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IMA Wellness Blog

Putting Healthcare Consumers in the Driver’s Seat 

by Gillie McCreath

Mazars USA LLP is an IMA B2B Partner

The use of electronic health records (EHR) came out of the American Recovery and Reinvestment Act of 2009 with $19 billon of the stimulus package dedicated to healthcare IT improvements. However, the disconnect between medical devices and EHR, or even between different systems, persists. A movement to connect clinical and financial data would ultimately allow the industry as a whole to get new insight into consumer behavior, and for consumers to make more informed decisions about their healthcare.

Technological Capabilities to Improve Interaction

Today, 50% of consumers are okay with sending their health information digitally. Take the example of a patient who has recently received an EKG, but now another health system is asking for a new one. Would the second procedure be deemed necessary if the provider had access to more complete data about the patient? This duplication of procedures has cost and clinical implications. And ultimately, it’s just a big waste of healthcare, especially for a system that’s experiencing extremely high rates of physician burnout and data fatigue.

Add to that the fact that 9% of patients’ misidentifications ultimately lead to death or permanent injury, and that 35% of denied claims are due to patient misidentifications, and the seriousness of this data problem comes into focus. In this era of unprecedented change and innovation, many segments of the healthcare industry are still leveraging outdated record review and storage processes, ultimately putting their patients as well as their bottom lines at risk.

While the patients themselves might be willing to share their records and additional data between doctors, specialists, or health systems, they often find that the hospital, perhaps their past insurance company, and even the technologies themselves are acting as barriers. The issue of data silos not only affects the clinical aspects along the provider chain, it affects the revenue cycle.

When hospitals or physicians are considering improvements to their technical capabilities, they should explore how they will affect consumers and staff around the multiple lines of business they serve, along with the operational, clinical, and financial impact. The ability to relieve operational pain points often features prominently into the decision-making process when selecting technology solutions. Often, though, it’s worthwhile to flip the discussion, examining the operational ineffectiveness of the organization that needs technology, and what solutions will result in the highest return.

Cost and Price Transparency

To better meet their patients’ needs for affordability, some hospitals are beginning to put pricing information on their websites. But it’s important to note that there are two types of transparency: cost transparency and price transparency. While “price” refers to what the hospitals are charging consumers, is it going to actually cost me as a consumer out of pocket? The healthcare system has a relatively long way to go in terms of becoming truly transparent. By and large we still don’t estimate or pre-adjudicate a claim around the whole consumption of care. Patients today want to know not only what their hip surgery will cost, but also the complete cost of recovery and rehabilitation. Many medical practices in other countries are able to pre-adjudicate claims, with the full cost of service ultimately being paid for upfront.

Even with new technologies, hospital consolidations, and staffing strategies, maturing the Quadruple Aim (reducing costs, reducing physician burn out, improving patient experience, and improving health populations) is still a formidable challenge. We can’t lose sight of the key elements that healthcare consumers need – accountability, accessibility, and affordability.   We certainly have tools that are maturing and going to help us along that spectrum, but until we put the consumer in the driver’s seat of their own data, it’s going to be a real problem to get behavioral health and other information across the system.


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