Redesigning healthcare: How accessible data leads to better care

Compared with other wealthy countries, the United States has lower life expectancy and higher premature mortality. This is despite the fact that we spend almost twice as much per capita on health care.

High costs and disappointing outcomes indicate that our health care system needs to change. Our current billing system is a framework with misaligned incentives that prioritizes profit over patient care.

Value-based care promises to right the wrongs of fee-based health care. But today, we are still a long way from a value-based system. One way to get there faster? Prioritize access to data.

The following three steps will help enhance data connectivity and make widespread value-based care a reality.

1. Complete data sharing work

Currently, electronic medical record data is siled. Each electronic medical record contains only data about that patient entered by its own specific medical team.

As Americans, we have nearly 19 doctors at the time of our death. As a result, much of the care we receive is managed by providers who lack much of the data we currently have. It's like the parable of the blind men and the elephant – providers are dealing with an incomplete picture.

Data sharing is now required by law, but that doesn't mean it's happening or happening effectively.

However, sharing is only part of the problem. Full data sharing is a lot like everyone getting a full copy of everyone else's trash when it's taken to the curb. What a mess. Fortunately, we are in the age of artificial intelligence, where sophisticated agents can read large amounts of “junk” records and turn them into a logically consistent, readable, meaningful object.

Once completed, software companies can easily set up workflows to automatically begin performing some of the vertical care work that is not commonly done today:

• Population Stratification: Which patients need our attention most, whether they call us or not
• Recommended tracking: We know more about where Domino's Pizza is than we do about the patients.
• Get up to speed and stay current About the patient’s medical history

Picture this: A PCP receives an alert that a patient has just been discharged from an emergency room in another network. They immediately have access to the emergency room physician's notes, including the medications prescribed to the patient.

The PCP has all the information needed to call the patient, check on their health, and answer any questions. With this real-time data, PCPs can ensure patients understand their post-discharge care plan and potentially avoid costly readmissions.

2. Give patients more access to data

Once healthcare providers have a clear, logical understanding of their patients for the first time ever, they will be in an excellent position to publish helpful, patient-facing summaries.

Thank God. People do want access to their health data. When they get it, you can trust them to use it: health and wellness apps will be downloaded 3.6 billion times in 2024 alone. They are hot! However, they lack the rich medical record data that exists on people…imagine when this problem will be solved!

Currently, patients who want to view their complete medical records must log into each provider's portal and collect the details themselves. This may take several hours. Each new visit requires a manual update of their “data tracker”.

Having all their health data in one place and updated in real time is a game changer. The effect is doubled if health and wellness app data is also integrated.

Data overlay can provide valuable insights that empower patients to take control of their health without the need for costly professional intervention.

For example, a patient's fitness tracker may now set a standard goal of 5,000 steps per day. But if the app has access to a patient's medical data, it can tailor that targeting. It may note that they have a family history of cardiovascular disease and recommend increasing their step goal as a preventive measure.

The app may even ping the PCP to verify the recommendation—the PCP can do this in minutes without having to travel to the office.

Giving patients access to their medical data puts them in control of their health so they can make changes that lead to better outcomes.

3. Reduce regulation to increase competition

So what’s stopping us from turning this vision into reality today?

Healthcare, technology and government leaders are currently working to create a more connected healthcare industry. But regulations that hinder competition in health care are slowing progress.

We can connect data faster by eliminating regulations like the Anti-Kickback Statute, which makes it a crime for anyone to offer or accept kickbacks designed to generate health care business.

The regulation was designed to prioritize patients over profits, but it had the unintended effect of making innovation less profitable.

Rebates exist in all other supply chains to connect people to the products and services they need. DoorDash connects restaurants with available delivery drivers in their area for a fee. Priceline connects travelers with hotels in exchange for a share of profits. AirBnB, Chase and Amazon use rebates. etc.

The anti-kickback statute means that companies building data solutions to enhance healthcare connectivity cannot be compensated through kickbacks. The loss of potential revenue makes it harder for them to increase sales and build a viable business model.

Increasing competition in healthcare can pave the way for data innovators to create solutions that reduce costs and help us achieve more affordable, value-based care.

More connections means more humanity in the system

I started my career in healthcare as a first responder, working the night shift in New Orleans. It was an eye-opening experience.

My colleagues and I are willing to sacrifice a lot to treat patients. But the level of inefficiency—unnecessary costs and cumbersome processes—is frustrating. This system not only wastes money, it wastes humanity.

It felt like there were endless opportunities for improvement, so I turned my attention to making value-based healthcare a reality.

In my opinion, the best chance of implementing a system that puts patients at the center of healthcare decisions is to make data accessible and usable by all providers. By providing providers with the data they need to collaborate on patient care, we will bring humanity back to the healthcare system.

Photo: Jordan Ley, Getty Images

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