In Healthcare

The current mantra in healthcare is “do more with less,” as health systems struggle against government mandates to pour billions of dollars into electronic health record systems while at the same time, insurance companies and Medicare reimbursements are shrinking.

There is one area in which healthcare is seeing a massive expansion and we can actually do more with more: Data. As everything goes electronic in healthcare, mountains of data are piling up.

There are enormous opportunities lurking in that data – opportunities to solve other challenges of the new regulatory environment. Lately, one of the challenges I hear most about from Inmar’s healthcare clients is medication adherence. With five-star quality ratings and Plan Benefit Manager (PBM) incentives in the picture, a lot of resources are being devoted to numerous ways to reach and engage patients.

That’s all well and good, but there is a major barrier diluting the effectiveness of those efforts: Segmentation.

Back in the day, you had a doctor. It was a big deal if you went to a specialist. The advent of specialization has divided care among different providers for such commonplace things as colonoscopy, mammogram, sleep study, back pain evaluation, heart assessment, hearing test… the list goes on.

Specialization means better care. It also means your care is segmented.  And so are your data.

With care and its related data segmented, there’s no single, complete picture of patient health. The data are isolated into different records with different providers who can’t necessarily see the information everyone else has.

Consider this hypothetical patient: She’s diabetic. She has a primary physician who helps her manage that and her high blood pressure. For her upcoming shoulder surgery, she only trusts her husband’s uncle, an orthopedist at a different health system. She uses a sleep-apnea CPAP she got from the sleep center in Florida where she used to live, and she gets her medications – when she can afford them – from two different pharmacies.

Here’s the rub: There is no complete picture available to any one of her health partners. None of them ever sees a complete picture because they only see the data from their own segment. They can get her history from her, what she remembers or thinks is relevant.

Would they want to know that she has been prescribed antibiotics five times in the last three years, but never picked them up? With an incision and the healing problems associated with diabetes, you bet they do. Does she tell them? Nope.

Think of what’s possible if her pharmacy shares (with her consent) her medication nonadherence history with her providers:

  • Her surgical discharge team can devote extra attention to educating her on the importance of taking her antibiotics and how that will affect her healing from the surgery.
  • Her physician can talk with her and perhaps try a more affordable antibiotic the next time one is called for, or direct her to assistance programs or even coupons if available.
  • The patient takes the medication and avoids additional care (and related expense) of extra, unnecessary doctor visits to manage an infected wound.

This is not to say nothing is being done. I’m saying we’re not doing all we can. Meaningful Use requirements in stage 3 will require better data sharing among health providers. Pharmacies are starting new patient education and refill reminder programs. Insurance companies are creating incentives for pharmacies whose patients have better adherence.

Does that mean it’s all coming together? Not exactly – it’s still an incomplete picture. If each of the participants in a patient’s care continuum makes improvements in their own arena but stay data-isolated from each other, the patient only benefits where she intersects with each of them.

What’s possible if, instead of just reaching out to patients, pharmacies, providers, health systems, even health and wellness-conscious retailers, all start sharing data with each other?
Imagine the power of a pharmacy sharing patients’ data. Our hypothetical patient’s doctor has no idea she hasn’t even picked up the antibiotics he has prescribed for her, so he can’t prescribe alternate, less expensive meds, direct her to assistance programs or even manufacturer coupons or co-pay cards.

The possibilities are endless for vendor services, financial assistance, discount programs, patient-engagement app development, and other tools that would help such a patient manage her disease and improve her life.

Think about all the data piling up in pharmacies nationwide – trillions of transactions in both the front and back of the store – that paint a vivid picture of people’s “health lives.” It seems such a shame: All that data – information that could be helping people and transforming an industry from struggle to profitability – and it’s sitting there unused.

Do we not all have a fiscal responsibility to improve the cost equation?  Is not healthcare the one thing that brings us all together? We will all have to use it at some point during our lifetime.  The key will be whether or not we can afford it.

With the application of the right analytics to identify trends, behaviors, needs and opportunities, we can connect hospitals, providers and pharmacies to complete that comprehensive patient-data picture to improve care, change people’s lives and drive down unnecessary industry costs. And, we should. Inmar does this all the time for major retailers, with predictive and behavioral analytics that engage customers in ways that drive reduced cost and increased profitability.

How can we do it in the healthcare industry? First, we have to all be at the table, willing to share data while protecting patients’ privacy. From there we identify key tools to engage patients, drive the right behaviors and provide valuable products and services that have just-in-time relevance and patient-specific, targeted solutions.

We can – and we should – put our collaborative brain power to work to paint the complete patient-data picture and develop tools with the agility to do amazing things for patients with real-time intervention, predictive trending, pre-emptive treatment, discount programs, lifestyle-specific food guides, medication adherence, health incentives, the list goes on.

For now, all this information is just sitting there, not being used to full potential. What role will you play in unlocking this future for patients?

Can we unlock this information? What do you think? What challenges does it pose? Please share your thoughts in the comments section below.

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