While these are important questions that still need answers, we also have an opportunity to take a step back and look at how far we’ve come in just a year. Specifically, in the last 12 months, the health IT industry took major leaps forward to create a more seamless healthcare experience for patients and providers. Let’s celebrate this progress.
Interoperability is finally becoming a priority
A key lesson learned from the pandemic so far is the importance of data sharing among patients, providers, payers and healthcare innovators. If there had been true interoperability established for optimal data exchange, we would have detected COVID-19 cases earlier and helped to mitigate the spread.
Former Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said that if passengers quarantined on cruise ships during the early days of the pandemic had access to their electronic health records and data, they would have been better equipped with details of their medical conditions or medications they were taking.
While the interoperability infrastructure was not in place at the start of the pandemic, the prior administration laid the necessary groundwork for more seamless data exchange this year. For example, in March 2020, CMS passed its Interoperability and Patient Access final rule, empowering healthcare consumers with access to their health records by introducing opportunities for better data sharing between payers, providers, third-party apps and patients.
More recently, in January 2021, CMS finalized another rule requiring insurers to allow providers and patients electronic access to prior authorization decisions and other data about whether a treatment will be covered. Each of these rules moves the industry in the right direction for improved data sharing. Though the recent final rule is frozen for review by the Biden Administration, the direction from CMS is clear.
We’re already seeing this heightened focus on interoperability pay dividends. In February 2021, pharmacies like Walgreens and CVS announced they would begin administering the COVID-19 vaccines, a crucial step to vaccinating the population more rapidly.
Why have pharmacies been able to step up so quickly? Because pharmacies invested heavily in real-time interoperability well ahead of traditional providers in the inpatient and outpatient settings. In the competition for new revenue streams, the pharmacy companies accelerated work on “event notification” to alert primary care providers about flu shots, blood pressure checks and other vaccinations.
We’re closer to curing the administrative burden in health care
The progress the industry has made with interoperability has paved a path for robotic process automation (RPA) to achieve its full potential. RPA, which is automation of the prior authorization process, allows providers and patients to spend less time navigating the burdensome administrative requirements of health care and more time focusing on delivering and receiving quality care. While RPA won’t completely cut out the human processes, it will allow more automation that will learn from and predict when human intervention is needed, such as with the prior authorization process.
According to the American Medical Association, physicians spend 14 hours per week sending prior authorization requests and waiting for responses, time that would be better spent providing care. While it may be the less-sexy side of interoperability, RPA will equip doctors with the information and support they need to make decisions about the right care that improves outcomes.
Digital health market momentum shows no signs of slowing
Improved data sharing and administrative processes are not the only bright spots on the horizon. We can also expect deal momentum to continue into 2021. Aside from the IPOs, mergers and acquisitions and funding announcements that flooded headlines in 2020 and have spilled into 2021, we will see payers offering a financial lifeline to providers this year. With payers sitting on more reserves than usual due to patients postponing care, they will look for opportunities to support network providers suffering from cash flow problems as a result of the slowdown in discretionary care under the pandemic.
Digital health investors will also be on the hunt for 2021’s “deal of the year.” According to Rock Health’s 2020 Market Insights report, investors poured $14.1 billion into the industry in 2020, a 72% increase from 2018. Based on the investments already announced this year, the digital health market will continue to be hot throughout 2021.
Further, vertical integrations, much like Cigna’s purchase of Express Scripts and CVS’s of Aetna, will not receive much pushback from the federal government because they seem to provide the promise of increased patient value. The same is true for transactions between health plans purchasing provider groups and large tech vendors, and large providers further consolidating and investing in startup tech vendors.
While 2020 was a challenging year, the additional burdens placed on the healthcare system accelerated innovation more than ever before. Perhaps we’re turning a corner towards a “new normal” in healthcare; a system with seamless data exchange, less administrative work for providers and patients and strong deal flow that encourages even more healthcare innovation.
Kelly is principal business advisor for Edifecs, a health care information technology company based in Bellevue, Washington.