Bipin Thomas, president of the IT consulting firm UST Global Health Group, believes health care will change in dramatic ways due to health IT. DOTmed News spoke with Thomas about what this new ecosystem looks like, and what will be required of existing players.

DMN: What is driving the move toward a consumer-centric model of health care, and what does this mean for health IT companies?

BT: Two things are driving the shift: technological capability and consumer behavior. Technological advances will help organize the unstructured health information out there and enable its sharing in powerful new ways. These new capabilities have been put to use in industries from banking to investment to transportation—and consumers now expect the kind of access they have in those fields. Consumers are also getting accustomed to comparison-shopping for their services. Think about it. They’re already visiting health-related websites for medical answers and ways to improve their well-being, but more and more, especially as they grapple with out-of-pocket expenses, they are also interested in the dollar value of healthcare.

These trends are responsible for healthcare’s shift from a business-to-consumer (b2c) model to a consumer-to-business (c2b) model. And IT companies are critical allies for the payers and providers who must adapt to this new reality.

DMN: How do you see that new reality changing the delivery of health care?

BT: One of the most transformative changes is the development of accountable care organizations (ACOs), which bring together various health systems and proactive care management into a single organization that is incentivized to keep its patient population as healthy as possible. ACOs’ success in containing cost increases through improved outcomes will depend in part on the efficient sharing of information both at the point of care and over the long-term.

Information will alter healthcare delivery at several levels: value-based networks will influence contracting and lead consumers to the lowest-cost and highest-quality providers; value-based benefits will hold the consumer responsible for his healthcare choices; and sharper data will improve clinical integration. All three levels are essential to a well-functioning ACO. Success will also depend on these organizations’ ability to improve the quality and lower the cost of care.

DMN: Describe the new health care ecosystem. Who are the players, and why do they need to be connected?

BT: The new system consists of the same players as the older model, but with IT playing a far more active role in binding those players together. Providers and payers alike will have to use technology to become more retail-oriented, and evolve quickly from B2B to B2C businesses. For instance, insurance companies might tailor policies to specific patient health conditions, or to prompt certain behaviors. Similarly, payers might offer incentives such as premium reductions for their members to undergo wellness training or to practice a healthier lifestyle. Care teams will begin to counsel their members and patients on exercise, physical therapy, drug compliance—and will begin to monitor and track members’ progress on these counts. Pharmacies will become more important, for instance, in sharing data to keep consumers more compliant with their drug regimens. Using real-time communications and data, they will more efficiently interact with providers to adjust dosage and prescriptions where needed to reduce the need for clinic appointments—all of which saves costs, resources and also importantly enhances patient satisfaction.

The new ecosystem will require different skills from the existing players. For example, both health plans and health systems have to add retail health expertise and the skills necessary to become easy to do business with for consumers. Data-driven healthcare requires the ability to harness analytics to understand and improve the consumer experience.

DMN: In order to connect the continuum of care and enable consumer access to personal health information, a considerable amount of unstructured data must be organized. Can you describe what that entails?

BT: Most of the unstructured healthcare data is comprised of images and multi-media. Currently, technology for mining data from such unstructured data is not fully developed. However, textual data such as physician’s notes, transcripts, and medication description can be readily mined for meaningful insights and analytics. Big Data and analytics are vital to progress. We are already seeing the impact and value of it in accelerating clinical trial outcomes, determining and practicing evidence-based medicine, and designing personalized treatment plans.
While Big Data and analytics will undoubtedly reshape the healthcare industry, it is only in the earliest stages of transforming individual healthcare organizations. So far, health insurers have been the earliest adopters and users of Big Data for analytics; healthcare providers and caregivers have yet to realize the potential.

DMN: You say that health care leaders still have a way to go. How can they prepare for the analytics-driven industry-wide transformation?

BT: Both Payers and Providers must acknowledge the new realities in healthcare: empowered consumers, rapid innovation, and increased competition from non-traditional players. And then they have to adjust accordingly. They have to see themselves as retail and technology enterprises who will need to partner with others to tailor their offerings to sophisticated consumers—offering low price points, for example, and responding to consumer demand. Being effective in this new landscape will require expertise in how to finance, deploy and share innovative technologies, and how to capitalize on analytics to comprehend and improve consumer experience.