The past decade has been one of significant evolution for the health care industry, shifting from a disparate and transactional environment to a more value-based model where patients are at the center. With untold amounts of health and medical information at their fingertips, patients now are in the driver’s seat as a consumer–playing a more active role in selecting their provider, demanding better quality of care, and requiring greater transparency for health care costs.
Changing with the times: The consumerization of the health care industry
With the emergence of innovative technologies, including artificial intelligence, more than ever patients are being empowered to make better, informed decisions regarding their health care. This new power shift requires a new framework, data-driven technological solutions and a greater focus on and ongoing commitment to advancing patient-centered care.
While reforms such as the Patient Protection and Affordable Care Act of 2010 (ACA) have helped patients gain access to better health care–for instance, enabling patients with pre-existing conditions to secure previously hard to obtain health insurance coverage–nothing has empowered patients as consumers more than the technological advancements that have been made within the past decade. Artificial intelligence has redefined the health care experience, enabling patients to be informed consumers and allowing them “to optimize the things they couldn’t in the past, such as choosing care based on quality or making decisions about price.” As a result of this real-time access, patients are approaching their health–and more specifically, their health care–with more of a consumer mindset regarding the services and quality they expect from their providers. As health care costs have increased, so too has the amount patients are paying out of pocket. Since they are paying higher deductibles, patients expect to receive greater value. As the “retailer,” the health care system now has incentives to provide higher quality health care to meet patient demands, or as with any business, risk losing revenue.
Artificial intelligence and other machine learning technologies have had an impact on every facet of the health care ecosystem–with significant improvement occurring in recent years–proving to be a pivotal tool for both patients and physicians. With its ability to analyze and combine data from disparate sources, and deliver actionable insights, artificial intelligence provides data-driven, predictive analytics that physicians can leverage to create more insightful patient care plans, better diagnose diseases, conduct research, and detect patient risk. While the technology will never replace the role of physicians, it has arguably created a data-driven environment to dramatically improve patient outcomes.
Patients as consumers: How patients navigate the health care industry
Traditionally, patients have relied on referrals and recommendations from their social networks and primary care physicians when selecting a new health care provider or specialist. However, with the emergence of health information sites, such as WebMD, Mayo Clinic, Healthline, Drugs.com, and many others, patients now have a vast array of resources to choose from in their search for a physician or for information on symptoms or about a certain medical condition. These sites work toward one goal: bridging the gap between the health care system and patients. Whether it is breaking down complex medical terminology or providing reviews of a physician, their goal is to help ensure patients are informed every step of the way in their health care journey.
Providers have also taken an active role in providing patients with more transparency in their health care journey. Patient portals have become increasingly popular as a way to provide access to various kinds of health care information allowing patients to view health care benefits, gain insight into Star Rating scores, access tools that predict out-of-pocket costs for physicians in and out of network, view health savings account balances (HSAs), and much more – all allowing patients to plan and budget for costly health services and choose the best physician that meets their needs.
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About the author
William Kinsman, senior manager of product innovation, manages Inovalon’s Artificial Intelligence team and the implementation of their products. In his first year at Inovalon, Kinsman has made it his goal to bring clinicians and this technology together by leading the development of the advanced natural language processing algorithms presently in Inovalon’s product offerings. He collaborates with professors and Doctorial candidates from the University of Maryland and the New Jersey Institute of Technology to bridge the gap in health care data extraction and develop never before seen approaches in patient-centric health care, with a focus on patient gap detection and intervention optimization.