EMPOWERING THE NEW HEALTHCARE ECOSYSTEM

Transcription

1 EMPOWERING THE NEW HEALTHCARE ECOSYSTEM

2 2 Today, the healthcare industry finds itself on the threshold of a new era in which key stakeholders, empowered by technology, are breaking down barriers and redefining what s possible in medical care. Find out how IT is shaping this new healthcare ecosystem. A NEW ERA Never before has the healthcare industry offered so much hope amid so much uncertainty. In the last decade, we have seen the unlocking of the human genome, which has put personalized and predictive medicine within reach for the first time in history. Advances in biomedicine and pharmaceuticals are achieving unprecedented success against formerly intractable diseases. And the next generation of information technology is sparking innovation across the healthcare value chain. Yet we are also living in a time of great economic and social upheaval, with healthcare businesses and organizations contending with extraordinary new financial, demographic, and regulatory pressures. A challenging global economy continues to strain the bottom lines of providers, payers, and pharmaceutical companies - not to mention the businesses and taxpayers who ultimately foot the bill. What s more, the economics of healthcare are set to become even tougher in the years ahead as aging populations in industrial countries place new demands on both private and public healthcare systems. Tighter finances and thinning margins have made cost cutting and operational efficiency a top priority across the healthcare supply chain. It has also fueled innovation, with stakeholders ranging from hospitals and insurance companies to drug companies and pharmacies learning to exploit Health IT to become leaner and more agile without compromising the end goal: patient care. Indeed, Health IT is quickly turning into a competitive differentiator, helping healthcare organizations attract new patients and plan members with more personalized services and rich healthinformation resources. In the U.S., the convergence of medical advances, technology innovations, and policy shifts are rewriting the rules of a $2.5 trillion industry that makes up an astonishing 17.3% of the nation s 1 economy. When President Obama signed the Patient Protection and Affordable Care Act in March 2010, an entire industry was mobilized by the prospect of serving 32 million newly insured people. A year before, the Health Information Technology for Economic and Clinical Health (HITECH) Act-part of the 2009 economic stimulus program2 - poured billions of dollars into the development of electronic medical records (EMRs).

3 3 In the U.S., the convergence of medical advances, technology innovations, and policy shifts are rewriting the rules of a $2.5 trillion industry that makes up an astonishing 17.3% of the nation s economy. These new programs come with sticks as well as carrots, and the new era of healthcare will be marked by a ratcheting up of regulatory rules, mandates and penalties designed to cut fraud and waste and jumpstart new solutions such as health information exchanges. Similar government initiatives are reshaping the healthcare landscape of Europe, Asia and other developed economies around the world. What does this all mean for industry stakeholders? At a minimum, stakeholders will need to prepare for a world of escalating complexity and volatility. Navigating this new environment won t be easy. It will call for flexible strategies that can evolve in step with the changing economic, technological, and regulatory landscape. It will call for smart investments in technology - ones that emphasize interoperability, scalability, and cost-effectiveness. And it will call for strategic partnerships to help stakeholders thrive in the new healthcare ecosystem. Navigating this new environment won t be easy. It will call for flexible strategies that can evolve in step with the changing economic, technological, and regulatory landscape. THE NEW HEALTHCARE ECOSYSTEM Who are the stakeholders in the new ecosystem? At the highest level, we all are. Anyone who seeks medical care as a patient has a vested interest in the healthcare system. So the architecture of the new healthcare ecosystem begins with the patient the first P in what we call the 6 Ps of healthcare, as shown in the figure on the next page. The following key stakeholders populate the rest of the ecosystem: Providers - doctors, nurses, therapists, hospitals, physician groups, clinics and other medical professionals and organizations that provide medical care to patients. Payers - health insurance companies that cover the cost of medical care, as well as businesses, organizations, and individuals who either directly pay for care, or pay for insurance coverage. Pharmaceutical companies - makers of drugs prescribed by

