A 360° view of the health consumer will improve the triple aim of care

The triple aim of care (reducing the cost of care, enhancing the experience of care, and improving health outcomes) is in decline. Healthcare costs increase faster than inflation, healthcare’s net promoter scores (NPS) are lower than the used car sales industry’s, and, according to the Centers for Disease Control and Prevention (CDC), six in 10 Americans have a chronic condition resulting in their life expectancy regressing to 1996 levels.

It is possible to reverse this decline if healthcare providers (HCP) improve their efforts to share health and care data with health consumers, including patients, beneficiaries, customers, and employees, on an ongoing basis to enable them to become the custodian of their healthcare data. Only by taking ownership of their health, the care they need, and their data can consumers ensure they receive the experiences, outcomes, and fair costs.

Access to healthcare data is the key to putting the triple aim back on track

We must do two things to realize the value of data and impact the triple aim of care.

First, health plans, HCPs, and pharmacies must acknowledge the obvious: Healthcare data belongs to the consumer! Consequently, they must create a path for health consumers to access their data. The healthcare industry must engage with its ecosystem of industry partners to create an improved means of securing, sharing, and synthesizing data for immediate and relevant uses, such as diagnosis, therapy, and wellness.

Second, health consumers must proactively become better educated about accessing, understanding, acting on, and protecting their data. Technology providers must play a major role in making healthcare data consumable, contextual, and consolidated while protecting how that data is stored to meet privacy and regulatory requirements.

Health consumers can improve their understanding of their health and care needs and help those responsible for their care through a 360° view of their health record, including clinical, administrative, social determinants of health (SDoH), and psychographic data. This holistic view can only be created through partnerships between health plans, HCPs, technology enterprises such as hyperscalers and software, regulators, and services firms. This ecosystem can substantially enhance experiences, reduce costs, and improve health outcomes.

Data availability is not the issue; providing timely, contextualized access is the challenge

Currently, four barriers block improvements in the use of healthcare data (see Exhibit 1). Overcoming the challenges in each of these will require investments to improve data, provide education, and pursue a more collaborative approach.

Exhibit 1: Critical barriers need attention from the healthcare ecosystem

The healthcare industry is flush with data (see Exhibit 2). Data can be clinical, administrative, social determinant, and psychographic. Services companies can play an integral part in improving this data.

Exhibit 2: The data soup of healthcare records is based on complex collection and organization

Source: HFS Research, 2023

Aggregating health and care data to craft a 360° view of the health consumer is critical

The life cycle of a healthcare data record is complex. In its simplest form, it travels from creation to aggregation to contextualization to personalization (see Exhibit 3).

Exhibit 3: To create a holistic view of health consumers’ data, we must capture, aggregate, contextualize, and personalize it across these eight health inputs

Source: HFS Research, 2023

The more healthcare consumers understand the data created in the lifecycle, the more astute they become in sharing relevant data to the services they need. A simplified lifecycle of healthcare data is reflected in Exhibit 4.

Exhibit 4: The healthcare data lifecycle is not unlike those of other regulated industries, yet it lacks similar organization and transparency

Source: HFS Research, 2023

Consumers and employers will gladly pay for a 360° view if it helps people stay healthy and disease free

The value in healthcare is delivering a better quality of living for the health consumer. To do so, we must return to the triple aim: cost, experience, and outcome. The willingness to spend and incur costs is positively correlated to the positive experiences and outcomes of receiving quality care and experiencing better outcomes from it.

Creating a 360° view on the consumer side provides many advantages to all healthcare stakeholders—HCP, payers, service providers, and consumers—by better-managing risk, improving access, and connecting care, as described in Exhibit 5.

Exhibit 5: Health consumers and employers will see significant benefits

Source: HFS Research, 2023

Health consumers and employers will likely invest in solutions that streamline health and care data aggregation, consolidation, and secure and user-friendly sharing. Commercialized data usage has improved lives in many ways:

• The adoption of consumer apps is driving education, applications such as Talkspace and Heal, and wearables like Oura and Fitbit, which are increasingly being used to improve wellbeing.
• Banking apps have made the idea of access and control over sensitive data acceptable and the norm.
• Tools like Apple Health and MyChart educate health consumers on improving and monitoring their health.

Employers also have many reasons to want to invest:

• Employees’ health prevention and wellness drive revenues, but sick employees increase costs.
• Payers will provide employers with financial incentives for fewer claims.
• Employers will find 360° views of employees critical to helping them with wellness, faster recovery, and health maintenance.

The Bottom Line: A true 360° view of the health consumer will sustainably improve all attributes of the triple aim of care and keep us healthy longer.

We cannot ignore that health and care data is extremely personal and private. Advances in personal technologies and an empowered consumer must be a keystone of any effort to aggregate data. With solutions like self-sovereign data (your data is yours) as part of the Web 3.0 premise, a capability that allows the healthcare industry and the consumer to become true partners in solving many of the challenges of today’s society is an imperative.