Developing a Future Generation Integrated Healthcare System

If we were to envision a new integrated health system from scratch, what would it look like? We can benefit from taking note of what’s happening in other nations around the world.

The United States needs more bold visioning in health care. In the 1990s, integrated health care came into vogue, and it was a good step. However, most would agree that, since then, incremental change has been happening too slowly. Costs are slowing, but not enough; quality has improved, but access often has not; many aspire to the “Triple Aim,” but it is far from being actualized.

Visualizing a different approach to care may provide a means to addressing these challenges. An approach that is already in use by tech-savvy young people in China provides an example of integrated health care that is going a long way to meeting the needs of this population segment.

The User Interface

Arguably, the most sophisticated interface between user and goods and services is evident in what has been referred to as Silicon Valley East: Shenzhen, China. ^a Most tech savvy residents of Shenzhen seldom use cash, and they do not have credit cards. They order goods and services and pay with their mobile phones.

Transactions in Shenzhen typically occur through one of two apps: Alipay, started by Alibaba; and WeChat, started by TenCent. Both Alipay and Wechat have more complex networks of apps and sub-apps, more market reach, and more knowledge about their users than their counterparts in the United States today. Think of AliPay and WeChat as examples of future “interface hub applications.” These hubs already know a lot about their users:

• Their identities (facial recognition)
• Their buying habits and sources of funds
• Their locations (GPS)
• Other apps they use
• Other apps they should use for specific needs

These hubs are constantly being linked to new businesses and other apps and to apps within apps, many of which disappear after they have completed their function, leaving their captured data within the hub interface application. Taking a lesson from China’s approach, let’s assume our nation’s next future generation system starts with a hub interface application—the same user interface application tech-savvy consumers use to buy groceries.

Moving from the User Interface to the Ambulatory Care Interface

“Siri, where do people like me go for primary care?” The appeal of a future integrated system’s answer to this question goes well beyond convenience. It harnesses information to benefit the end user. The future generation user interface could link to a wide range of other applications that provide healthcare organizations with data-driven inputs regarding key questions:

• Which ambulatory organizations, which physician offices, and which physicians are most proficient in delivering primary care? Which deliver excellent specialty care?
• What care options exist within network? And what are the costs and benefits of going out-of-network?
• How effective will the primary care practice be at ensuring its patients have timely and effective access to specialty care given their insurance, cash position, and expected specialty needs?
• Who are the patients? Are they healthy? Do they want strong ongoing relationships with care teams they know, or is that not important to them? Among the following, which are they more likely to require: exceptional care in a known field, remarkable diagnostic skills, great follow-up, or average care at a good price?
• Can patients handle their current needs with telemedicine and worry about an ongoing relationship to a primary care practice later?

Navigating Between Business–to–Business Apps

This part might seem a bit tricky. On the one hand, the interfaces nearest to the user must be tailored to the needs of the individual. On the other hand, the business-to-business linkages need to be broad-based. The same underlying business platforms that serve tech-savvy young people also will serve most other population segments. And they may all intersect with an Amazon-like supply chain. They also may serve a wide variety of health systems, physician groups, and other care givers.

It may not be long before healthcare providers are asking their electronic devices for help in matters such as increasing their multiples, decreasing their costs, and delivering the right higher quantities of Tamiflu to the right locations, or finding out how many other cases in the world appear to show similar symptoms to cases they are treating.

These interfaces may not be as tricky as they seem. Ironically, significantly large data sets combined with other significantly large data sets on related issues facilitate the development of fine-tuned, individualized diagnoses. And other large databases on personal expenditures and other forms of information allow for fine-tuned predictions of a person’s future choices among options.

Agents of Change

Who will make these changes, and why? We now have a mix of traditional change agents such as consultants, business integrators, health system, and other leaders, and new agents such as online retailers, pharmacies, and business start-ups. This situation may take quite a while to sort out.

There may be visions, egos, and dollars to sort out. Not everyone will be successful, and some may run into unwelcome challenges. There may be leaders who are accustomed to working with others they trust but find themselves compelled to work with people they do not trust. Risk-averse organizations may need to work with risk-seeking organizations. Those who are sensitive to patient needs may need to work closely with those who care only about multiples. And who is going to work across these platforms on fraud protection?

The Road Ahead

Of course, the approach used in Shenzhen, China, is just one scenario, and it involves only one patient segment. Nonetheless, it provides enough perspective to suggest the road ahead will be complex. It suggests increases in efficiency can bring significant opportunities. It also points to the many potential changes in career directions and new winners and losers.

The scenario also suggests numerous policy issues. What is privacy in this context? The young Chinese users in Shenzhen gave up on the concept of privacy a long time ago.

Also, what requires competition versus cooperation?

If this scenario is any indication of what lies ahead for the U.S. healthcare system, we could be in for a wild ride.

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Keith D. Moore, MCP, is CEO, McManis Consulting, Denver, and a member of HFMA’s Colorado Chapter.

Dean C. Coddington is a senior consultant, McManis Consulting, Denver.

Footnotes

a. Bellini, J., “China’s Great Leap to Wallet-Free Living,” Moving Upstream, The Wall Street Journal, Jan. 18, 2018.