The 'Edge Report Blog

You Can’t Lower Healthcare Costs or Improve Outcomes in a Siloed System

Everyone wants better outcomes and lower costs. It sounds good when people in the industry talk about achieving those ends, but the Triple Aim has been a goal for many years now. As the use of technology and data increases within healthcare, the challenge of effectively using that data also grows.

EHRs, mobile devices and wearables, claims data, and population health analytics have the potential to create enough insight for healthcare to increase outcomes at lower costs. But, according to Leo Anthony Celi, M.D., head of the MIT Critical Data group, the problem is that most of this data exists in silos and is not integrated within an organization; worse it’s also not shared across organizations wrote Celi and his MIT colleagues in the Journal of Medical Internet Research.

That’s a sentiment echoed by healthcare economist Jason Shafrin who says that most healthcare companies don’t have any incentive to share their data since that data is perceived to be a competitive advantage.

The McKinsey Global Institute estimates that the volume of healthcare data and the industry's inability to take advantage of it, for whatever reason (HIPAA, old technology, business strategy, etc.) leads to potentially more than $300 billion annually in wasted value.      

While there is much investment in innovation and a consistent pipeline of disruptive applications in the marketplace, few effectively connect the key constituencies, which is what the industry needs more than ever.

The first step is better collaboration amongst payers and provider organizations. For payers and providers to align on shared goals, critical data must also be shared to enable providers to understand and even anticipate their patient’s health status.  Both administrative and clinical data can contribute to providers taking important proactive steps to get or keep their patients healthy. Without it all parties acting within the healthcare industry are just taking steps with a limited amount of information available to them.

Health plans that make accurate data in real-time directly available to their members and physicians within their networks benefit from greater efficiency. Customer service representatives spend more time efficiently resolving individual queries or speaking with more members on a daily basis, for example.

For members, it means they walk away from a shorter conversation with the right information or go into a conversation armed with the right data to have a productive call – no frustrated call-backs necessary.  The downstream impact of this? Increased member satisfaction and greater likelihood of follow-through on care plans or better medication adherence to stay healthy.

HealthEdge improves outcomes by providing the right information at the right time to all parties within a plan, enabling care managers to identify prospective high utilizers and create a care plan that will help avoid costly hospitalizations and other encounters. The technology at HealthEdge has also been proven to make sense of the volumes of data while connecting it to all stakeholders.

Healthcare has a formidable challenge that persists: break down the silos between all key stakeholders. Only with technology that provides accurate data in real-time in a manner that is consumable by all will this occur. Of course, the players in the healthcare ecosystem have to want to collaborate and make the best use of these insights. Once that happens, better outcomes and an improved patient experience are inevitable.


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