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Health care in the 21st century

What will a modernized system look like? 

When it comes to writing an article about health care, it is a lot harder these days to decide on the topic. Do you talk about the crippling impact of ever-rising health care costs? Or perhaps the implications of US health reform legislation on national and international health care markets and business models? Another approach might be to focus on the need for performance-based incentive structures in driving health delivery transformation. Or how medical tourism and the rise of the informed health consumer are driving changes in behaviors for both businesses and consumers. You could even spend a few pages talking about the effect of doubling the health IT market size through federal subsidies and incentives.

The list of potential topics is pretty long, and the picture is evolving at an unprecedented rate. The only absolute certainty is this: The future practice of medicine will look considerably different than the model prevalent in the 20th century. The people, products, delivery processes and payments will – by necessity – have a much greater bias toward outcomes. And once the growing pains are over, the world will be a better place for patients everywhere.

What will a modernized health enterprise look like? At a minimum, it will be:

Collaborative. Whereas the historical view of health communication involved one-on-one exchanges between two or three practitioners, health care delivery will become truly collaborative. Multiple practitioners across institutions will work together to develop and monitor treatment programs for their patients. Providers, researchers and payers will learn how to maximize health outcomes at the individual patient level. And patients themselves will be active collaborators and contributors to their own therapies and wellness efforts.

Cost-Aware. Without question, the single largest driver of health transformation is cost. In a climate dominated by unsustainable expenditures and expensive inefficiencies, no one has benefited: patients unable to pay skyrocketing premiums and prices, payers unable to financially manage risk, and providers unable to profitably maintain the practice of medicine. All constituents in the modernized health system must become more fully cost-conscious in terms of efficiencies, incentives, discretionary spending, risk management and quality.

Outcomes-Oriented. The top care providers have always sought the best health outcomes for their patients. But a modern view of health outcomes is multidimensional. Efficacy, sustainability, prevention, quality, safety and cost all represent important facets of health outcomes. So while the betterment of patient lives is always a primary concern, a more comprehensive view of health outcomes will be required to support the care delivery model.

Of course, creating a collaborative, cost-aware, outcomes-oriented health care system requires embracing an ability and priority of information-based decisions. And those decisions will be powered by analytics. Analytical applications in health and life sciences can be conceptualized as existing on a continuum between business analytics (e.g., cost, profitability, efficiency) and clinical analytics (e.g., safety, efficacy). Whereas health care institutions have historically undertaken initiatives targeting the extreme ends of that continuum (e.g., an activity-based costing initiative at a hospital), the largest challenges still reside in moving toward the middle of the continuum – linking clinical and business analytics into a more comprehensive view of health outcomes and costs.

Linking business and clinical perspectives will not be easy. Data from all three traditionally siloed markets – care providers, health plans, and researchers/manufacturers – must be joined in order to produce a more complete picture of quality, efficacy, safety and cost. In short, the analytically derived insights needed to drive health industry transformations require industrywide collaboration on shared information and common analytical needs to formalize the link between clinical and business concerns.

Thankfully, the gap between the worlds of paper and electronic records is rapidly closing, especially in the face of IT adoption strategies and incentives such as those attached to US health reform. The next gap will exist between electronic data and usable information, and that gap will be closed through analytical technologies. In this document, you will hear from some of the leading experts in the industry on how analytics can help transform health enterprises: measuring clinical and safety performance, detecting and preventing fraud, driving better treatment outcomes, restructuring costs, tapping into social media analytics, and much more. As illustrated in the figure below, the applications of analytics to improving health outcomes and costs are limited only by the imaginations and motivations of the people enabling change. And the opportunity for innovation is astounding.

The journey to fully utilizing health analytics to drive health transformation is just beginning. In addition to dealing with the practical aspects – data integration, quality management, computing capacity, governance – institutions must also face up to the changes in organizational capability and culture that accompany any evolution of this type. It is a tall order, but through the articles you read here, you will see that this is not some far-off future. Organizations are successfully making the transitions today and reaping the benefits of a more fully empowered, efficient and even profitable health enterprise. The power to know is at our fingertips, and now is the time to embrace it.

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