How digital tools can help deliver on the promise of value-based care

3 strategies to embrace technology for meaningful improvements to outcomes, cost, and experiences

There are terms we use regularly in healthcare that, when you step back, can seem absurd. One of my favs is “patient centricity.” While I laud the intention when people use it — and, admittedly, I also use the term — the fact that it even exists as a term is kind of bewildering - if not for the patient, then what are these trillions of dollars for?  

Let’s consider “value-based care” (VBC). If we are not providing value (utility or outcome divided by cost), then what are we doing? Revenue-based care? Volume-based care? Profit-based care? The U.S. government has been trying to rein it in with VBC programs and pilots, but we are still spending north of 15% of our GDP on healthcare (twice that of the closest country), and have middle-of-the-pack health index outcomes compared to the rest of the world. The problem is getting more urgent with more and more care delivered by mega-corporations with quarterly earnings as their North Star.

Now that I have all that off my chest, what can we, who work in the field and not in D.C., do to move towards delivering on the aims of VBC?

Human-centered approaches  

Two of the “quadruple aims” of VBC are improving patient experience and provider experience (in addition to better outcomes and lower cost). It is not that hard to put these most important humans at the center of your process. It’s not that hard — whether you are using design thinking (an inherently human-centered approach), simply involving providers and patients in your research, strategy, ideation, and governance work; using personas and journeys; or formal validation/usability testing. 

I can’t tell you how many projects I have been a part of that feel like the real orientation is org-centric, billing-centric, C-suite-centric, EHR-centric or legal/risk-centric design. Not that these aren’t real and important considerations that need to be factored in — but they should not be at the center of the process. 

Remote patient monitoring and virtual visits 

There are a host of mature devices, technology, and data standards that enable care to extend beyond the four walls of the clinic or hospital to improve and measure outcomes as well as reduce cost and deliver convenience. These tools benefitted from a rapid acceleration and normalization during the pandemic. But some of the guidance I would offer organizations here is to develop a holistic, enterprise strategy including a single data architecture, best practices, logistics, and funding models. I see these technologies so often being deployed as one-offs, episodic or even “off the books,” and they end up being less effective and more expensive.

Rather than isolated point solutions, an ecosystem approach can deliver more powerful, technology-driven results. Consider the patient of the near future (as imagined in our 2030 workshop) who receives real-time medical advice and care through a linked set of networked devices and appliances, all from the comfort of home.

For large-scale connected health to evolve, organizations will need to partner with best-in-class innovators for certain parts (i.e. Amazon for logistics, Amwell for telehealth, Best Buy for device set-up/support).

Leverage AI in smart ways 

AI has certainly been having a big coming out party in the last couple of years, and this class of technologies can be incredibly valuable for certain use cases. In addition to having a cohesive enterprise strategy and methodology for exploring AI, here are a few areas that could be worth looking at to deliver on VBC:

1. Orchestration and care navigation. We know that navigating care across multiple episodes, providers, and agencies is complex, and especially difficult when individuals are compromised. We also know that assigning a care navigator can be key to outcomes, but is also expensive and hard to scale. What if each patient had a “care agent” who could act as a care navigator, data custodian, coach, and information source, and work across providers and episodes?  
2. Population health management. While this is another questionable term, AI / ML can be very good at looking across a large set of individuals and proactively predicting who may need care, outreach, resources, etc., as opposed to waiting for an expensive, stressful visit to the ER with an escalated condition. Deploying care proactively, whether as a provider, employer, or agency can make a big difference on outcome and cost. 
3. A sea of efficiencies. There are likely a bunch of activities, workflows, and moments in your organization that AI could make much more efficient and effective. And small gains can add up: If you have five use cases that increase efficiency by just 2%, that’s 10%. Here are some examples: 

• Gen AI can be very effective at drafting patient communications to be reviewed by an HCP before sending. This saves time and allows for content that can be more empathetic and personalized because it’s not written by a doc who is 25 minutes late to her next visit.  
• Conversational experiences including scheduling, onboarding, and triage. 
• Prior authorization letters to payers can be almost fully automated. 
• AI engines can manage the complexity of scheduling - booking patient appointments and workforce scheduling. 
• Imaging and pathology data “pre-reads” by AI tools can reduce HCP time and improve quality at the same time.
• Deployment of general office tools like Gemini and CoPilot (studies show an increase in desk worker efficiency of 20-40%). 

The road away from our reactive, fragmented volume-based care model to the shimmering city on the hill of value-based care is slow and filled with potholes, oil slicks, trolls, and roadblocks. But if we all keep pedaling in whatever spheres we can influence, we may just get there. Let’s focus on more human-centered approaches while leveraging the recent advancements in remote technologies and AI. Then we can truly start to deliver on the promise of value-based care.