4 4 doctors and healthcare providers; pharmaceutical companies sell approximately $300 billion worth of products in the U.S., and $650 billion worldwide. Pharmacies - a sometimes overlooked player in the healthcare ecosystem, pharmacies represent a $277 billion industry in the U.S., often providing critical guidance to patients. Policymakers - government agencies and industry organizations that set healthcare policy, write and enforce regulations, and oversee industry standards. THE 6 PS OF THE NEW HEALTHCARE ECOSYSTEM UNIQUE ROLES, SHARED INTERESTS In the past, these stakeholders occupied distinct niches in the overall healthcare ecosystem. Their roles were completely clear, in part because interfaces between stakeholders were either weak or nonexistent. Payers before the advent of managed services, for example, stayed largely uninvolved in medical management; pharmacies, lacking the enterprise software and networks to link to providers and payers, served as passive dispensers of medicine; providers, for their part, occupied silos of their own, lacking the means to track patients from place to place, or automated systems to offload the burden of paperwork. The new paradigm reflects a systems thinking view of an industry where the walls separating stakeholders are steadily crumbling - where the success of one depends on the success of others, and where new business models of coexistence and co-development are rapidly becoming the norm. That s partly due to new government

5 5 regulations that have opened up vast flows of information between patients, providers and payers - and throughout the ecosystem; and partly the result of runaway medical costs, which have spurred the entire complex to live within its means. That priority demands more collaboration, more information sharing, more interoperability, and more integration. In short: more convergence. This new ecosystem presents tremendous opportunities for creating value when stake-holders learn to grasp the full potential of technology- and policy-driven convergence. In this new era, we see stakeholders coalescing around a common goal: delivering better care, to more people, at a reasonable cost. Getting there will require vision, skill, and the confidence to invest in innovation. What is clear, also, is that information technologies, services, and solutions will play a central role in this value-creation process. THE TECHNOLOGY EDGE Historically, healthcare has been slow to embrace information technology. The healthcare industry is where most of corporate America was a decade or more ago in adopting Internet-style computing, writes Steve Lohr in the New York Times. There are innovators, intriguing experi-ments and lots of interest, but the technol-ogy hasn t yet gone mainstream. But the situation is rapidly 3 changing, he adds, and only the pace of the shift is in question. In truth, information technology has been transforming healthcare organizations for more than a decade, albeit in low-profile venues like hospital back offices, where enterprise resource planning (ERP) systems have been installed to automate billing and other revenuecycle functions. Today, healthcare organizations large and small are equipping themselves with enterprise systems and solutions to optimize tasks ranging from claims processing and patient admissions to workforce management and regulatory compliance. Pharmaceutical companies, meanwhile, are investing heavily in IT to speed drug development and testing programs. Far from a trivial development, the growing adoption of Health IT has generated enormous value for organizations. Among other initiatives, strategic outsourcing and selected business-process partnerships are generating immense value to healthcare stakeholders, translating into billions of dollars in bottom-line savings across the industry. The move is letting healthcare organizations spend less on tasks that fall outside their core competency and transfer more resources to areas that matter most, such as clinical care, scientific research, and healthcare education.

