Data Sharing Paves the Way for Universal Registration, and Ties in to Insurance Transparency

Arun Mathews, Chief Medical Officer, MultiCare Health SystemMy parents live in Kerala, South India. I live in the US. What this translates to is a minimum of one yearly international trip to visit them. We decided some time ago that exposing my decidedly American offspring to their Indian heritage would pay dividends later on in life in terms of opening up their world-view. Also, my parents would disown me if they couldn’t regularly anticipate hugging their grandkids every so often.

Over the years the task of trying to keep in touch with folks at work while my family and I take our two-to-three-week break has become increasingly easier. And yet I came to accept that if I wanted to use my regular cell phone, it was going to entail a series of phone calls and roaming-plan adjustments with their various additional fees. Regardless of how peachy everything would seem at the outset, the final result would be a bill that left me scratching my head in disbelief.

So then I read about this thing called Project Fi (now called Google Fi). Google Fi is Google’s version of a cell phone carrier. It offered me two coveted things: flat rates and global roaming. And just for giggles, they threw in incremental refunds for unused data.

The real icing on the cake for me was the fact that a flat pricing model had been negotiated with carriers in 200 countries around the world. You know, because it’s Google. The thought of being able to take my phone off airplane mode upon landing in a new country and instantly have access to cellular service 1) at LTE network speeds, and 2) at the “exact same rates” I pay back home – was just too enticing. So I decided to take the plunge. We typically travel to Cochin, India and landing there I was more than pleased to see the phone, upon being awakened from airplane mode, track down a network, offer me a nice “Welcome to Cochin from Google Fi” message, and reassure me that none of my data rates were changing in the slightest. Everything just worked! Google Maps and GPS worked flawlessly, I received calls and voicemails and sent texts as if I were still in the US. Even my Nike running app had no difficulty mapping out my beautiful morning hill run in the small township where my parents live. Pure joy.

Google had cracked the cellular price transparency code while simultaneously giving me the gift of effortless cellular data access as a moderately frequent global traveler.

Which brings us (admittedly in a long-winded fashion) to my world of healthcare. Clinical integration seems to be a buzzword these days, and my experience with Google Fi seemed to crystalize some of the frustrations that our patients deal with when systems suffer from a distinct lack of integration.

Regardless of how well-meaning healthcare systems are, the simple fact remains that large, complex organizations often have large, equally complex payment structures that need to be navigated. Here are some of the frustrations that I and other chief medical officers I’ve talked to hear from patients from time to time:

● When I need a physician, there are multiple hoops I have jump through to secure an appointment.

● Assuming I can get an appointment in a timely manner, I have to go through a registration process, seemingly multiple times.

Even the most elegantly developed software with strong emphasis on end-user experience can be hobbled by poor integration into a particular process or workflow

● At times my insurance covers certain services, at times it doesn’t.

● I never know what to expect from the bill. The bill is written in a way that I cannot understand. Occasionally, I have to call and contest a bill or ask for a rebate, but mostly, I just give up and pay.

● When I’m referred to a new provider, this triggers another round of registrations and permissions.

● The provider has to ask me the same questions again, plus a few new ones.

Furthermore, the actual process of bringing patients into the entry-points of the healthcare system can be riddled with unique workflows that make things like referrals, lab and radiology services delivery, and care coordination all the more challenging.

What if the patient-centered approach became the gold standard, and we engineered the patient-centered system to also work for providers, ancillary services, finance folks, etc., instead of the other way around? Robert Wachter takes a similar approach in chapter 7 of his book, The Digital Doctor. Titled “Toward a Brighter Future: A Vision for Healthcare IT,” it envisions perhaps one of the most impressive future states of a truly integrated clinical-care delivery network that I have ever read about. And yet, as I transitioned my role from chief medical information officer to chief medical officer, I realized that healthcare IT was only part of the solution. Even the most elegantly developed software with strong emphasis on end-user experience can be hobbled by poor integration into a particular process or workflow.

So, based on my Google Project Fi experience, my humble advice is to consider re-engineering healthcare in this regard. Yes, it will involve some pain – but it need not be overly burdensome or costly. Managing cellular communication is incredibly complex, involving everything from semiconductor technology to municipal ordinance, cellular towers, and even negotiations with satellite system operators. But this is all made invisible to the consumer.

What if we engineered systems that leveraged integrated EMRs and federated data-sharing agreements?

Insurance payers’ stipulations should be front and center, allowing the consumer to see just how restrictive their carrier plan is and base their care on realistic options tied to the plan they have chosen. Doing this would cut out 80 percent of the preauthorization back-and-forth that occurs in between patient visits, which can unfortunately delay care and hamper the patient experience.

Data-sharing agreements between EMRs would need to be in place for health systems to safely exchange information with each other. Epic’s Care Everywhere and the Cerner-backed CommonWell initiative suggest that we are finally getting traction on this concept.

Data sharing paves the way for universal registration, and ties in to insurance transparency, bringing revenue-cycle transparency into the mix and leading us to the final hurdle in the consumer experience – price transparency and the creation of a unified billing experience.

With all of this in place, my version of Google Fi (let’s call it Healthcare Fi) would involve:

• A health insurance experience that clearly lays out my options for care based on the plan I have chosen.

• One clinically integrated EMR experience that my providers can share as and when required, via permissions that I set.

• One single registration experience.

• One bill at the end of the entire episode of care with very few surprises.

• One portal from which I can access all of this information, based on the severity of my presenting complaint, and access and schedule care via telemedicine vs. AI supported triage into urgent care, my primary care provider, or the emergency department.

When Google unified its Android operating system with hardware that it had designed in the form of the Pixel, the industry applauded. Incremental gains in battery life, camera performance, and the usability of the stock Android experience were appreciated. The game-changer, however, was when they married this with their own cellular service, or Project Fi, controlling every aspect of the cellular-ownership equation and optimizing towards customer experience. I believe we in healthcare can learn from this to make the experience for our patients cleaner, more integrated, and, as a result, better.