The unfolding of this week’s news has been fascinating to watch, from the chaos on the steps of the Supreme Court to the various analyses from a wide variety of stakeholders and the resulting news coverage. No matter your political views, the ruling from the Supreme Court to uphold the Affordable Care Act, including the individual mandate that all Americans buy health insurance, has removed much of the uncertainty that has dogged the health care industry for the last two years.
And with the clarity of health reform comes the need for more sophisticated analytic standards to support clinical, financial and operational decision making. Health analytics will continue to play a key role as data collection, convergence and analysis are critical to the health care transformation taking place in our nation. Health care stakeholders including health plans, providers and pharmaceutical and medical device manufacturers, can now move forward with their investments and implementation of innovative programs that require advanced analytics such as accountable care initiatives, bundled payment programs, value-based contracting, and more individualized health insurance offerings.
The law is anticipated to have a far-reaching impact on the nation’s health care system, with approximately 30 million of the 50 million uninsured Americans able to get coverage beginning in 2014. This presents both opportunities and challenges.
- If there were any lingering doubts, it is now clear that payers will need to be armed with more sophisticated intelligence to help drive consumer engagement and support decision-making. In an open insurance market, insurers will compete on a wider variety of factors than in today’s geographically-oriented business models.
- Connecting data silos within and across enterprises will be required for an improved understanding of the needs of both individual patients and populations and to accurately reflect provider performance. Most executives I talk to clearly realize the untapped value of the data they already collect, but they also acknowledge a lack of the deeper analytic insights needed to improve patient outcomes, address reimbursement challenges and enhance margins.
- With or without the ACA, the issues of rising health care costs, declining workforce health and productivity, and rapidly rising chronic health conditions remain and will continue to affect our nation’s ability to compete globally. Solutions will need to be multifaceted: employers, providers, payers, researchers, and consumers will all need to experience changes in behaviors and incentives. The politics involved shouldn’t matter, but the data involved and the end goal of improving health and health care for all Americans does.
The political polarization of this issue – especially in an election year – will undoubtedly fuel ongoing debates and maneuverings that will hold the attention of media, industry stakeholders and consumers alike. And that is a real shame because virtually none of the weekly public discourse focuses on the fundamental truths of health reform. Right now, the system is unsustainable. Right now, patients need more medical and financial decision making to be fact-based. Right now, behaviors and incentives are not optimized or even aligned towards any measurable health value that would enable us to simultaneously manage costs and outcomes. The real issues facing our industry are not about government powers or taxes or political philosophies. Until our industry is routinely making information-based decisions, every person in our country will be paying – in one form or another – more than necessary for care that too often falls short.
Vivek Wadhwa wrote in the Washington Post yesterday about the growing opportunities for innovation in health transformation. In an email to me and others concerning the article, he drew a comparison to Peter Diamandis’ book Abundance: The Future is Better Than You Think, saying that “instead of rationing healthcare and fighting over who gets insurance coverage, we should focus our energies on making it abundant.” I could not agree more. Here’s hoping the priority and attention shifts to building a health ecosystem where health insights are in abundance.