6 6 Beyond the administrative streamlining, Health IT has now moved to the forefront of medical best practice, giving providers the knowledge and tools to head off disease before it strikes, while empowering patients with the resources to take charge of their healthcare and make smarter decisions from both a medical and cost perspective. In these areas, Health IT s strength lies in its power to distill massive amounts of data from disparate sources, to provide mechanisms for faster, better decision-making, and to open up new channels of communications between patients, providers and payers. At the end of the day, enabling the predictive, preventive and participatory approaches to healthcare made possible by IT is expected to yield the most meaningful and lasting returns to the industry and society as a whole. EMERGING TRENDS The tech-enabled future is already visible in several key trends emerging now. Chief among them may be the accelerating adoption of electronic medical records that share data across networks. EMRs - along with the closely affiliated EHRs (electronic health records) and PHRs (personal health records) - will soon become pervasive, boosted by nearly $20 billion dollars in government incentives as well as advances in information security and portability that have addressed initial concerns about the concept. Nearly 200,000 providers have already adopted EMRs, yet its potential for improving patient health remains largely untapped. Healthcare will be more coordinated in the future, continuing a trend of patient-centric care that emphasizes preventive primary care and close partnerships between patients and providers. Guided by shared information, patients will move seamlessly between all types of care - givers in an integrated fashion, with each provider staying fully informed of the patient s overall progress. Care coordination will drive savings by improving medical outcomes and focusing care more effectively. Increasingly, evidence-based medicine will become the norm for the healthcare profession. This methodology depends on analyzing massive stores of data, including genomic and epidemiological databases, to refine diagnoses and set the best course of treatment for each individual. The approach is one of the most reliable ways to improve treatments and outcomes, which makes it an attractive option for every stakeholder in the industry. Information technology will enable healthcare to be delivered on a

7 7 more constant basis in the years ahead. Telemedicine will support that trend, enabling expert care to be delivered wherever the patient lives via broadband multimedia networks. Such technology bridges vast distances in an instant, giving patients new options for home healthcare and extending the specialized skills of experts to more people and geographies. Guided by shared information, patients will move seamlessly between all types of caregivers in an integrated fashion, with each provider staying fully informed of the patient s overall progress. CONCLUSION In the new healthcare industry, stakeholders will continue to be challenged by tough choices as they seek to deliver the highest level of patient care with limited economic and human resources. For that reason, information technology will remain at the center of the new healthcare ecosystem, helping stakeholders harness the power of collaboration and knowledge sharing to improve care, stretch budgets, and spark innovation. Convergence will be a dominant trend in this world, and the most successful stakeholders will be those that exploit the tremendous value potential of cross-boundary integration and innovative technology partnerships. ABOUT AUTHOR For more information about how HCL is enabling the future of healthcare, contact Pradep Nair, Senior Vice President - Healthcare Practice, HCL, at pnair@hcl.com. REFERENCE Also known as the American Recovery and Reinvestment Act (ARRA) 3 Health Care Industry Moves Slowly Onto the Internet, Steve Lohr, New York Times, April 5, 2009.

8 8 ABOUT HCL HCL Technologies HCL Technologies is a leading global IT services company, working with clients in the areas that impact and redefine the core of their businesses. Since its inception into the global landscape after its IPO in 1999, HCL focuses on transformational outsourcing, underlined by innovation and value creation, and offers an integrated portfolio of services including software led IT solutions, remote infrastructure management, engineering and R&D services and BPO. HCL leverages its extensive global offshore infrastructure and network of offices in 26 countries to provide holistic, multi-service delivery in key industry verticals including Financial Services, Manufacturing, Consumer Services, Public Services and Healthcare. HCL takes pride in its philosophy of Employees First which empowers our 77,046 transformers to create real value for customers. HCL Technologies, along with its subsidiaries, had consolidated revenues of US$ 3.5 billion (Rs. 16,034 crores), as on 30 June 2011 (on LTM basis). For more information, please visit About HCL Enterprise HCL is a $6 billion leading global technology and IT enterprise comprising two companies listed in India - HCL Technologies and HCL Infosystems. Founded in 1976, HCL is one of India s original IT garage start-ups. A pioneer of modern computing, HCL is a global transformational enterprise today. Its range of offerings includes product engineering, custom & package applications, BPO, IT infrastructure services, IT hardware, systems integration, and distribution of information and communications technology (ICT) products across a wide range of focused industry verticals. The HCL team consists of 85,000 professionals of diverse nationalities, who operate from 31 countries including over 500 points of presence in India. HCL has partnerships with several leading Global 1000 firms, including leading IT and technology firms. For more information, please visit