Creating Health Care 2.0 through Information and Technology

Innovation in five key areas could radically change the way health care is delivered, experienced and paid for, Ingenix Chief Executive Officer Andy Slavitt told attendees of the Ingenix Health Care Technology Conference on May 16 in San Francisco. In his keynote address, Slavitt said Ingenix refers to these changes collectively as "Health Care 2.0" because they represent a transformed health care system.

Health plans, employers, hospitals, physicians and drug companies all have a role to play in this transformation, according to Slavitt, "Your organizations will either be drivers of the change or simply cope with the effects. There will be winners and losers."

Ingenix has spent months examining what Health Care 2.0 will mean for the industry, he says, and "is committed to helping our clients prepare for the change, drive it, and become winners."  

The areas that will change dramatically under Health Care 2.0 are (1) the clinical process; (2) drug development and delivery; (3) administration; (4) user's experience; and (5) access.

Evidence-based medicine makes clinical care more reliable  

To improve the health care system, physician performance, which varies widely and is not transparent to consumers, must be given a closer look. “The biggest problem with bad doctors is that they look just like good doctors,” Slavitt said.  “They all wear white coats and have MDs after their names, and you and your loved ones can’t tell them apart.”

Vital to improving physician performance are identifying best practices, sharing evidence-based treatment data in an open collaborative manner, and incentivizing the best physicians to collaborate with peers, he said. Adherence to evidence-based standards can be achieved using rules-based software tools; technology also can provide doctors with real-time clinical collaboration with physicians anywhere in the world when cases prove to be complex. 

Health plans and integrated delivery systems can play a key role in clinical collaboration by assigning care “quarterbacks” to help manage care decisions for each patient and to review and ensure the proper use of the patient’s electronic clinical information.

Safe, effective drugs move to market faster

Innovation in the prescription drug arena has changed the face of medicine in recent years, helping doctors manage patients’ chronic and acute conditions more effectively. “The most successful consumer product in recent years is probably not the iPod,” Slavitt asserted. “It’s likely Lipitor.” With a simple lab test, he explained, any doctor, anywhere, can prescribe a drug like Lipitor and accomplish what healthy eating and weight loss have not been able to control.

However, there are obstacles to drug innovation -- including a slow and expensive drug development and approval process, safety issues and side effects -- that need to be overcome to keep health care headed in the right direction.  

Currently the drug development and approval process costs pharmaceutical companies roughly $1 billion and takes about seven years to complete. New, adaptive approaches to clinical trials can collapse the development process into two simple phases: learn and confirm, according to Slavitt. Combined with clinical and economic outcomes analysis, Slavitt states that product development cycles can be cut in half.

Safety problems and side effects also have the potential to derail some of the most important and promising therapies. As Health Care 2.0 becomes a reality, Slavitt said, genotyping and phenotyping will allow doctors to prescribe personalized medicines and biologics, which should make it possible for the Food and Drug Administration to approve more effective therapies while minimizing safety risks for specific patients as necessary.

Increased standardization reduces administrative costs by half

Complex, paper-based processes add an unnecessary layer of administrative cost to the health care system and create confusion for stakeholders. Today, it often takes months for physicians to receive reimbursement for the services they have rendered. This uncoordinated, paper-based processing system adds 25 percent to health care expenditures, and offers a significant opportunity for positive change and cost cutting.

 “By increasing standardization and connecting the industry together with secure, real-time capabilities,” Slavitt said, “we can reduce administrative costs by half. And we can do this while also putting clinical data in the right place at the right time.”

Technology can shave months off of payment times for both the patient and the provider. For example, a rules-based engine can be embedded within a practice management system to alert physicians and facilities to unique coding requirements that might otherwise stall claims reimbursement. Using such a system assures proper payment and can verify claims at the point of data entry.

Health care becomes simpler and easier to use

One of the principal goals of Health Care 2.0 is to make the system easier to use, Slavitt said. An abundance of new technologies and tools are available to consumers and physicians. Unfortunately, few of these tools actually mesh with how a consumer interacts with the health care system. The result is a fragmented, complex user experience.

Health Care 2.0 will require integration of these unrelated tools, according to Slavitt. “We need to really study and understand workflow and wrap information around health care user experiences, [instead of] forcing consumers and physicians to learn to navigate disparate tools and data repositories.”

Under Health Care 2.0, Slavitt predicts that patients will be able to handle common health care tasks like selecting physicians, comparing treatment options, and managing health care expenses using such mainstream devices as cell phones. “Technology can make it possible for your health plan to settle claims in near real time, accelerate payments to your doctor, and help you understand what, if anything, you truly owe as an out of pocket expense,” he said. “From the consumer’s perspective, the entire health care transaction can become as routine and as easy as online banking.”

Everyone is covered, everyone is paid

Perhaps the most troublesome aspect of the health care system today is how expensive health care is, how it is financed and, as a result, how many people are left out of the system. “In Health Care 2.0, everyone is covered and everyone is paid,” Slavitt said. “Predictable care with fewer handoffs and improved time to market will be less expensive, driving down the cost of premiums.” Increased patient flow and a reduction in uncompensated care will more than make up for the investment in better performing systems, he added.

Indeed, companies that embrace Health Care 2.0, figure out how to compete, and adapt their systems accordingly, will win more patients and more members, he predicted.

“I’m very optimistic about the promise of Health Care 2.0 and the positive impact that all of us can make,” Slavitt said.

Next year’s Ingenix Health Care Technology Conference will be held May 13-15, 2008 at the Gaylord Palms Hotel and Conference Center near Orlando, Florida.

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