By William Kinsman
The past decade has been one of significant evolution for the healthcare industry, shifting from a disparate and transactional environment to a more value-based model where patients are at the center. With vast amounts of health and medical information at their fingertips, patients are now in the driver’s seat as a consumer of healthcare—playing a more active role in selecting their care provider, demanding better quality of care, and requiring greater transparency into healthcare costs. This power shift requires the industry to adopt a new framework that includes data-driven technological solutions and a greater focus on advancing patient-centered care.
The Consumerization of the Healthcare Industry
While legislative reforms such as the Affordable Care Act have helped patients gain access to better healthcare, nothing has empowered patients as consumers more than technological advancements made within the past several years. Artificial intelligence (AI) is one example of a technology that is providing real-time access to more healthcare information. As patients increasingly shift to a more consumer-driven mindset, they are also becoming more discerning in evaluating the quality of care they are receiving and their healthcare experience. This is exacerbated by increasing healthcare costs and out-of-pocket costs shouldered by patients. A recent report from TransUnion revealed that out-of-pocket costs for consumers increased 14 percent from 2017 to 2018. It makes sense that because patients are bearing more of the cost, they expect to receive greater value. As the “retailer,” the healthcare system is now incentivized to provide higher quality healthcare to meet evolving consumer demands, or as with any business, risk losing revenue.
Adapting Care Delivery
Physicians are adapting their approaches to care delivery and information sharing according to this new normal. Increasingly, physicians are taking a more active role in providing patients with transparency into their healthcare journey. Patient portals, for example, have become a valuable means of providing patients with access to various kinds of healthcare information, including benefits and quality scores. With portals, patients can also access tools that predict their out-of-pocket costs for physicians in and out of network and view health savings account balances (HSAs)—all empowering patients to plan and budget for costly health services and choose the best option to meet their needs.
With its ability to aggregate and analyze massive amounts of data from disparate sources and deliver meaningful information that can be immediately acted upon, AI provides data-driven insights that physicians can leverage to create more precise patient care plans, better diagnose diseases and determine patient risk. While the technology will never replace the role of physicians, AI has arguably created a data-driven environment that is capable of dramatically improving patient outcomes.
The Future for a Consumer-Centric Healthcare Industry
As the healthcare industry becomes more consumer-centric and patients become even more informed consumers, the question of “What’s next?” for the ever-evolving world of healthcare remains—in hospitals, board rooms, and on the minds of patients and lawmakers. How can we continue to improve and push the envelope to ensure physicians have the tools they need to provide the best possible care to patients?
Although the answers to these questions remain a topic of debate across the industry, it is safe to say that healthcare will only continue to become more patient-centric with time. With AI technology, care providers can access real-time insights into patients and their risk levels relative to broader populations, enabling providers and payers to also glean insights into key population health outcomes.
In today’s world, healthcare organizations need to develop new strategies that are derived from a holistic standpoint with the patient as the consumer in mind. Continued care and resources need to be provided for patients even after a product or service is provided. Patients must be actively engaged in the conversation and asked about the changes they would like to see in the healthcare industry. And, as with any industry, when your consumers are at the forefront of your business strategy, you have positioned yourself for success.
William Kinsman, Senior Manager of Product Innovation, manages Inovalon’s Artificial Intelligence team and the implementation of their products. In his first year at Inovalon, Mr. Kinsman has made it his goal to bring clinicians and this technology together by leading the development of the advanced natural language processing algorithms presently in Inovalon’s product offerings. He collaborates with Professors and Doctorial candidates from the University of Maryland and the New Jersey Institute of Technology to bridge the gap in healthcare data extraction and develop never before seen approaches in patient-centric healthcare, with a focus on patient gap detection and intervention optimization.
Mr. Kinsman has over 6 years of experience in the construction of machine learning algorithms. Prior to joining Inovalon, he led the development of several novel language processing algorithms as a contractor at the National Security Agency, but also has previous work experience as a developer at a high frequency trading firm and as an engineer at NASA. He received his Bachelor’s degree from Clarkson University in mechanical engineering prior to years of research in electrical materials research at Penn State University.
For more information, visit www.inovalon.com.