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Today’s Healthcare System: Undergoing Transformation

by Adam Bolio & Hafiza Pirani | December 15, 2021 | Related Healthcare Content

 

Today’s healthcare stakeholders are innovating in ways, and at a pace, we have not seen before. This is driven by various factors including ongoing cost pressures, regulatory requirements, and increased consumer demands; and is ultimately fueled by an increase in connectivity and access to data.

The COVID-19 pandemic has had a compounding effect as providers experienced revenue loss due to limits on elective procedures, and the shift to remote work and care necessitated technology investments and security enhancements to maintain operations in a virtual environment.

In this paper we discuss some of the trends in the healthcare ecosystem, share ways in which Entisys360 can help address client challenges, and initiate a discussion on where healthcare is headed. This does not cover all the trends and innovations in the industry – that is too vast and dynamic to capture in a single paper – rather it reviews some of the major shifts guiding elements of the healthcare system we are serving. We invite you to contact us to continue the discussion.

Health System Trends

Traditionally, health systems have been the ones to shape the way care is provided. In today’s environment, however, externally derived factors such as changes in reimbursement, regulations, and customer demands, are forcing health systems to respond and adapt the way they operate.

Shift in care setting. Cost pressures on providers, as well as patient preferences, are shifting healthcare provision out of the traditional hospital setting. From a cost standpoint, the increase in value-based contracts that reward on outcome over volume, incentivizes providers to find lower cost healthcare settings. Settings such as outpatient and ambulatory care centers allow providers to deliver procedures such as knee or hip replacement at 30-40% less than the cost of an in-patient facility.1

From a consumer preference standpoint, patients are increasingly seeking more personalized and comfortable healthcare. Concierge and spa-like services offer clinical care in modern and luxurious settings outside of the traditional hospital. In addition to appealing to consumer demands, these types of services are also creating new revenue streams for health systems. Recently, several new companies have emerged that offer healthcare services in the comfort and convenience of a patient’s own home. Through companies such as Ready Responders and Heal, patients use digital apps to request clinical care at a time that is convenient for them, similar to the ease of scheduling a ride through Uber.2 Care is then provided either virtually or through an in-home visit depending on what the patient prefers.

The COVID-19 pandemic has accelerated this trend. With healthcare facilities shut down for non-essential in-person care, the industry was forced to shift to virtual care solutions that enabled healthcare providers to visit with patients in the safety and comfort of their homes. Patients and providers alike have reported positive experiences with virtual care as well as the desire for continued expansion of telehealth models with enhanced capabilities.3,4

Continued evolution of regulatory and compliance requirements. Health systems face a range of regulatory and compliance requirements (see Image 1). While these standards were established to protect public health, promote the delivery of high-quality care, and enhance patient privacy, they have also placed a significant administrative toll on healthcare providers in order to comply. Healthcare entities must not only stay up-to-date on the constantly changing and evolving regulations but must also invest sizable resources to acquire, and implement, the technologies and processes necessary to meet requirements. A recent AHA report found that every patient admitted to the hospital, resulted in $1,200 of associated regulatory costs.5

Transition to a remote workforce. Businesses across industries are exploring remote workforce opportunities. For many healthcare organizations, remote workforces present a strategic opportunity: by shifting employees to home offices, health systems can realize significant real estate savings as well as access to a broader, stronger talent pool8 (see case study below).

Data Privacy Services

Entisys360 Advyz Cyber Risk Services

With HIPAA and the HITECH Act, healthcare was ahead of most other industries relative to data privacy and mandated security provisions.

To this day, in the United States, these acts remain two of the few overarching Federal level privacy laws. In recent years, the global, regional and state privacy regulatory landscape has evolved significantly with new laws to protect the use of personal data as well as to grant individuals more rights to access and safeguard their data. Data privacy implications to healthcare entities now extend beyond patients to the full gambit of physicians, providers, patients, consumers, customers, and employees, which are now also in the scope of an organization’s privacy program.

Entisys360’s Advyz Cyber Risk Services division helps our healthcare clients through HIPAA and HITECH, as well as state and international, compliance assessments. Our data privacy practice helps clients navigate the new privacy regulations, identifying impacts to their operations and incorporating new policies, processes and technologies to help protect them from the potential financial and reputational harm associated with privacy and/or privacy related security failures.

