The post-ACA era is a time of enormous challenge in the healthcare industry. For health insurers, the pressures center on member choice, millions of newly insured, and the shift toward population health and value-based care.
Health insurers are tasked with re-architecting care delivery infrastructures in order to enable patient-centered care models that improve quality and outcomes while achieving affordability. Data plays a key role as care coordination programs are created, and data is more freely shared between healthcare entities.
Although claims-driven data models are still relevant, it has become clear that they must be combined with clinical data in order to produce timely data feedback loops, improve care coordination, advance disease management, and enable population health.
There is little question that this innovation, which will involve substantial structural changes, is needed. Currently, our healthcare system consumes 17 percent of U.S. gross domestic product4 and is expected to increase to 20 percent by 2021.5 Improved care coordination is needed to decrease healthcare costs for patients with multiple chronic conditions, which account for more than 66 percent of total healthcare spending.
Better care coordination can also reduce wasteful healthcare spending, which was estimated at $25 to $45 billion in 2011,7 and lower unnecessary readmissions. Currently, almost 20 percent of Medicare patients return to the hospital within 30 days of discharge, costing $12 billion per year.
