Delivering value in healthcare, both for patient outcomes and financially, relies on communication and collaboration between patients and their clinicians, other healthcare providers and funders in the public and private sector. Implementing technology that enables effective collaboration underpins not only the goal of universal health coverage (UHC) but also enables proactive engagement, support and empowerment of patients.
Healthcare in Africa is making rapid strides towards developing pieces of a mobile, modern, digital health service that reaches all citizens with an acceptable standard of quality of care. Realising the benefit of disparate systems requires the backbone of a secure health informatics platform as the foundation for information exchange between the stakeholders. This platform supports public health analytics, coupled with complete claims-based and clinical information which are key to business decision-making for health. For patients, access to accurate, timely personal information, presented simply, helps them understand and encourages ownership of their health, an essential component of healthcare value.
The quest for healthcare value
Healthcare value is generally expressed in terms of improved patient outcomes, cost-effective care and associated greater patient satisfaction. Current payment models are increasingly being designed to balance these objectives rather than the fee-for-service models which may not.
Proposed bundled payments tie financial returns to highly coordinated care and proactive population health management. There’s an assumption that the interests and behaviour of patients, healthcare providers and medical schemes can be aligned to achieve common goals by sharing the risk of success or failure. In practice, value and quality in healthcare improve when risk is proactively managed, patients are well informed and engaged, and health service providers are supported in delivering care.
The inherent challenge of risk-sharing models is that the health of patients changes. Emergency room visits, acute illnesses, hospital admissions and discharges, changes to medical aid coverage and other factors alter risk profiles and can happen at any time. The same holds true for changes to medication formularies, laboratory testing and shirting adherence to care plans for chronic diseases.
To effectively manage risk, medical coverage plans and healthcare providers must share timely, comprehensive, information to support decisions and response to changes. Real-time analytics coupled with alerts and shared workflows between care teams based on accurate clinical and claims-based data make this approach feasible.
Information such as collected prescriptions; diagnoses and procedures; admissions; discharges and transfer notifications (ADTs) laboratory results; and clinical notes all help complete the status of an individual and their care requirements. This provides quality metrics on compliance to treatment, to better informed decisions at the point-of-care. Optimised, information-based interventions can reduce the risk of avoidable events; improve medical scheme member and patient health; increase patient and provider satisfaction; and lower costs, all of which contribute to better value.
For this to happen, all healthcare providers need a secure, seamless experience where actionable, important information is delivered directly into their preferred workflows using industry-accepted, messaging standards. It is not only point-of-care health service providers who need this information; care coordinators, case managers and administrators need information that enables them to make the right decisions on behalf of patients and to communicate appropriately with the care team and patients.
Connected care communities are built on a foundation of information sharing
Medical schemes and healthcare organisations generally have made substantial investments in operational and analytical information technologies. Many of these systems are capable of sending documents and data to one another, yet very few are designed to bring together and share the full spectrum of health information necessary for collaboration and engagement, much less presenting that information in a way that is timeous and compatible with clinical workflows.
A secure health informatics platform encompassing data management, interoperability and analytics acts as a strong foundation to bridge and connect care communicates of medical schemes, health service providers, medical scheme members and patients with each other.
InterSystems HealthShare® software helps organisations entering into alternative payment models to create value by sharing information and collaborating across care networks.
HealthShare provides technology for health information sharing that connects all the dots on the healthcare continuum. It allows you to capture health and health-related information from health plans, health service providers and patients; share that information among all the constituents in the care process; analyse and understand that information; and act to drive improvements in care and efficiency. It provides the basis for patient engagement and care management solutions and it currently powers successful information exchanges across the world to deliver better health through connected care.
More information about HealthShare can be found here.