What a "Healthcare Platform" Is and Why It Should Matter to You: Industry Analysis by Loyale Healthcare

LAFAYETTE, Calif., July 2, 2019 /PRNewswire-PRWeb/ -- According to an analysis published by Oxford University, the U.S. Healthcare System's defining characteristic is fragmentation. Fragmentation exists within every function of the system. From insurance coverage to care to administration, fragmentation in our system of care has led to unnecessarily high costs. Costs that are attributable to inefficiencies the industry now must address.

Experts have agreed for years that improved integration would do much to address systemic inefficiencies to reduce cost and improve patient outcomes. Many of the same experts point to the importance of innovation to achieve that integration. Yet, innovation in the healthcare industry continues to be painfully slow despite increasing costs and growing patient bad debt, stemming in part from the industry's persistent lack of pricing transparency and poor patient financial engagement.

For the last decade or so, efforts to correct these deficiencies to improve the quality of care and patient experience have often focused on local interventions ? or point solutions ? designed to improve a single element within the episode of patient care, an incremental approach that has resulted in modest improvements and an inability to manage the entire patient revenue cycle due to the complexity of the individual point solution components.

While most quality improvement efforts to date have missed the larger opportunity to redesign the fabric of health care, some encouraging signs are appearing on the horizon. Old and new companies alike are embracing a systems-integration or platform approach, incorporating the fundamental building blocks of health care - from equipment and technology to clinical insight, patient revenue cycle and all associated workflow processes. Proving the merits of an integrated approach, innovative networks such as HCA Healthcare consistently demonstrate superior financial performance.

These evolving and innovative companies aim to transform healthcare by enabling integrated service delivery that meets the World Health Organization's working definition: "The management and delivery of health services so that clients receive a continuum of preventative and curative services, according to their needs over time and across different levels of the health system." To that definition we would add providing a financial experience as good as, or better than, their clinical experience.

How Powerful is a Platform based strategy?

One need only to look at the largest technology companies to answer this question. These companies' revolutionary application of the technology platform business model has driven performance and market valuations never before thought possible as many approach or exceed $1 Trillion. These well-known companies include:

• Amazon
• Apple
• Alphabet ( Google)
• Microsoft
• Netflix, Facebook and others

Healthcare Platform Leverage ? The Difference between Thriving and Struggling to Survive

For many healthcare providers, transformation is a matter of survival. Here's why:

• Increasing demand of healthcare services from a growing and aging population
• With rising costs and rapidly growing employer adoption of high deductible health plans (HDHPs) the patient is now directly concerned with the cost of their treatments. In a recent TransUnion (TU) study, patient costs were up 12% in 2018 vs 2017. Even outpatient costs have broken through the $1,000/ encounter barrier. TU estimates that eventually 40% or more of all Health System revenue will be paid by patients.
• Decreasing availability of coverage through Affordable Care Act (ACA) exchanges and declining, unpredictable Medicare and Medicaid reimbursement rates.
• Increasing epidemics and sudden health emergencies such as Ebola, HIV, and reappearing diseases from our past including measles and tuberculosis
• Increasing nutrition-related problems, metabolic diseases and spikes in complex and costly diagnoses such as autism spectrum disorder.

If the industry attempts to address these issues with a "business as usual" approach, these phenomena will continue to drive up healthcare costs in the U.S., which are already the highest in the world. The need for integrated technology to deliver better care and deliver it more efficiently for the patient and the provider is now much more acute. Meeting the challenge has become an operating imperative.

A Day in the Life... Inefficiency is the Norm

According to a study from the American College of Physicians, "during the office day physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on electronic health record (EHR) and desk work." This administrative burden aggravates the growing problem of physician burnout and can have deleterious impacts on patient care. The proof? In a recent Commonwealth Fund study of patients around the world, 52% of American said they couldn't get a same- or next-day appointment with their provider when they were sick.

Similarly, healthcare's approach to the financial dimension of the patient experience has not kept pace with patients' increasing financial burdens and patient expectations for much more retail-like interactions. Instead, healthcare tends to rely on manual processes and a kaleidoscope of point solutions, outsourcers and large human labor pools. The industry is in a perfect position to solve the challenge of patient consumerism, but a fundamental change must occur that only a platform technology strategy can accomplish.

The Benefits of an Integrated Platform

By integrating systems on a platform, providers and insurers can overcome the intrinsic inefficiencies presented by multiple standalone systems and disconnected heath interventions. In one study, West Health Institute estimated that integration and interoperability could save the industry as much as $36 billion.

Key considerations in creating an integrated Health Services Platform, designed to achieve these savings include:

• Identifying the key entities in the ecosystem and considering each entity's objectives relative to the delivery of an integrated whole
• Exploring and defining multiple value propositions in the platform
• Understanding the key exchanges/transactions between ecosystem entities and the appropriate channels for flawless transactions
• Understanding how the platform supports and empowers participants (patients, clinicians and staff) to facilitate better performances and better results

Technology Platforms, like Loyale's Patient Financial Managertm can easily integrate various financial, diagnostic, record and documents systems, making them easy to use by the patient, the provider and the insurer so that all parties have a common, helpful frame of reference. Further, platform technology is capable of mining data across disciplines throughout the patient care cycle, informing more productive workflows and generating business intelligence to drive continual improvement.

Advancing Integrated Delivery through Platform Expansion

Integration empowers healthcare providers to deliver services through a common platform. One that is seamless, smooth and easy to navigate. Patients and the people who care for them want a coordinated, platform-enabled experience of linked services. Such a platform "minimizes both the number of stages in an appointment and the number of separate visits required to a health facility.", according to the WHO.

To providers such as hospitals and doctors, integration means that separate technical services (and their management support systems) are provided, managed, financed and evaluated either together, or in a closely coordinated way.

To achieve the level of integration needed to meet both patient and provider expectations, the industry is experiencing a high number of mergers, partnerships and alliances, some conventional and some unconventional. Thus, the current trend of mega mergers such as JP Morgan and Instamed, CVS and Aetna and the newly created Haven, a joint venture of Amazon, JP Morgan and Berkshire Hathaway, are just some examples of the developing trend to create technology and service platforms to improve patient care and reduce costs and inefficiencies.

Within Revenue Cycle alone we are seeing platform companies emerge with designs on holistic services capabilities. As with most industries at, or nearing, maturity - players such as Waystar, NThrive and Change Healthcare represent the beginning of a large-scale consolidation where platform leverage is the essential approach for any healthcare company that expects to survive.

Loyale Healthcare is an active proponent for integration to cure the fragmentation that hobbles healthcare in the U.S. Our patient financial engagement platform was built from the ground up for seamless integration in the most complex healthcare ecosystems. With it, providers deliver their personnel and patients transparency and continuity that improves financial outcomes and overall staff and patient satisfaction. Loyale is proving every day that by delivering more consumer-friendly experiences to their patients, providers can achieve improved efficiencies and better financial outcomes.

Kevin Fleming is the CEO of Loyale Healthcare

About Loyale

Loyale Patient Financial Managertm is a comprehensive patient financial engagement technology platform leveraging a suite of configurable solution components including predictive analytics, intelligent workflows, multiple patient financing vehicles, communications, payments, digital front doors and other key capabilities.

Loyale Healthcare is committed to a mission of turning patient responsibility into lasting loyalty for its healthcare provider customers. Based in Lafayette, California, Loyale and its leadership team bring 27 years of expertise delivering leading financial engagement solutions for complex business environments. Loyale recently announced an enterprise level strategic partnership with Parallon and has completed deployment of its industry leading technology to all HCA hospitals and physician practices.

SOURCE Loyale Healthcare