate security and privacy considerations for patient ownership of health information. Allowing patients to access health information on personal devices increased organizations’ vulnerability to data breaches and HIPAA violations. The risks of patients owning their health information have been greater than the potential rewards.
In the Patient Era, patients have more control over, and access to, healthcare information. Just as health systems and providers have EHRs that communicate in terms of medical records, EDI, and claim reimbursements, patients will have access to applications and tools that enable them to navigate care and drive better financial outcomes. As patients increasingly access healthcare services and information across multiple devices, new data security tools and cloud-based technology help protect patient information.
This means a new surface for value creation, and a platform approach anchored around the individual. As providers continue to optimize patient access technology, patients will enjoy improved access to healthcare information and services, boosting loyalty and patient satisfaction.
Take something as simple as your home address and phone number. Traditionally, this information would reside in every one of your previous physicians’ medical record systems as part of your patient record. When you move to the other side of town, the record breaks.
In the Patient Era, this model is reversed. Instead, patients grant permission to their healthcare providers and insurance companies, allowing them to access their personal information, including their address. Next time you move and update your address in your mobile health wallet (that you own and control), your entire care team is kept in the loop and their systems are updated automatically.
And this extends to your insurance coverage, your immunization records, and more of your health information over time.
Patients’ demands for price transparency have ushered in long-awaited regulatory changes: the Hospital Price Transparency Rule in 2021, and the Transparency in Coverage Rule in 2022. These federal regulations expand on the Affordable Care Act’s promise to provide patients with the right information at the right time and comprehensive out-of-pocket cost estimates prior to care. This allows patients to be informed consumers, able to better understand and manage their financial outcomes.
Even with these regulatory changes, getting an accurate total price estimate today remains challenging. Take shopping for a tonsillectomy. Many providers can provide estimates for the procedure, but these likely won’t resemble the final bill a patient will receive. Determining out-of-pocket costs, while accounting for a patient’s deductible, out-of-pocket maximum, and added costs including anesthesiology costs, facility fees, lab work, or medications remains a persistent challenge.
In this new era, healthcare better supports patients—and the clinicians who provide care—at every step of their journey. As healthcare organizations become more efficient, they will also realize administrative savings.
Since our inception, Tegria has been committed to empowering patients through better access to their personal health information. By partnering with payers and providers, our solutions are designed to share data in new and engaging ways, privately, securely, and portably, so that patients are empowered to make better, and more well-informed decisions about their healthcare, leading to better outcomes and healthier communities.