As we enter 2021, there is much to be hopeful for. As we continue to battle a global pandemic, manage the largest vaccination distribution in history, and keep our health systems operational, I’d like to turn our attention to the future. While most will remember 2020 as a year of confusion and suffering, there was a hidden signal in all of the noise - the onset of the next era of healthcare that brings promise and hope: The Patient Era.
The Digital Era marked the introduction of privacy and data standards and the adoption of Electronic Health Records. Now, the Patient Era will introduce the patient as the new platform - and with it, a new breed of digital solutions and ecosystems oriented around the individual and consumer. In this new world, patients will have greater control of their health information than ever before, and this will change how we share information, shop for care, provide transparency, and better coordinate among healthcare's many parts.
Change is Needed
We’ve talked about the need for transformational change in healthcare before, and the many challenges rooted in core administrative process and information availability (or lack thereof). For Lumedic, we continue to be focused on the patient financial journey through healthcare. From patient registration and eligibility to price transparency and billing confusion, healthcare still operates in an administrative world that was built for providers and insurers in support of claim reimbursement processes.
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. Instead, patients are left to fend for themselves often times. We need to comprehensively rethink the patient’s role in healthcare. This means putting greater information in the hands of patients at the right time, so that they can behave as informed consumers and make better decisions.
We also often stress the importance of change that originates from within our health systems, not simply external solutions that fail to penetrate healthcare’s core. Change on the scale that we need it won’t simply come from a new app, better tech, different processes, louder advocacy, or industry standards alone. It’ll come from cooperation among healthcare’s many parts, and it must start from within. But change is hard, and how do we get started?
The Right Conditions for Change
When we look to the past, change happens when we have the right convergence of technology and industry demands, complemented by regulation. It was only ten years ago that HITECH 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, we have the right conditions: Rising consumer demands, new enabling technologies, and comprehensive regulation.
Consumers are demanding more from healthcare. From price transparency and shoppable services to rising out of pocket costs and high deductible health plans, meeting patients not just on their health journey, but on their financial journey through healthcare is more important than ever. Patients owe a greater share of their healthcare bills than ever before, and when they look for answers and tools to help understand and manage their costs they rarely succeed.
Innovation continues to open new opportunities for technology to help us work smarter and faster, at less cost. From AI to blockchain to cloud computing and smartphones, a new pattern exists today that lets us rethink the processes and systems that defined the last era of healthcare. Leveraging technologies like verifiable credentials and decentralized identity, the right tools exist today that will let us build solutions for patients in a way we haven’t been able to unlock until now.
With the 21st Century Cures Act (Cures Act), we are ushering in a new wave of empowerment and control for patients that has never before existed. This will change the role that patients fundamentally play in the coordination and management of their healthcare. With the passing of the Cures Act, patients will be supported with:
- Transparency into the cost and outcomes of their care
- Competitive options in getting medical care
- Modern smartphone apps to provide convenient access to medical records, at the patient’s request
- An app economy that provides patients, physicians, hospitals, payers, and employers with innovation and choice
“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.”
The Patient as the New Platform
Until now, patients have not had access to the information they need to navigate their healthcare journeys as informed consumers. Technology has also not existed to provide patient ownership of the health information with adequate security and privacy considerations. Said another way, the risks of patients owning their health information have been greater than the potential rewards.
In the Patient Era, we see a world where patients exist as the new platform. Similar to how health systems and providers have EHRs that speak medical records, EDI, and claim reimbursements, patients will have a platform that speaks healthcare to navigate care and drive better financial outcomes. This means a new surface for value creation, and a platform approach anchored around the individual.
Patients Will be a Trusted Source of Information
Take something as simple as your home address and phone number. Today, this information lives in every one of your previous physician’s 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 will 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 Will Finally Have Price Transparency
We’ll be able to provide patients with the right information at the right time, to provide comprehensive out of pocket cost estimates prior to care. This will enable patients to behave as informed consumers, able to better understand and manage their financial outcomes.
Take shopping for a tonsillectomy. Getting an accurate total price estimate today remains challenging. Many providers will be able to provide estimates for the procedure, but these likely won’t include the anesthesiology costs or the facility fee, let alone any lab work or medications.
In the patient era, patients will receive an accurate out of pocket estimate prior to care because they’ll have all the required information in their control
- insurance coverage with real-time eligibility status (how much you’ve spent against your deductible)
- negotiated fee schedules for the full care team, and whether they’re each covered benefits (the real prices for you)
- a single out of pocket estimate that contemplates co-insurance and coverage limits
- a single payment experience that presents your tonsillectomy as one bill, not five.
In the patient era, this is all magically instantaneous. But it’s only possible if we embrace patients and enable them in their new role.
The Patient Era is Here
This is what gives us hope. We see a path to a state of healthcare that better supports patients at every step of their journey - and it means administrative savings at every step of the way.
Since our inception, Lumedic has been committed to empowering patients through better access to their personal health information. The Cures Act, combined with modern technology provide a powerful combination to usher in the Patient Era in a time of unprecedented patient need.
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.