Traditionally, healthcare data has been isolated across various stakeholders within the healthcare system, such as individual providers, payers, and patients. This fragmentation has often posed a barrier when attempting to access and utilize data for comprehensive healthcare management. To address this challenge, there is a need to drive greater access to healthcare data across all parties, particularly for patients, who are central to the healthcare ecosystem.
The democratization of data as a practice must be adopted to enable greater transparency, increased information-sharing, and improved communication within the healthcare space.
Bridging the gap between payers, providers, and patients
One of the primary benefits of democratizing healthcare data is the enhancement of patient outcomes. With the increased availability of healthcare records, providers can gain a comprehensive view of the medical history of patients, enabling them to spot trends and patterns that may not have been apparent in the past. Empowered with this holistic perspective, healthcare professionals can provide better diagnoses and effective treatment plans, leading to more personalized and targeted care for patients.
Another significant advantage of data democratization is enhancing transparency and accountability for payers and providers. When patient outcome data and provider performance data become accessible to payers and providers, respectively, they can work together toward negotiating improved reimbursement rates while ensuring effective healthcare delivery. This data-driven approach allows for a more objective assessment of the quality of care being provided, enabling a more sustainable healthcare ecosystem that benefits all stakeholders.
The journey towards healthcare data democracy has bumps
While data democracy within the healthcare ecosystem offers attractive benefits, there are some significant challenges that need to be addressed before its full potential can be realized.
The primary obstacle to democratizing healthcare-related data is data privacy and security. Patient medical records and related information are highly sensitive and can be subject to unauthorized access or data breaches. Robust security and regulative measures must be implemented to ensure that patient health records are secured and protected from misuse.
There is also a deep concern with data democratization causing a power imbalance between payers and providers in the healthcare ecosystem. They often have a contentious relationship due to the competing interests of providing high-quality care and controlling costs. Specifically, payers may use patient data to negotiate lower reimbursement rates with providers while disregarding the best treatment solutions for patients. To avoid such scenarios, it is crucial that patient data is used transparently and equitably so that all stakeholders work towards the common goal of providing the best care possible. Emphasis must be placed on developing standards for data sharing and ensuring that payers and providers act in a responsible manner.
Democratizing data is only half the battle won
Democratizing data alone is insufficient for bringing payers and providers together. Other crucial factors, such as payment models, incentives, and regulations, go hand-in-hand with data democratization in shaping their relationship.
For instance, regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the USA make it difficult for patient health data to be shared easily between payers and providers, hindering efforts toward data democratization. There is a need for more clarity around how HIPAA regulations can ensure patient privacy during sharing of healthcare data.
Another critical factor that affects the relationship between payers and providers is the payment model. A traditional fee-for-service payment model encourages providers to focus on the number of services they offer rather than the quality of care they provide. Providers can gain monetarily by withholding information from payers regarding additional, unnecessary services and procedures. In such circumstances, providers may not reveal the actual performance data to payers, creating a setback in democratizing data.
It is imperative that payment models such as pay-for-performance (P4P) and value-based reimbursement (VBR) be adopted, which reward providers for delivering quality care and motivate them to share complete performance data with payers.
Achieving healthcare symphony with small impacts
Data democratization has already brought significant changes within the realm of healthcare. A major impact can be seen through collaborative care models, where various healthcare providers work together to develop a comprehensive treatment plan for patients. This is made possible by establishing end-to-end patient records with seamless and regulated access for all providers. Another successful implementation of healthcare data democracy is with the initiative – Bundled Payments for Care Improvement (BPCI), consisting of healthcare models where payments are made to multiple providers during a treatment cycle. In this approach, payers and providers work closely to ensure the quality of care while maintaining financial and performance accountability.
Based on the real-world applications of healthcare data as described above, it is evident that a healthcare data-sharing system that operates on democratic principles is the cornerstone of a modern healthcare industry. In pursuit of this objective and to make high-quality and affordable healthcare an immediate reality, we must prioritize democratizing data across the healthcare continuum.
AUTHOR
Prasanna Gunjikar
Senior Vice President and Practice Head – Health and Insurance
SUBJECT TAGS
#healthcare
#healthcaredatademocracy
#patienthealthcareexperience
#qualitycare
#patientdatasecurity
#BPCI
#valuebasedcare
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