The past 100 years have seen a level of medical innovation unprecedented in human history. In just a few generations, we’ve seen the development of antibiotics, x-rays, organ transplants, the mapping of the human genome and the digitization of many medical functions.
Breakthrough technologies get plenty of attention, but patient experience, medical administration and health care operations have also evolved. Where have we come from and what’s ahead?
Patients are increasingly driving their own health care experience, collecting real-world data on their wrists and pushing for personalized care from a care team.
These trends are sure to have a major impact on health care systems for years to come. One or more of these forces may be instrumental in shaping sustainable solutions for our current major health care issues.
Since its earliest days, health care has had a strong focus on continuous improvement to deliver the highest possible value to the patient. One of the quality movement’s early leaders was surgeon Ernest Amory Codman. In the early 1900s, he led reforms for the creation of hospital standards and enacted processes to assess health care outcomes.1
Following innovations included the creation of the National Committee for Quality Assurance, the widespread adoption of peer review systems and the use of metric-linked incentives for health care providers.
Data-driven quality improvement initiatives are the “new normal” across all levels of health care. Every aspect of health care delivery is increasingly subject to quality assessments. Economic rewards and penalties are also becoming more tied to those assessments.
And those economic consequences have kicked up a notch as the fee-for-service model gives way to value-based care. Success is less often measured by the number of services rendered or patients served than by the health and outcomes of patients.
According to one study, value-based care “is bending the health care cost curve, reducing unnecessary medical costs 5.6 percent on average while improving care quality and patient engagement.”2
As part of value-based care, more organizations are adopting delivery models like patient-centered medical homes, Medicare Shared Savings and Accountable Care Organizations.3
The future will likely include an increasing reliance on episode-of-care models. In this model, providers receive one payment for the entire suite of care a patient receives for a specific medical event. Many payers are finding this to be effective at improving care quality.4
There will continue to be a drive to find more innovative and effective value-based analytics, automation and reporting. To make a sustainable shift to value-based care, organizations will need to develop deep and substantive understandings of the foundations of patient data, clinical conditions and services delivered.
Studies of value-based care in action have shown promising data, but there is still more work to do. Systemic improvements in collecting and analyzing care-related data will help value-based care metrics stay relevant.
While health care delivery once followed a standard protocol for every patient, medicine is moving away from a one-size-fits-all approach. It’s heading toward unique, personalized care based on highly individual situations and conditions.
Patients increasingly receive treatments customized for them. Human genome mapping, machine learning and AI are among the advancements that make this possible.
Machines will never replace human qualities like empathy, intuition and compassion. But people are getting boosts in making faster, more accurate decisions, thanks to new technologies.
The concept of “swarm intelligence” (the kind found in schools of fish and swarms of bees) will likely move to the forefront of diagnostics. In one recent example, combining artificial intelligence with human specialists was more effective at diagnosing pneumonia from chest X-rays than a previously validated automatic diagnostic algorithm.5
Data science will also help identify factors that can have the most impact on predicting patient outcomes and determine the best therapies for conditions that are hard to treat. Predictive models for treatment-resistant depression are already showing results.6
Wearing our health care diagnostics on our sleeves (and everywhere else) is also likely to continue. Our fitness trackers will provide more services, like measuring the heart's electrical activity, detecting low heart rates and irregular rhythms.7
Some innovations on the horizon include pills with sensors that can deliver real-time data to doctors after a patient swallows them.8 The wearable category also will likely come to include “smart bandages” that cover wounds, dispense drugs and delivering real-time status updates.9
SOCIAL DETERMINANTS OF HEALTH
Perhaps one of the earliest proponents of the importance of social determinants of health (SDOH) was Florence Nightingale. As a battlefield nurse during the Crimean War, she identified the association between poor living conditions and high death rates among soldiers treated at army hospitals. She knew that where and how you live can have a significant impact on your health.
According to the World Health Organization (WHO), SDOH are “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.”10
Many experts say that cultural, environmental and behavioral factors influence 80 to 90 percent of health outcomes. Medical care accounts for the remaining 10 to 20 percent.11
Many health care providers already are asking patients about factors like housing, food access, transportation and social isolation. Screening tools identify factors such as education, exposure to crime, literacy, socioeconomic conditions and social support.12
There are still barriers to effectively integrating SDOH tools into practice. They can be time-consuming additions to clinic and site workflows, and they may tee up offers of help that patients aren’t interested in receiving.13
Future approaches will need tools that can connect to potential resource assistance options, provide a means for follow-up and use analytics to determine success.
In the old days, the doctor was the boss. Period. Now, the doctor is one part of a team, with the patient as the final decision-maker in their own health.
As people play a larger role in their own health decisions, providers and payers are increasingly focused on improving the patient experience at all levels. It’s becoming increasingly clear that a satisfied patient is also an engaged one. Studies have linked patient engagement to better outcomes and lower costs.14
Many providers, especially hospitals, now have patient and family advisory councils, which apply firsthand knowledge to improving the experiences of other patients and caregivers.15 In a recent NEJM Catalyst survey, 49 percent of clinicians said patient councils or other patient representatives are the most promising way to bring the patient voice into health care. Forty-eight percent said incorporating consumerism into care delivery also shows promise.16
In the future, there will be a heightened effort to solicit and use patient feedback and responses. This means not just “asking to ask,” but asking with the intent of making real change. Look for health care leaders to step up efforts to act upon what they hear from patients.
Navigating a complicated medical system can be overwhelming for many patients. Care coordination can help smooth that process.
One way to coordinate the work of multiple people involved with a single patient is through community health workers. These health professionals build relationships with people outside of a clinical setting. Often, they go to individuals’ homes, places of worship or community centers to meet people where they are and connect them with the care they need.
They help patients navigate the health care system, find affordable care and provide resources to support long-term health. Their duties include scheduling doctor appointments, finding transportation and answering questions about health coverage or benefits. They also listen to patients’ needs and visit people who haven’t responded to phone calls or emails.
Another trend to note is integrated care for mental and physical health. This has been driven by recognition that physical, mental and behavioral health conditions are connected and often occur at the same time.
As the elements and deployment of coordinated care continue to evolve, look for increased integration of data from electronic health records or other health information technology systems. As technology becomes more robust, so will the necessary analytics, including social network analysis.
There will be an increased focus on making a full continuum of coordinated care the standard for each patient, especially at critical transition points.
These major trends in health care delivery and operations will have big impacts on the patients and care teams of the future. One thing we can be sure to expect is a continuous evolution toward connecting across the health care system, with patients at the center.
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