Calling the U.S. healthcare system complex would be like calling the universe big: an understatement that poorly conveys its true scale. It’s populated with primary care physicians, specialists, pharmacists, insurance companies, labs, therapists, caregivers and others – all using different tools, methods of communication and care delivery solutions.
Our healthcare system attempts to deliver coordinated service from distant silos, hoping for better health outcomes.
Recent policies have aimed to synthesize the back end of healthcare in order to give stakeholders in the healthcare ecosystem better visibility and simplified coordination. This systems-level approach is welcome and will likely yield results that make healthcare more efficient and effective.
What’s missing, however, is a simplified experience for the end user navigating the healthcare journey: the patient. Currently, the patient carries the burden of ensuring these systems, their providers and caregivers work seamlessly together.
Think about the challenges you or a loved one faced during a transition in the healthcare journey: moving from one insurance plan to another, from wellness maintenance to addressing a disease, or shifting out of acute medical care to rehabilitation or chronic-condition management.
Even the simple act of determining which services are reimbursed by insurance, and which are not, can feel daunting.
These situations are not rare or exceptional. Navigating healthcare in the U.S. has become universally difficult. The fault lies with the system itself: We have built friction points into our healthcare experience.
The patient has no choice but to accept this system, despite knowing health issues do not magically resolve at the hospital door or disappear when an insurance plan’s coverage ends.
Like an old house whose owners added and renovated rooms through the decades, the healthcare system has become more complex. It is unlikely we will dismantle the whole system and start over with a fresh plan for a system tailored to today’s patient needs.
So what is the path forward?
Fixing the old house is possible. Integration-focused companies are using technology to streamline patient care navigation, more transparent healthcare cost models are emerging and other innovations are starting to usher in a more holistic, unified healthcare experience for the patient with an eye on a healthier population.
Digital solutions that improve the patient experience have exploded during the pandemic, with telemedicine rapidly developing better modalities, more intuitive interfaces and better ways to engage patients who were previously hard to reach.
From mobile apps that manage care for chronic conditions to those that teach and reinforce wellness habits, the patient journey is starting to improve in many ways. The question now is whether these innovations help to coordinate and connect the dots in healthcare or if they simply add more distinct rooms to the house.
This is perhaps the most important question healthcare investors and innovators can ask themselves when evaluating emerging solutions: How do we use technology to bring together the myriad systems and services?
It’s unrealistic to think one tech solution will eventually dominate all facets of healthcare. More likely, apps and software systems must find a way to communicate.
Take as an example conditions that frequently occur together. We know that behavioral and mental health issues have traditionally been treated in isolation, yet there are direct links between physical and mental health, like diabetes and depression, or COPD and anxiety. Managing complex care is ripe for a system that vertically integrates health services.
Who will remodel the old house?
It’s not unreasonable to think the government will, in the future, step in and regulate front-end interoperability, just as it has with back-end systems. However, it would be far better to build a system that is organically suited to allowing patients to navigate transitions and access complementary services than to have these requirements cobbled in later out of necessity.
We will not achieve true interoperability with the products and services our healthcare system offers now. But critical investment in innovation can and will move us toward this goal.
When venture capitalists back products and companies that factor patient-focused interoperability into their growth and sustainability plans, the patient’s healthcare journey will be smoother, and they will be healthier.
Ricardo Johnson leads Healthworx, the innovation and investment arm at CareFirst BlueCross BlueShield.