Impact of NextGen Access Decision Makers on Health Care Services and Therapies
Introduction
In the midst of the pandemic uncertainties, organizations are continuing their quest for value-based care. Who will be the next generation (NextGen) access decision makers (NADMs) that will successfully take the Triple Aim premise of value-based care, couple it with lessons learned from the pandemic, scale it up, and sustain success over time to make a palpable difference in the US health care system?
As it turns out, there are a lot of players taking aim, and the target is the primary care gateway, a person’s first key point of contact with health services and the key point of entry to the entire health system. The primary care gateway also plays a significant role in shaping and determining a consumer’s overall access to various services and resources within the health care ecosystem.
Emerging from the pandemic are many payers, health care systems, and new entrants looking to become the NADMs to transform this gateway entry and shape the entire patient journey. NADMs are increasingly focusing on health and well-being while impacting access to downstream services and therapy utilization, driven by two NextGen Models.
Virtual Care Access Models
As consumers increasingly turn to virtual care for their healthcare needs due to the pandemic, companies such as Teladoc, MDLIVE, Amwell, and many others, are addressing consumer’s short- and long-term health issues remotely, including wellness and prevention care; chronic conditions, such as diabetes; mental healthcare; dermatology; and other health conditions. The use of virtual services has skyrocketed in the last year and has provided these NextGen virtual care delivery models with incredible opportunities to gain a solid footing in delivering healthcare differently and quality care anywhere.
Hybrid Care Access and Delivery Models
tities such as Amazon, CVS Health, Cigna’s Evernorth, Oak Street Health, Optum, Oscar Health, Walmart, and many others are redefining the entry level of care, leveraging virtual and in-person care delivery models—the hybrid model for patient optionality and convenience. They are also creating new integrated healthcare ecosystems focusing on wellness and lifestyle changes, social influencers of health, chronic and population health, mental and behavioral health, streamlined pharmacy benefits, as well as other services, where, when, and how the consumer wants it. NADMs are also seeking to redefine and optimize the patient experience, leveraging patient convenience and connectiveness, while pursuing affordable and cost value care. As these organizations seek to leverage this hybrid model to change how consumers access care from the onset of a need or issue, to addressing acute or chronic care conditions, to influencing the services and therapies patients utilize across their healthcare journey, they look to impact healthcare utilization and costs across the care continuum.
As the scaling of NADMs virtual care and hybrid models continue, they will increasingly become a first point of contact and gateway into the health care system for health services. The ecosystem is extremely complex, thus the strategies being put in place within these models, accelerated by new technologies, are helping to advance key focus areas NADMs are tackling to further establish themselves as NextGen health care access providers and decision makers in the evolving health care landscape.
It is critical that traditional healthcare systems and practices pay attention to these gateway-to-health strategies, catalyzed in part by the pandemic and NADMs entrants to the game. They will need to transform their current organization and/or partner with these entities to leverage evolving health innovations and practices with their own experience to further accelerate the shift towards value-based care.
Drug manufacturers and device companies will also need to work closely with these increasingly influential entities as they continue to raise the bar on value demonstration of resources, including therapies, services, and digital devices, against their costs.
As we head into the next generation of care and NADMs continue to grow, scale, and gain influence and experience (especially the non-traditional healthcare entities), their impact on downstream access to specialty services, drug costs, and therapy utilization could be significant. Their aim is to deliver care differently and their goal is to go beyond the Triple Aim to the Quadruple Aim where patient and population outcomes will be optimized, the patient experience enhanced, the total cost of care reduced, while at the same time creating an environment where the work life of clinicians and staff is supported so that they can deliver high quality affordable and patient-centered care to all.
Current Issue
Subscribe
