Consumers or Patients? How Data Can Boost Preventative Healthcare and Reduce the Cost of Care

Healthcare is patient centered, but as hospital systems grow and the way we utilize and access technology changes, data is becoming an increasingly important aspect of the industry. Leaders are now tasked with the challenge of utilizing data to reduce the cost of care by empowering patients to make preventative healthcare decisions.

“Only a handful of years ago where the idea of health data analysis and informatics was virtually unknown in the general population and now that those are coming to the forefront and people have an understanding of the amount of healthcare data that is available to them, whether at the consumer level or the management level,” Matt Kaszubinski, MS, program director of health informatics and University of New England.

And more data means a great understanding of their healthcare choices, and the ability to lower the cost of care by focusing on prevention rather than just emergency treatments.

“People will be able to make those decisions based on factual information, based on numbers, based on data,” Kaszubinksi said.

However, not all the data is being shared in a way to make it easy to help with those decisions or to even understand it at all.

Changing Priorities

According to Tej Anand, PhD, MS, professor at the McCombs School of Business, University of Texas at Austin, sickness level in the United States is declining but that doesn’t mean healthcare costs are as well. He referred to a study in the Journal of the American Medical Association which attributes some of the rise in healthcare costs to an increase in population and a higher percentage of an aging population.

Anand noted that half of the increase in the cost of care, however, comes from price and service intensity. He added that this means some of the following choices are being made:

• Using the incorrect place of service
• Using the most expensive medications whether they’re needed or not
• Getting services from the highest cost licensure clinician rather than one that is more appropriate
• Using the most expensive medical devices

“These are the factors that drive the cost, and our incentive is to take sick people and make them better. We would do a lot better if we focused our incentives and our priority on keeping people healthy,” Anand said.

Betty Jo Rocchio, DNP, MS, RN, CRNA, CENP, senior vice president and chief nursing informatics officer at Mercy, agreed that the complexity of the healthcare system is getting in the way.

“It’s because the patient is struggling to navigate the complexities that we set up to be able to manage ourselves,” Rocchio said.

She added that the nurses are the ones responsible for keeping people healthy, but they are not always set up to intervene on the preventative side.

“That’s not where the money is, that's not how people make their money,” Rocchio said. “We're not incentivizing people to stay healthy. We are taking care of them after the fact.” 

Personalization of Data

The way the healthcare industry is using data, however, may make it easier for preventative care to become a regular practice.

“We’re seeing a rather large shift from guidelines for care that are based on studies that are using very specific patient populations with predefined characteristics to one that's much more individually based for care planning, and this shift is really leveraging one's individual's own body as a guideline to better understand what's optimal for them,” said Wilson To, PhD, worldwide head of healthcare and life sciences at Amazon Web Services.

He added that organizations are using machine learning to identify clinically actionable information.

“It's advantageous to look at new concepts where data is actually being used to move up the screening process rather than downstream where it generally results in complications and very different treatment paths,” To said. “We're actually seeing much more investment in terms of how data is being used.”

Data is being used in population health management to help with early disease detection and prevent hospital readmissions, which in the end will reduce the cost of care.

Silos

One challenge in utilizing data to help improve a patient’s experience is the different ecosystems of information throughout the healthcare industry. From insurance companies to individual practices, healthcare systems, etc., there are so many places gathering the same data and processing it differently.

According to Anand, this creates some inefficiencies.

“We do a lot of redundant work. Everybody does the same work. We do a lot of rework because when everyone does the same work, they do it differently. We look at data differently, and then when we realized we've looked at it differently, we rework it,” Anand said. “And then even after we rework it, we don't agree with each other because you've got these siloed ecosystems, then we reconcile. And that's how we spend all our money, not taking care of patients, not helping them stay healthy, but just kind of talking to ourselves.”

Consumer vs. Patient

Even those receiving care themselves will process the data differently, according to Rocchio. She said there is a difference between a patient and a consumer in the healthcare industry.

“The consumer is somebody that's informed and is making a complete choice about the healthcare, the environment, and understand what they're doing,” Rocchio said. “A patient, at least in my mind, is more dependent on the system.”

She noted that while everyone decides on where they get their healthcare, as a patient other things might impact that decision.

“We all should aim to be consumers of healthcare and rarely patients. But we oftentimes, especially in the United States, become patients before becoming consumers,” Rocchio said.

She added that from the nursing perspective, she would rather help people make the right health decisions up front, and that could impact the cost of care.

“We have so much expense and we let the healthcare system manage us instead of us managing our healthcare and making decisions that are informed because half the time, the data is not out there and secondly, it's difficult to navigate. We haven't made it easy to do that,” Rocchio said.

She noted the creation of EMR was around getting healthcare information in one place for the patient to be able to access easier.

“It hasn't gone the patient or consumer route quite yet. We haven't aggregated at that level. We're getting better at it, but not enough to create decisions as a consumer,” Rocchio said.

Anand agreed that the goal is to give consumers agency.

“We want to create a scaffolding for them so that they can consume, act in a way that they don't become a patient. This will then help us reduce all the preventable patients,” Anand said.

To said this is similar to the framework his customers have shared for how they are reimagining their engagement strategies.

“It largely is anchored around three core pillars. The first is around how do I educate those healthcare consumers and patients, second is around how do we engage them, and then third, largely, how do they empower them,” To said. “And what we've seen across the board is, as unique as healthcare is as an industry, the consumer expectation that arises from engagements in those individuals' lives across multiple industries actually drives a different type of expectations that they have for what is front and center to them in this sector.”

He said they have to bridge the gap between those seeking healthcare and making it look like other experiences they have in their lives. For example, how streaming services recommend shows to help consumers figure out what to binge next, so too should healthcare services provide that same level of recommendations.

“That expectation really drives an understanding of what sort of challenges that we need to solve one together by working backward from our customers there,” To said.

Anand warned, however, that many recommendations come from stakeholders with an agenda, and it is important to avoid that in healthcare.

“I am really focused on is working with not populations, but working with people so they can decide what they should be doing and they can critically think through the options and the implications of their options, and make them aware of resources and data that they can leverage to make those decisions,” Anand said.

Ultimately, the cost of care for patients and consumers will decline when patients have access to data to help them make informed decisions. To make this possible, all stakeholders must have this same goal in mind.

“I do think that overall, whether you're a healthcare payer, a healthcare provider, research organizations or large corporate organizations in healthcare, I think there is an agenda and it's ‘how do we help patients actually improve their lives,’” To said. “I think there is a shared mission across the board in each of these different organizations that really lend themselves to that common spirit.”