Changing Healthcare Landscape Through Interoperability

By Dr. Roy Beveridge, Chief Medical Officer, Humana

Transcend Insights is a wholly owned subsidiary of Humana. How do these two companies work together?

Transcend Insights is based in California. It is a company that we have put together that’s been very focused on our population, health, and insurance. We have based the company in California because a huge amount of talent is present in this area. Californians are the hotbed of understanding population health in physical expertise. They are great programmers and software developers, who think about population health and integration technology and around that. We help it as we continue to think about how to be relatively agnostic with entities that we work with. We wanted the expertise that we see with Transcend Insights to be able to work at the eager system, not just from the point of view of Humana, but from the broader perspective.

"I think interoperability is an event, which is going to revolutionize the healthcare industry in the next coming years"

Interoperability is a prolific topic in the healthcare technology landscape, but it’s hard to connect the topic to how improving interoperability could help patients. How would you explain the benefit of it in terms a patient would understand?

I would say that when we started talking about interoperability some five years ago, people often like to remain silent about this topic. That’s when we decided to make healthcare affordable and seamless. And it started by making a trusted relationship with our members so that we can help them in the context of their particular circumstances. But unfortunately, the current healthcare system is plagued with the disintegrated system; the problem here is it is challenging to expose day-to-day data and share it across the system. Interoperability is the solution to this problem as it is all about exchanging critical clinical information among healthcare providers, consumers, and providers’ insurance companies.

I think interoperability is an event, which is going to revolutionize the healthcare industry in the next coming years. It is going to allow patients and their families to deeply understand their medical conditions, have the transparency of seeing their data, not just their bills, but their laboratory reports, their improvement, their equation with their providers. So I think interoperability is one of the most exciting things that is happening at this point in time and is transforming the way we look at healthcare.

Also, interoperability of care allows physicians, caregivers, or providers to see the population as a whole. So the big difference here is the ability not just to take care of the individual, while taking care of the population as a whole.

From a clinical and also technology standpoint, what do you think has been the biggest barrier to achieving interoperability?

It is not about the technical barrier, but it is related to the mindset. Any company that want to succeed, especially in the healthcare industry has to embrace interoperability. I think we have got the fire–interoperable acceptance. I think that where we have a barrier right now is the buy-in by the provider community and we offer the complete transparency into data to their patients. The data which is coming is increasingly important; it is the detailed information that happens at a patient level. So, the pathology report, it’s a progress note, it is coding that needs to be transparent to the patient so that they can use the data in an interoperable way; which can be used in an app that helps them with their exercise or modified behavior. So, I think that we are okay in terms of interoperable data right now and its ability to offer very detailed medical information is going to have a lot of sophisticated change that’s required.

Have you seen physicians or hospital leaders start to see the benefits of improved interoperability over time? If so, in what way?

I will give you one simple example in terms of how the physicians see interoperability. If you take the physician in the emergency room as we deal with the opioids crisis, and there he meets a patient. So, interoperability allows him to see a cost system as a whole; it allows the physician to know what is happening with that individual, it is also a very powerful tool to ensure that they reduce waste in the system. Interoperability also helps in ensuring that people are not abusing the system as in maybe the opioids crisis.

How do you identify the right solution provider from the plethora of offerings that are out there? Is there a mechanism to shortlist the right solution that sinks well with the existing systems in place?

I think the important thing is to have a common tool, common linkages between systems, common thread, and common flow of data. There also must be a thorough analysis that should comprise an organizational assessment focusing on the data exchange needs. Though the market is full of interoperability solutions, the search for the right one can be frustrating and time-consuming, and on top of that confusing also. So, according to me the best way to find the perfect solution is to ask the right questions from the start to the vendor.

How crucial is it to leverage predictive analytics when aiming to get a holistic view of patients? Can it prevent impending health issues?

Predictive analytics is crucial to healthcare. Predictive analytics gives a holistic view of the patients about the impending health issues. I mean data analytics is absolutely crucial for how we develop population health, how we understand and anticipate what’s going to happen to the patients. The example will be if you have a patient with dust disease, with heart failure, who was recently treated for it but need expensive help so that we will take that person to another administrative hospital and his data which is already saved with us will help in his further treatment.

So, having a whole lot of patients, you begin to realize that you do not just prescribe the right medicine to the patient but also think about the patient if he has the transportation to hold the prescription. Because when you look at the population health, it is about improving the health of the population. So, if the population does not have the ability to transportation or the patient does not have a caregiver or has socialized relation or has the behavioral health issue, once you understand the patient, you are not going to be able to impact their health. So set a different way, the predictive analytics allows you to understand an engaged member of the patient and you can engage that member so that you can affect change to that person.