CASE STUDY

Remote Work as a Strategic Advantage

After experiencing the rapid and successful transition of their workforce to home offices amidst the COVID-19 pandemic, our client saw an opportunity.

As a regional, not-for-profit health system, our client struggled to attract and retain high caliber talent. By removing the walls of the traditional office, the health system could open up their talent pool and realize cost savings through decreased lease costs.

Entisys360 partnered with the health system to conduct a permanent workforce transition engagement. Our team kicked off the project with a comprehensive analysis to identify the most cost-effective technical solution that would meet the organization’s business requirements. A Virtual Desktop Infrastructure (VDI) solution was selected as it provided centralized IT control, desired security and data access features, and a preferred user experience.

Entisys360’s engineers designed and architected the VDI solution, acquired the technology and licensing on behalf of the client, and provided implementation oversight to the client’s internal information technology team.

User experience has been extremely positive—a consistent user interface across office and home environments facilitated a seamless transition. Our thorough and systematic approach to data security protected sensitive patient data being exchanged virtually and maintained the client’s compliance with HIPAA.

Finally, having established the VDI framework, the organization can easily scale and adapt the solution to new and existing employees regardless of physical location, achieving their primary goals of talent attraction and retention.

Consumer Trends

Health innovation is on the rise. Funding for health tech innovators exceeded $7.4 billion in 2019.9 At the root of this technology expansion is consumer demand. Today’s healthcare consumers, and in particular Millennials, are more interested in healthcare that is convenient and digitally enabled than allegiance to a specific provider.10

Emergence of Disruptors

Traditional and non-traditional partnerships are paving a path to a new form of healthcare delivery. Walmart and Humana, CVS Health and Aetna, Cigna and Express Scripts, and Anthem and IngenioRx, are all new business models aimed at addressing the increased demands of Millennial and affluent senior populations. These players offer digital tools and technologies that provide a more consumer centric healthcare experience and reduce the cost of care. For example, CVS Health is building HealthHUBs within 1,500 neighborhood pharmacies where consumers can access in-person and virtual care services, chronic disease management, health education, wellness classes, and more.11 Healthcare stakeholders that are unable to meet  the patient demands for increased transparency, convenience, and digital solutions, will be pushed out.12

Greater Ownership of Health

Consumers are becoming active owners of their own health. Wearable devices such as smartwatches, wearable mobile sensors, and other mobile devices can collect a range of health data including blood sugar, exercise routines, sleep, and mood. Platforms such as Google Fit and Apple HealthKit aggregate data from multiple sources providing a more complete picture for monitoring.

With close to 60% of US adults willing to wear these sensing technologies and the rise of devices that are compatible with electronic health records (EHRs), these tools are likely to play a significant role in the management of chronic diseases. Large health systems are likely to roll out wearables as part of their preventative care programs allowing both care providers and consumers the ability to track and trend key health indicators.13

Interoperability, Security, and Privacy

A truly patient-centered healthcare system requires a seamless and secure method to share data across the technologies involved in each individual’s healthcare journey. Consider the benefits of interoperability expanding beyond traditional clinical data points delivering scenarios such as drawing insights and triggering activities to support the individual’s health. For example, automatic authorization and prescription delivery, or proactive and personalized follow up calls based on data provided from a heart-rate monitor.14

The traditional scenario of a health system creating and storing a patient’s data is being replaced by a marketplace of retail health clinics, health applications, and retail virtual health providers. All of which are creating critical data that is instrumental for a primary care physician to understand their patient’s complete health picture. While at the same time, all of which creating sensitive data, which is distributed beyond the traditional health system’s perimeter into cloud infrastructure and software as a service applications. Disparate data and the need for sharing (to create a holistic health picture) creates privacy, security, and legal challenges for organizations. Each element needs to be considered; for example:

Privacy – Is an organization authorized by the consumer to share their information? Are policies and procedures correctly aligned to pertinent laws or regulation?

Security – Is the transmission and storage of sensitive data done securely, and who has access to the data at any given point. Does the security architecture adequately and efficiently support the remote workforce?

Legal – Are there laws or regulations that need to be followed and are the appropriate business associate agreements completed for information sharing?

To support evolving business operations, security and privacy also need to adapt. Technical challenges of disparate workloads can be managed by leveraging architecture concepts like the Secure Access Service Edge (SASE). To maintain privacy and legal defensibility, options are available via subscription or retainer that can provide ongoing and up-to-date policies and procedures.

