The Coming Health Care Transformation: Empowered Patients and Better Value

Population Health ManagementVol. 26, No. 4 CommentariesFree AccessThe Coming Health Care Transformation: Empowered Patients and Better ValueBala Hota and Brian SteinBala HotaAddress correspondence to: Bala Hota, MD, MPH, Tendo Systems, Inc., Hinsdale, IL 60521, USA E-mail Address: [email protected]https://orcid.org/0000-0003-4389-1109Tendo Systems, Inc., Hinsdale, Illinois, USA.Search for more papers by this author and Brian SteinDepartment of Medicine, Rush University Medical Center, Rush Health, Chicago, Illinois, USA.Search for more papers by this authorPublished Online:14 Aug 2023https://doi.org/10.1089/pop.2023.0123AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail IntroductionWe are optimistic about the direction of American health care in the next 3 years. A well-known quote from Bill Gates is that “We always overestimate the change that will occur in the next 2 years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction.” The past 3 years have seen the rapid change and partial reversals that occurred during COVID-19: for example, telemedicine, at-home work, universal masking, and the politicization of public health. Ultimately, we believe the future offers hope to get right those challenges that we have struggled with for many years.Current BarriersThe US health care system, despite years of initiatives and plans, has not improved on some core challenges. We spend nearly 18% of GDP on health care—versus the OECD average of nearly 10%—whereas we have the lowest life expectancy at birth of all OECD countries.1 Likely causes of this difference in outcomes are the highest rates of avoidable deaths, maternal and infant deaths, deaths from assault, chronic diseases, and most recently, deaths from COVID-19. African Americans have been found to have a 26% overall higher risk of death versus Whites,2 with some cities having much higher differences in rates between African American and White individuals, highlighting the inequities in the system. Clinical inertia—a failure to start or intensify treatment for patients with chronic diseases—is a significant contributor to worse outcomes, and has shown ethnic and racial disparity in distribution.3,4An additional barrier is that our care is fragmented, crossing systems and providers, leading to incomplete information, medication and test overuse, and increased cost.5 Fragmentation has been estimated to cost the health care system $25–45 billion annually.6 What has been underappreciated is that fragmentation is also contributing to most stakeholders feeling disempowered. Physicians feel burned out and struggle with moral injury, subject to incomplete information, hard to use technology systems, and incentive structures that feel arbitrary. Health systems are in a challenging economic environment in which margins are declining, and post-COVID-19, are struggling with rapid changes in health care delivery and new entrants. Patients, who carry the human risk in the system, continue to struggle through confusing and difficult to navigate systems, payment models, and care pathways.SolutionsOur view is that several key trends will align, and we will see change in the next 3 years across 3 axes.Empowered patients with better outcomesConsumers have come to expect high levels of functionality from consumer-based applications. Software that can guide a consumer through a pathway that crosses experiences longitudinally can unify complex steps that includes multiple handoffs into a single cohesive experience. By putting the patient at the center of the longitudinal health care journey, we can solve the fragmentation of the experience and drive downstream effects. More activated patients can improve engagement with care plans, and more transparent views of next steps can lead to reminders and behavioral methods to drive connection. Personalization can help to address social determinants of health differences, with linkages to services and surfacing issues for providers.Generative artificial intelligence (AI)—such as GPT-4 (and GPT-5 and 6?)