Healthcare Finance –
Featuring Jesse Ambrosina, COO, Ivenix.
There was a time in the country’s history when healthcare accounted for just 5% of total gross domestic product. Today, that number is closer to 20% and combined with emerging technologies, this has heralded a significant shift in how patients seek and evaluate healthcare services.
Consumers — as the industry is increasingly forced to think of them — are now able to shop around for things like lab work and MRIs. Add to the mix online web portals replete with patient information, and individuals are now being spurred to own more of the responsibility for their care. It’s a parallel to how people are increasingly managing their personal finances, using technology tools and accessible information rather than handing over their retirement and investment strategies to a professional.
Jesse Ambrosina, COO of Ivenix, a company that specializes in creating infusion systems, said the shift is necessary given the ballooning cost of care, which he said translates to about $11,000 per individual in the U.S.
“The only way to bend that curve is for individuals to take the responsibility for themselves,” he said. “And that’s not an everyone-for-themselves perspective, but I think if you have awareness and you’re a participant, you’re going to be more invested in your care.”
Already, there’s a shift happening. Companies like CVS and Walgreens are building mini urgent care clinics on almost every corner, transforming them into convenient places to receive care rather than just pharmacies that fill prescriptions. Concurrent with this trend are small startups and other companies developing diagnostic tools that are usable for consumers, not to mention a growing transparency of information in electronic health records. Patient portals are actually becoming functional.
The retail clinics, said Ambrosina, are “more the stick than the carrot. It evolved from the top down, forcing people to pay more for their own healthcare, companies pushing that responsibility onto people with high-deductible plans, which is clearly a cost-cutting measure. So I think unfortunately that’s a driver. People are going to shop around.”
And then there’s EHR interoperability, or the ability for disparate medical records to communicate with and share information with each other. It’s not yet a pervasive reality in healthcare, and still has plenty of room to grow, but investments made in the EHR space 10 or 15 years ago are starting to pay dividends.
“I think that is kind of an enabling base,” said Ambrosina. “It will feed into the individual taking ownership. Unfortunately, a lot of the baseline EHR work has kind of become a billing system. It’s become a legal record of what happened — a retrospective. We haven’t yet seen the next phase where you take that information and improve the delivery of care proactively. If you can leverage the big data being generated through EHRs and push that to the bedside where care is being delivered, you’re going to start seeing that gain.
“It’s like any technology cycle,” he said. “It’s going to pick up in some areas, be delayed in others. It’s going to be a spectrum, a continuum. Look at how many people still don’t have access to high-speed internet. Same thing in healthcare: You’re going to have bleeding-edge systems that push the envelope, and rural communities that struggle to get the benefit of that technology. We’re at step one.”
A TIPPING POINT
Consumers adopting a proactive role in their care, demanding more information and taking a bigger part in decision-making, is a demand side variable that will likely drive the supply side, Ambrosina said. The confluence of all of these trend lines will create a tipping point.
To an extent, this is visible in some of the investments the government has made in healthcare IT over the years. In the first wave, subsidies became available for hospitals to implement EHRs, which caused a massive shift. The second wave was meaningful use, in which providers got more money if they could prove it was being used to create efficiencies.
Now, the shift to value-based care models is having an impact on technology and how consumers access care. Accountable care organizations are possible the best evidence of this; the basic concept is that a healthcare delivery network is given a bucket of money to manage a defined population, and they choose how best to use those funds. ACOs aren’t widespread yet, but are emerging in pockets.
“There’s some traction in that space, (but) I have my doubts as to whether or not that’s the model,” said Ambrosina. “To me it doesn’t exactly map over to the individual taking ownership of their care. It doesn’t work well for mobility. A big component of an economy is mobility and being able to move when you need to. Sometimes it’s unnecessarily challenging to move from point A to point B. If you go overseas and get sick, it’s a hassle. If the individual owned and controlled their healthcare, it should be easy to get access whatever they need, wherever they are. That’s good for everybody: payers, patients, governments.”
Mobility, access, stakeholder involvement: these are among the factors bending healthcare in a direction similar to personal wealth management, in which pensions are disappearing and being replaced be personal 401K accounts. In both scenarios, the beneficiary — the healthcare consumer, or the person saving for retirement — has more ownership, and more stake in the process.
That shift will only continue.
“There’s some interesting shifts happening now around thoughts of who owns the data,” said Ambrosina. “Historically, the hospital-owned the data and had kept it proprietary. If we’re empowering consumers as they become more self-aware, they’re going to demand more transparency.”
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