October 25, 2021
Despite decades of annual proclamations by gurus that this finally will be the year of a “tech-tonic” shift in healthcare to digital and virtual care and financing modalities, it has yet to happen.
That is, until now. Despite the most aggressive foot dragging by incumbent healthcare organizations, the three Ps—payment, platforming and personalization—will propel legacy care and financing modalities into the future.
Let’s look at how each of the three Ps will accomplish this previously inconceivable objective.
In healthcare as with any business, there’s an inextricable link between money and behavior. Behavior follows money, and money follows behavior.
Fee-for-service reimbursement models pay providers with little regard for cost or outcomes. It’s why we as a nation pay more for healthcare than any other country yet don’t see our investment manifest itself in superior clinical or population health outcomes.
But that is changing. A decade or more of experimentation with value-based reimbursement models has taught us a lot about what works and what doesn’t work in terms of changing behaviors. Most VBR models to date are fee-for-service one-offs. They pay for volume and offer bonuses for hitting cost and quality targets. Others are voluntary rather than mandatory. The results have been mediocre at best.
The next generation of VBR models will offer two-sided risk—a bonus if you do well but a penalty if you don’t. They’ll be mandatory, not voluntary. Think full-risk bundled payments for episodic care and full-risk capitation for population health.
Such new VBR models will change behaviors to reduce costs and improve outcomes. Central to those twin goals will be digitization and virtualization. Time-saving and cost-cutting automation will replace time-consuming and cost-driving manual tasks. Virtual care options will expand access, increase use of preventative care and enable faster interventions to avoid more intensive and costly interventions later.
Everyone has a platform just like everyone’s technology is powered by artificial intelligence and everyone’s care model is patient-centered. Overuse of the term platform has rendered it virtually meaningless.
It doesn’t mean that all your propriety services to you customers are on a single server, IT system or cloud-based software program. That’s integration. That’s operations. That’s cooking and serving all the food on your entire menu from the same kitchen.
Sticking with that restaurant analogy, true platforming is more like Uber Eats or DoorDash or Grubhub. You can order whatever you want from wherever you want from a single—wait for it—platform that can deliver it right to your door on time. Platform companies create value by seamlessly connecting what they offer to what their customers want on a unified system that engages customers on their terms.
For healthcare organizations, platforming means focusing on outputs based on what customers want instead of focusing on ownership and controlling production based on what the organization wants. That customer-driven pivot will force healthcare organizations to digitize and offer virtual care options that they may or may not own but subcontract for to make it available to their customers on their platform.
We’ve all experienced the third P. You buy something online and then the next time you log on, you get a pop-up ad trying to sell you a related product or service. With every transaction, you leave behind a breadcrumb of who you are, what you want and how you behave.
Retail companies have figured that out. Healthcare companies? Not so much. But again, that’s changing. Smart healthcare organization want to know who you are, what you want and how you behave. That’s true from both a service perspective (do you prefer in-person or virtual visits?) and from a clinical perspective (do you buy fresh fruit or a lot of smoked meats?).
To capture that non-traditional patient information, healthcare organizations will need to elevate their digital and virtualization capabilities. They’ll need to integrate it with existing IT systems like EHRs, patient accounting systems and customer relationship management tools. Like their retail counterparts, healthcare organizations will need to build complete, accurate pictures of each customer, patient or member to succeed in the new healthcare economy.
Unlike their counterparts in retail, though, smart healthcare organization will take personalization a step further via precision medicine. Advances in genetic and molecular diagnostic testing and treatment options will spawn individualized care plans for each patient.
Dig deeper and discover more about the impact of the 3 Ps and see what's driving this "tech-tonic" shift to make healthcare delivery more efficient, customized, and engaging - read the paper.