In today's healthcare environment, health plans and providers are under market pressures to create value by improving health outcomes at a lower cost per capita while delivering exceptional customer experiences. These expectations can't be met by doing business as usual. As the Institute of Medicine reported in its 2001 Crossing the Quality Chasm report, "The current care system cannot do the job. Trying harder will not work. Changing systems of care will."
What does this mean for health plans?
To make these changes, health plans must find innovative and highly scalable ways, beyond payment incentives, to get and keep consumers engaged in their health in concert with clinicians. The answer lies in retooling providers with innovative technologies that increase their impact and reach, through seamlessly coordinating care across the entire healthcare community.
Beyond payment incentives
Unlike payment reform, transforming the delivery system requires changing healthcare processes to correct inherent structural deficiencies.
Siloed management of chronic care: The current system is fragmented and lacks accountability. A typical primary care provider who sees 257 Medicare patients a year has a network of 183 peers in 108 different practices.
Primary care shortage: Health in the U.S. lags behind other developed nations, in part because of a decline in the vitality of primary care. In the last decade, the proportion of third-year residents who become generalists declined from 55% to less than 20%.
Low health literacy: Ninety million American adults have difficulty obtaining, processing, understanding, and acting upon health information.
Behaviors and environments: Poor health status and chronic diseases are much more the products of our behaviors and living environments than of what happens in hospitals, emergency departments, or the doctor's office.
Unwarranted variability: Overall spending on patients with serious chronic illness varies by a factor of nearly three across geographies and providers.
Administrative complexity: The U.S. spends six times more for administration than do other nations and estimated administrative costs range from 15% to 30%.
Toward a solution
The greatest opportunity for health plans lies in incenting, digitizing, and scaling the end-to-end processes that will continuously engage consumers in their health in concert with clinicians. This requires a shift in care delivery from the traditional face-to-face encounter to coordinated health interactions that follow consumers across locations and devices (PC, Web, and phone) and continuously nudge them in the direction of better health habits and self-management of their conditions.
This new approach requires a highly scalable infrastructure that is already familiar to users, adapts to the way clinicians and consumers work, saves time, and works with or without existing solutions. This infrastructure enables clinicians and consumers to instantly locate each other, communicate, work together, and coordinate care across organizational boundaries-as if they were in the same location. Microsoft technologies support these end-to-end scenarios.
The new health economy requires health plans to think beyond the present world, which uses computing power merely to "retrieve" or "exchange" information, to a world where technology works on our behalf. For example, computers can work alongside consumers who want to replace their poor health behaviors with healthy ones. Technology might amplify the impact and extend the reach of primary care providers, nurses, care managers, lifestyle coaches, and personal trainers-not replace them. In other words, we need to rethink how computing power might dramatically increase the productivity and impact of all health professionals.
