Lack of personalized care long precedes the pandemic. The industry has struggled to surface patient information necessary for tailored care.
We live in a time when close to everything is personalized. Spotify plays your favorite music. Netflix suggests movies you'll like. Amazon shows countless products picked just for you. Yet in one big area of daily life, personalization is much harder to find: healthcare. The lack of individually tailored care is standing in the way of better, healthier, and happier lives for virtually every American.
The COVID-19 pandemic has shone a light on this crisis, along with many other issues in healthcare. Fear of catching the coronavirus has caused many patients to avoid care, even for serious conditions like heart disease. Their health issues typically compound, leading to serious consequences and often hospitalization—things that could have been prevented if they had sought care earlier.
However, even those getting care face a considerable barrier to getting the tailored care they need. Most physicians lack access to patient data from across the broader medical ecosystem. This blind spot to essential information can lead to diagnoses and treatments that are less than ideal, unhelpful, or even harmful.
Lack of personalized care long precedes the pandemic. The industry has struggled to surface patient information necessary for tailored care, leading to physicians being over-reliant on patients to track and remember their own medical needs and histories. This is a challenging ask for people with heavy prescription loads who see multiple doctors to treat their chronic illnesses. Caregivers, who look after children or sick, elderly, or disabled individuals, also experience this burden.
This is because the system misses key data that physicians could use to personalize patient care. Electronic health records, the tool most doctors have to track patients' medical histories, were built mainly for practice administrators as a billing tool. Due to this, they often fail to surface relevant data and aid in clinical decision-making during the time of the visit, or at all, for that matter. This gap puts patients in the tough position of having to advocate for their own care, sometimes repeatedly with the same doctor, instead of physicians being empowered to advocate for them.
Without a complete understanding of a patient's data and previous diagnoses, physicians end up ordering tests patients don't require, or prescribing medicines and treatments patients don't need or can't use, or even worse, that interfere with their other medications.
Considering the duplicated tests, wasted hours, and unnecessary administrative tasks, the redundancy and inefficiency of the current system costs huge amounts of money. No wonder healthcare accounts for nearly a fifth of the economy—and growing. No wonder the U.S. spends significantly more on health care than any other country—nearly 40% more than the next closest country, as a share of the economy.
Yet for all the money Americans spend, we don't benefit from correspondingly better health outcomes. We're paying more but getting less. That's the opposite of how healthcare should work.
Fixing these major problems is no small task. But there is a way forward. It relies on using interoperable technology to break the barriers that stand in the way of individualized care. Physicians' clinical judgment is essential to effective healthcare delivery, but physicians can only make clinical decisions based on the information in front of them. If more physicians had access to the full range of data, diagnoses, and treatments of their patients—from across the entire healthcare ecosystem—they'd be able to provide better and more tailored care. That, in turn, would save time, resources, and ultimately money. The more personal the care, the better the patient's health, and the bigger the savings.
This isn't speculation. It's already happening.
Apple's HealthKit made waves in 2014 by combining health and fitness data from various sources and making them accessible on your smartphone. The concept seems promising—by storing patient information in one easy-to-access location, it enables quick data sharing with medical professionals. Those doctors can then use that information to avoid the pitfalls of duplicative work and unnecessary tests and provide more tailored care.
Where HealthKit can fall short is putting all the pressure on the patient—not the physician—to share and surface information and determine when to seek care. The challenge is even greater for individuals who are less experienced with digital technology and have physical or cognitive needs that make smartphones difficult to use. The bottom line is that while more comprehensive health data does help doctors make more informed clinical decisions, that data needs to be easily accessible to physicians so they can take an active role in managing their patients' health.
Kaiser Permanente understands this need. Its vertically integrated system gives patients a provider network that tracks and shares information across the entire ecosystem. But their model tends to be narrow and closed networks—meaning Kaiser patients typically obtain care from a pre-approved set of physicians. There are upsides to the narrow approach; keeping all a patient's care in one network allows physicians to easily access each patient's data, which can lead to individualized care and controlled costs. That said, patients might not be able to see the doctors they want to see or go to the hospitals they want to go to without having to pay for it out of pocket.
Oak Street Health has taken a similar narrow-network approach but applied it specifically to the Medicare population to reduce costs and improve health outcomes for a population that generally requires more (and more complex) medical care. It has combined a nationwide network of primary care centers with a technology suite that collects and bridges its patients' individualized health data and information from hundreds of data sources to deliver more comprehensive services and tailored care—which is especially important for the Medicare population. But Oak Street's model comes with its own challenges, notably that it is difficult to scale to as many patients as possible because it relies on opening its own brick-and-mortar facilities.
All these innovative efforts are exciting and present reason to be optimistic, but they are still in their infancy. The solution to the challenges they face lies not just in scaling physician networks or opening more care facilities but in the development and adoption of technology that truly empowers physicians and fosters interoperability across the entirety of the health system. Only then will individualized healthcare become a reality. The sooner this happens, the sooner we'll empower all of us to lead happier, healthier, and better lives.
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Andrew Toy is President and Chief Technology Officer at Clover Health.
Contact: press@cloverhealth.com
“There is a way forward. It relies on using interoperable technology to break the barriers that stand in the way of individualized care.”
Andrew Toy, President and Chief Technology Officer at Clover Health.
Andrew Toy is President and Chief Technology Officer at Clover Health.