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Guest blog by James Selden

It’s no secret that the current healthcare system isn’t working. Though well-intentioned, the original model was not built for today’s complex healthcare environment where fragmentation and integration co-exist (see New Health Economy). Private practice physicians proliferated. As a result, the centralized communication needed to deliver a holistic perspective of the patient’s care that would have managed rising costs, improved patient utilization and provided optional health outcomes was never met. While the objectives of care management remain the same today, the strategy and execution of care management are undergoing a dramatic transformation powered by technology. Here are three key dimensions at the heart of this metamorphosis:

1) Proliferation of Electronic Medical Records

As the health economy is becoming more consumer-centric, consumers have more information at hand to make more informed decisions. Patients are moving away from large medical centers and opting for nontraditional or niche institutions, such as retail clinics, urgent care centers, and private, mom-and-pop medical practices. A particular patient’s medical history might be dispersed across several different providers – large and small –making it difficult for providers to coordinate care. Providers need an aggregated summary of patient medical history, such as referrals, medical outcomes, PCPs and other ancillary information to make optimal care decisions.

Electronic Medical Records (EMRs) provide a single record to track and report medical decision-making. To maintain a consumer-centric orientation, it will be important that transparency, continuity and standardization are not lost in the fray of our complex and fragmented healthcare system. CIOs seem to agree. According to PwC’s Digital IQ Survey, 86% of leaders in the provider space are either “somewhat concerned” or “very concerned” in its inability to gather, understand, and act on all the data about its customers. EMRs will continue to play an integral role in providing more transparency and continuity in medical records.

2) Rapid Adoption of Mobile Health

Often lost in the conversation of care management transformation is mobile health, or mHealth. It is estimated that 91% of the U.S. population owns a mobile phone, according to a study by the wireless association, CTIA . Moreover, according to a GSMA (Groupe Speciale Mobile Association) and PwC analysis, worldwide mobile health revenues are projected to rise rapidly, reaching $23 billion by 2017. Clearly, business and IT leaders need to build mHealth into their business strategy plans.

New systems have emerged that enable U.S. patients to find nearby doctors and book appointments. Another example of mHealth is a company that helps patients avoid counterfeit drugs by verifying drug authenticity via text message, which protects pharmaceutical supply chains in emerging markets. Lastly, a plastic surgery unit has developed a way to enhance treatment protocols for burn patients. They use mobile to estimate burn area percentages, calculate 24hr fluid protocol and improve accuracy over paper assessments.

Going forward, it will be important that healthcare organizations continue to pursue these types of ventures through mobility. mHealth is more than messaging and communication with customers, it can prove to be a competitive advantage for organizations and also improve the lives of its customers.

3) Fast Data Delivers a Competitive Advantage

Data should be seen as a strategic asset, and those organizations with the largest data assets, as well as the ability to take advantage of them, will be at a substantial competitive advantage over institutions without such means and resources. It’s imperative that proper leadership is put in place to bring these strategic initiatives to market (see Finding a Home for the Chief Data Science Officer).

While big data is one of the frequent buzz words we hear in the marketplace, “fast data” – data that is easily retrievable – should not be overlooked. Without fast data access, real-time programs such as 24-hour nurse lines will fail to guide members to the right referral. Hence, it is important that an organization employ a holistic data strategy to improve the integration and currency of data so that decisions can be made without sacrificing quality of care. According to PwC’s Digital IQ Survey, integrating internal data across systems was among executives’ top two priorities in decisions pertaining to data, further cementing this initiative as a “must do” among an organization’s broader data strategy.

With so much change reshaping today’s healthcare economy, it is important that organizations have a strategy in place to fully realize their business goals. According to PwC’s Health Research Institute (HRI), the revenue opportunity in the New Health Economy is greater than $2.8 billion. Moreover, the relationship between CIO and CMO will be strategic and it will become increasingly important that both parties align on how best to deliver a robust, forward-looking, and technology-driven care management strategy. According to PwC’s Digital IQ Survey, 53% of business and IT executives across all healthcare sectors (payer, provider, pharma, device manufacturing) share the same detailed understanding of corporate strategy. While this initial figure is encouraging, there is still significant opportunity to cross collaborate and marry strategic interests between business and IT.

Is your strategy evolving along side the transformation of care management?

Adam Roumm, Steve Zaloga and Andy Sordi contributed to this post.

Image shared by Paul Bica

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