Artificial Intelligence graphic with Mark Mozley headshot and title of blog article (The Interoperability Opportunity in the Care Continuum)

True story, I used to love the fax machine at work; I LOVED IT.

I was straight out of University in a sales role, and the fax machine going off was always a sign a contract was coming in. My desk was close to the fax machine, and whether the fax was mine, or a colleague’s, it was always a special moment. Time moves on, technology changes, and I can’t remember the last time I used a fax machine; maybe 15 years ago, maybe longer.

Today we have a healthcare industry still heavily reliant – to the tune of $15B per year – on fax as a core component to critical healthcare processes. It’s not just a US problem. The UK struggles too. The National Health Service (NHS) Supply Chain has stated that it is no longer providing fax machines to the health service in a bid to improve data security and encourage investments in new technologies.

In the US, fax is still the primary, not to be confused with the preferred way that authorizations are processed. And it is inertia around these types of processes that impedes innovation in adjacent workflows, like value-based care.

Share of GDP vs. year graph visualization

Last month MedPAC, a nonpartisan legislative branch agency that provides Congress with analysis and advice on Medicare, sent a report to Congress reaffirming that healthcare spending as a share of GDP continues to grow (now at 18%), and government spending on Medicare and other major health programs is projected to exceed total federal revenues by 2038.

So, there have been decades of spending, no shortage of efforts to legislate, and still minimal progress across the industry – I will caveat that my comment on minimal progress is at an aggregate level. And through that same lens, payer/provider abrasion hasn’t eased, nor has the pharmaceutical industry’s approach to value-based reimbursement…and don’t get me started on the rebate models out there.

I say all of this to reinforce the importance of interoperability to enable value-based care.

In a recent conversation with Patrick Burton, VP of Business Development at Lightbeam Health Solutions, he said, “the desire to progress more deeply into value-based care is there, but we have reached a point where providers and payers are both running into hurdles preventing further adoption and limiting potential outcomes. Many of these hurdles are data-related. Examples like, ‘There isn’t enough data, there’s too much data, the data we have isn’t timely, the data we have isn’t accurate, etc.’ Absent solutions, any new value-based task will be categorized as administrative burden. The good news is that this challenge presents an opportunity for providers and payers to come to the table and address it together.

Thinking more broadly about value-based care, one huge market shift health plans and providers cannot ignore is the rise of the digital consumer. Healthcare consumerism is changing, and patients are evolving more rapidly than the healthcare industry’s ability to respond. This vacuum creates opportunities for market disrupters.

At NantHealth, we’re supporting health plans and providers with their interoperable population health strategies. And with our partnership eco-system, we are providing care navigation support to help close care gaps.

As a final thought, one thing that I’m hopeful of is that we all acknowledge status quo is not an option for our industry. Further reforms will always be looming. The question is: do we choose to drive that reform ourselves? Or wait until we’re told? I know which option I’d pick.

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  • Increase provider transparency – Payers can reduce risk while better aligning with providers, making sure patients get the right care at the right time.
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  • Inform referrals – Automate communications to permit referrals to the highest quality provider in the network and reduce network leakage.

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