 

Outlook to Tomorrow’s Healthcare System

Healthcare IT trends - Healthcare Outlook Tomorrow
Today’s healthcare system is at an inflection point. Advances in technology, consumer demand, commercial innovation and a supporting regulatory environment are all driving towards a more value-based and consumer-oriented healthcare environment. One in which the patient is at the center and all surrounding entities are unified in focus: achieving the maximum health potential for each individual.

At the foundation of this new healthcare system should be a robust technology infrastructure that is supported by a patient-centered ethical and compliance framework. This involves a well-designed cloud storage infrastructure that allows data to be stored, shared, and accessed by the right parties at the right time to benefit the patient. Next, a comprehensive governance model that identifies all stakeholders within the patient’s healthcare journey and establishes rules governing their ability to collect, access, and use the patient’s data.

While HIPAA provides some protection, broader governance is needed, as many non-traditional players in the ecosystem are not HIPAA regulated (e.g. wearable technology providers). In addition to governance, a strong security posture is needed across all players in the ecosystem. Not only will appropriate security protocols and configurations need to be applied, tested, and managed, but the right stakeholders need to be held accountable. Finally, as always in healthcare, the patient must be treated with dignity and respect, which applies equally to respect of the privacy of each patient’s data. Existing, and potentially new, privacy rules are needed to ensure that patients feel safe and protected as they share health data within the ecosystem in order to reach their optimal health status.

REFERENCES
1.Blue Cross Blue Shield Association (2019). Planned Knee and Hip Replacement Surgeries are on the Rise in The U.S. https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/HoA-Orthopedic%2BCosts%20Report.pdf

2.Hardin, L., Mason, D.J., (2019). Bringing It Home: The Shift in Where Health Care Is Delivered. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2747654

3.Adams, K. (2020). Telehealth patient satisfaction soared in 2020 despite persisting disparities: 6 stats. https://www.beckershospitalreview.com/telehealth/telehealth-patient-satisfaction-soared-in-2020-despite-persisting-disparities-6-stats.html

4.Sparks, D. (2021). Nationwide survey finds physician satisfaction with telehealth. https://newsnetwork.mayoclinic.org/discussion/nationwide-survey-finds-physician-satisfaction-with-telehealth/

5.American Hospital Association (2017). Regulatory Overload. https://www.aha.org/system/files/2018-02/regulatory-overload-report.pdf

6.Maryville University. 5 Important Regulations in United States Healthcare. https://online.maryville.edu/blog/5-important-regulations-in-united-states-healthcare/

7.Health IT.gov (2020). Health IT Legislation. https://www.healthit.gov/topic/laws-regulation-and-policy/health-it-legislation

8.Dyrda, L., Drees, J. (2020). The strategic vision for long-term remote work at 12 health systems. https://www.beckershospitalreview.com/healthcare-information-technology/the-strategic-vision-for-long-term-remote-work-at-12-health-systems.html

9.Micca, P., Boozer, C., Shukla, M. (2020). Health tech investment trends: How are investors positioning for the future of health? Deloitte Insights. https://www2.deloitte.com/us/en/insights/industry/health-care/health-tech-investment-trends.html

10.Harpaz, J. (2019). 6 Expectations Millennials Have For Their Healthcare. Forbes.  https://www.forbes.com/sites/joeharpaz/2019/08/26/6-expectations-millennials-healthcare/?sh=230850f430ec

11.CVS Health (2019). CVS Health announces significant expansion of HealthHUB to deliver a differentiated, consumer health experience. https://cvshealth.com/news-and-insights/articles/cvs-health-announces-significant-expansion-of-healthhub-to-deliver-a.

12.Transwestern, IMEG (2018). The Convergence Of Healthcare Delivery In The U.S.. https://transwestern.com/source/files/Convergence%20of%20Healthcare%20Delivery_June%202018.pdf

13.Dinh-Le, C., Chuang, R.,Chokshi, S., Mann, D. (2019). Wearable Health Technology and Electronic Health Record Integration: Scoping Review and Future Directions. JMIR Mhealth Uhealth. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746089/

14.Singhal, S., Kayyali, B., Levin, R., Greenberg, Z. (2020). The next wave of healthcare innovation: The evolution of ecosystems. McKinsey & Company. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-next-wave-of-healthcare-innovation-the-evolution-of-ecosystems

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