The pillars of Value Based Healthcare : RCM , HealthIT , Population Health , Analytics
This is a high level review of the basic essential requirements and ingredients to achieve an optimal value based healthcare delivery.
The providers ( hospitals / practices ) , the payers ( plans/insurers) and the patients being three main stakeholders, the key theme behind value based healthcare is to remain patient-centric and achieve maximum value for the buck in optimal healthcare settings. A balance between Financial , Clinical and Operational excellence to be achieved on case wise / patient wise basis.
In my view , Revenue Cycle Management ( RCM ) is the most critical process in terms of Financial side that needs to be supported through Health IT (EHR) system , Analytics and Population Health Management at various input points to make the sub-processes efficient and thus creating value.
An interesting aspect of Analytics and Population Health is that, AI ( Artificial Intelligence ) and ML ( Machine Learning ) along with ANN ( Artificial Neural Networks ) are increasingly being used to understand patterns in healthcare data (Big Data).
With the real time analysis of healthcare data , it is possible to report meaningful insights in healthcare delivery. In fact , such “Healthcare Data Platforms” that integrate large amount of data in real time , are now a critical part of every value based healthcare delivery. The dynamic clinical work flows tailored and catering to individual patient , are achieved with such platforms.
Connecting the dots of sub-processes of Revenue Cycle Management (RCM) through HealthcareIT and EHR using Analytic tools and methods of AI , ML , ANN give better insights for Population Health Management delivering Financial and outcomes oriented value to the stakeholders . “Smart Healthcare Data and real time data reporting Platform” is becoming an integral part of every ACO , payer or provider.
The US Healthcare ecosystem is in the early phase of this integration and is set to mature quickly because of pressures from Financial , Regulatory and business sides. The true value and benefits of this ecosystem could be delivered as the system matures further.
AI , ML supported healthcare data analytic platforms is the first sign of maturing of the healthcare ecosystem. Real World Evidence is the new buzz word that connects healthcare delivery , healthcare research and new therapies including Clinical Trials and pharmacovigilance. Real World Evidence (RWE) is already becoming a norm and is soon to add immense value in designing Clinical Work flows , Clinical Trials and Healthcare Delivery.
While challenges are evident, the opportunities are immense too. We are just beginning to see the value of Information Technology in Healthcare, there is a long way to go.