—also offers great promise. Amid the recent hype for these technologies, we have seen generative AI perform well on complex medical examinations7 and in patient communication.8 What must be solved before broad use of AI is safe, private, and compliant use of these tools. Generative AI will be an important aid to patients and providers to facilitate communication and act like a trusted advisor to surface concerns and provide reassurance. By acting as an intelligent intermediary, AI can reduce the load on physicians and improve knowledge for patients.Better choice through improved measures of qualityWe may finally be achieving the aims of interoperability, which is safe and complete transfer of information seamlessly between stakeholders in the health system. Key legislative and Office of the National Coordinator rules efforts have led to Trusted Exchange Framework and Common Agreement and information blocking rules (look up names). The practical application of these initiatives has yet to be fully felt, but many technology companies have incorporated the Fast Healthcare Interoperability Resources standard into their software stack. A tangible benefit of better data will be measures of quality and cost that are personalized and targeted. Better data that incorporate patient-reported outcomes, pain scores, and measures of comorbidity would enable patients to transparently choose providers and have better knowledge of care quality. Some promising beginnings in these domains are emerging, such as measurement of potentially inappropriate utilization and avoidable complication rates, but much more needs to be done, building on the base set by value-based care models.Better value through novel economic modelsContinued innovation in payment models may help move more care from the hospital to the outpatient setting. Health systems are seeing new entrants—nonhospital providers such as Amazon/One Medical, CVS and Walgreens, and Accountable Care Organizations and Medicare Advantage funded providers—innovate models of care at scale. Continuing experimentation with payment reform has led to alternative payment models, the expanding oncology model, and increasing Medicare Advantage use.These models continue to need improvement—Medicare Advantage plans have been criticized for excesses in comorbidity capture, whereas Accountable Care Organization programs have yielded more benefit for pure ambulatory providers, not hospital-based systems. Significant opportunity exists to reduce costs through more effective postdischarge care; incentives could be better aligned to reduce the costs of readmissions, skilled nursing facility, and long-term acute care hospital care. When combined with better data and measures, the power of these programs will be to fund better care outside the hospital in more convenient less expensive venues for patients.ConclusionAlthough health care is undergoing a period of rapid change, it is unknown what innovations will be successes and which will be forgotten. Clinical leads and technologists should focus on the patient, and how to center care on their needs and concerns. In that process, the opportunity to remove inequity and improve quality is significant.Authors' ContributionsBala Hota: Conceptualization, writing—original draft, writing—review and editing. Brian Stein: Conceptualization, writing—original draft, writing—review and editing.Author Disclosure StatementNo competing financial interests exist.Funding InformationNo external funding was provided for this work.References1. U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes [Internet]. 2023. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 Accessed May 1, 2023. Google Scholar2. Benjamins MR, Silva A, Saiyed NS, et al. Comparison of all-cause mortality rates and inequities between black and white populations across the 30 most populous US cities. JAMA Network Open 2021;4:e2032086. Crossref, Medline, Google Scholar3. Fontil V, Pacca L, Bellows BK, et al. Association of differences in treatment intensification, missed visits, and scheduled follow-up interval with racial or ethnic disparities in blood pressure control. JAMA Cardiol 2022;7:204. Crossref, Medline, Google Scholar4. Karam SL, Dendy J, Polu S, et al. Overview of therapeutic inertia in diabetes: prevalence, causes, and consequences. Diabetes Spectr 2020;33:8–15. Crossref, Medline, Google Scholar5. Kern LM, Safford MM, Slavin MJ, et al. Patients' and providers' views on causes and consequences of healthcare fragmentation in the ambulatory setting: a Qualitative Study. J Gen Intern Med 2019;34:899–907. Crossref, Medline, Google Scholar6. Hackbarth AD. Eliminating waste in US health care. JAMA 2012;307:1513. Crossref, Medline, Google Scholar7. Nori H, King N, McKinney SM, et al. Capabilities of GPT-4 on medical challenge problems. arXiv; 2023. Google Scholar8. Ayers JW, Poliak A, Dredze M, et al. Comparing physician and artificial intelligence Chatbot responses to patient questions posted to a public social media forum. JAMA Intern Med 2023;183:589–596. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Volume 26Issue 4Aug 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Bala Hota and Brian Stein.The Coming Health Care Transformation: Empowered Patients and Better Value.Population Health Management.Aug 2023.209-210.http://doi.org/10.1089/pop.2023.0123Published in Volume: 26 Issue 4: August 14, 2023PDF download