Personalizing healthcare with cloud-enabled data and analytics driven ecosystem

The Situation: The triple aim of healthcare (cost of care, health outcomes, and experience of care) is heading in the wrong direction. The cost of care is increasing at twice the inflation rate, the prevalence of chronic conditions is catapulting, and life expectancy was declining even before COVID-19. Executives and policymakers across the healthcare ecosystem recognize our trajectory is unsustainable, requiring immediate action. The industry must pivot toward personalization to meet health consumers (members’, patients’, and beneficiaries’) needs. It is time to leverage clinical, administrative, consumer, and social determinants of health data to personalize health and drive engagement to improve the triple aim of healthcare.

A roundtable connecting the healthcare ecosystem

HFS Research, in collaboration with NTT DATA and Snowflake, facilitated a roundtable in June 2022. The roundtable assembled 15 senior leaders from US health plans, health systems and global life science enterprises in Exhibit 1 to discuss ways the healthcare ecosystem can incentivize working together to better leverage data and personalize healthcare.

Exhibit 1: Influential enterprises across the healthcare ecosystem participated in the HFS-hosted roundtable – sample participants

Source: HFS Research, 2022

Discussing different perspectives always raise interesting ideas, but this roundtable was especially stimulating. Many participants had non-healthcare experience in their backgrounds, including financial services, mathematics, and customer data platforms, and shared examples of success from other industries that could be explored in healthcare.

Health plans, health systems, and life sciences can collaborate through OneEcosystem to deliver the possibilities of the triple aim of care

The delegates agreed that technology and process in healthcare are about two to three decades behind other industries. One delegate alluded to a time when his desk had just a “typewriter and an ashtray,” perhaps not different from the 1960s and 1970s for all industries. However, the evolution of health and healthcare has been unique due to the progression of diseases, consumer behaviors, healthcare funding (insurance vs. out-of-pocket), and delivery (at home vs. facilities, vaccines). Technology adoption was inconsistent across the ecosystem, with pharma starting to use computers in the 1940s, health plans in the 1970s, and providers after that. The lack of meaningful ecosystem collaboration stems from this history of different time horizons, problems to solve, and a lack of incentives to work together.

The challenges have metastasized due to, as one delegate indicated, “lowered risk tolerance, faith-based impacts, and the power of the unions.” The perverse motivation in the ecosystem has kept them connected in notion but disconnected in practicality, manifesting in a lack of sharing of clinical, administrative, behavioral, and other data. This disconnection has contributed to negative impacts on the triple aim of care, where the US’ per-capita spending is 3x OECD countries, 6 in 10 have a chronic condition, and experience is a fleeting concept.

Yet there is good news, through the possibilities when delegates from across the healthcare ecosystem come together: the tone of the discussion, the solution ideas, and, most importantly, the acknowledgment of the set of problems. There is hope in the air; delegates alluded to the fact that there are more clinicians in operational leadership roles helping make good health fiduciary decisions and recognizing the need to simplify healthcare. Health consumers are empowered and making deliberate food choices. Yet, more is needed to realize the potential of the OneEcosystem (see Exhibit 2). Industry leaders and policy makers must collaborate to help evangelize and legislate the good that we have learned in the many decades of this silent healthcare experiment.

Exhibit 2: Experiences must align across the ecosystem to be able to deliver consistent and relevant outcomes

Source: HFS Research, 2022

Leveraging data as a primary driver of personalized health and healthcare

Personalizing healthcare is amorphous; developing a consistent understanding of personalization is the first step in realizing its benefits. Consider the framework in Exhibit 3, describing personalization across the journey from health, sickness, recovery, and back to health. At each one of these journey points, personalization manifests itself in different ways, from custom nutritional programs to individualized care plans and personalized medicines. Personalization in healthcare requires technology and process orchestration at every health and healthcare touchpoint across the life journey.

Exhibit 3: Personalization manifests itself differently across the health consumer journey

Source: HFS Research, 2022

Orchestration to enable personalization will require the prompt capture, aggregation, analysis, and distribution of different data types. The sophistication required is unprecedented, given the diverse data types shown in Exhibit 4, including clinical, administrative, social determinants, and psychographic. These data types are typically difficult to capture consistently, analyze, and distribute securely.

Exhibit 4: Data attributes can form a 360-degree view of the health consumer and enable personalization

Source: HFS Research, 2022, data attributes are sample and not exhaustive

We can learn lessons from other industries; a delegate framed it as a “customer data platform” with the “same cookbook in all industries.” Setting aside that a health consumer (patient, member, employee, or beneficiary) is identified as a customer, the idea of capturing all their relevant data on a single platform, creating a 360-degree view, and leveraging it to provide timely service is considered mundane in some areas, yet it is novel in healthcare. Cloud-enabled platforms and data are available, and despite past reticence, it might be time to leverage the ecosystem to deliver personalization.

The Bottom Line: The healthcare ecosystem can and must work together to share data, insights, and experiences to personalize healthcare and impact the triple aim of care by engaging in small scale experiments to enhance trust to deliver change at scale.

The robust cross-industry discussion elicited some telling closing comments. Some contrarians believe it is time to “…tear it down, and rebuild,” while another delegate called out that “trauma brings change.”

Multiple delegates were encouraged by the efforts, indicating “heartened by progress, we showed up to try,” “very inspired,” and “heartened that we agree that consumer should be in the middle.” As the saying goes, acknowledgment is nine-tenths of the solution: “Agreement that we have a problem and semantics on the consumer is less important than their expectations.” A fourth suggested we had a “unanimous agreement to make healthcare work harmoniously.”

On more practical matters, a delegate indicated it was “reassuring to know the investment in integrating data is right,” while another indicated that “improving standardization would influence population health management,” and a third evangelized for “simplification and the use of technology.”