The digital health market, as represented by the HLTH showroom floor, is packed with companies focused on care coordination and care management for various health and wellness specialties, diseases, and chronic conditions, as well as organizations focused on increasing consumer access to various types of healthcare. Despite the growth of data analytics and interoperability, the constellation of companies and points of access are decentralized and disconnected. While the abundance of choice and options enhancing accessibility for healthcare consumers are positive indicators of progress in this space, the lack of holistic care coordination across this fragmented landscape affects patient outcomes, causes patient confusion and decision fatigue, and leads to potential care and resource duplication and waste.
While care coordination exists, it is often siloed to an individual provider or other stakeholder with whom a healthcare consumer interacts. Patient coaching has not yet found a way to persevere, but stakeholders agree that managing a patient well, both proactively and reactively, may be the key to a well person and a healthy industry. It is less clear how to carry the responsibility for holistic patient care coordination across the various service providers, payors, and healthcare resources.
Sanjula Jain, Ph.D., the Chief Resource Officer and SVP of Market Strategy at Trilliant Health, eloquently encapsulated this care coordination issue during a panel session at HLTH: "If everybody is coordinating care, then nobody is coordinating care."
The increasing complexity of our healthcare system makes this a difficult issue to solve and makes identifying which stakeholders should have which care coordination responsibilities equally difficult. For example, while payors have a wealth of information regarding their members and where those members have used their benefits to obtain healthcare items and services, healthcare consumers frequently obtain care outside of their payor benefits for various reasons. A common example is that an individual might use an at-home testing kit for diagnosing an illness or condition instead of seeking a diagnosis from a clinician where their payor benefits might be used. In such a case, the payor might not receive data on the results of the patient's test, including any relevant diagnosis, unless the patient follows up with a clinician using their insurance benefits. While this relatively low-risk example is fairly innocuous, the overarching point is that without any stakeholder owning the overarching care coordination role, it remains fragmented and leads to gaps in care and potential issues for any given patient.
Initiatives and incentives to improve this care coordination issue exist, but do not fully solve the problem. The federal government has recently started paying a small amount for certain federal healthcare program members who receive care coordination from providers. However, this initiative does not require coordination with the larger healthcare environment, and therefore remains siloed for now. Additionally, the global risk payment model inherently puts a premium value on care coordination and provides funding through the global risk percentage of premium to undertake such efforts successfully. Although these initiatives and incentives are helpful for care coordination, the healthcare industry still lacks the means to create coordinated care between the various sectors in healthcare and in the care delivery and payment vertical.
One potential solution is digital health "super apps." These apps offer a unified digital platform that allows patients, providers, and other stakeholders to manage patient information, appointments, insurance benefits, prescriptions, and related features all in one place. While digital health super apps have existed for at least several years, to date none have sufficiently integrated into the care delivery market to solve the issue. There may be a renewed focus on creating effective super apps, however, given the recent entry of large retailers and technology companies into the care delivery sector and those companies' focus on healthcare consumer experience.
The role of care management organization or division is often considered ancillary to the delivery of care, but in fact it is central to the delivery of care. Successfully bringing together all the pieces of care can be compared to bringing the notes of an orchestra together. An effective conductor aggregates and directs the various instruments and sounds to create something holistically new: music. Successfully achieving holistic care coordination will require stakeholders to come together to determine how best to share information, allocate the responsibility for acting on such information to manage a patient's care, and take ownership of this role.
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