How Purposeful Integration Can Break Down Health Care Silos

Digital health services have evolved over the past decade to improve the consumer experience around specific needs, like finding a doctor, chatting with a therapist, paying a bill, or getting a prescription. The overall experience, however, still leaves much to be desired. As the proliferation of solutions has not only failed to solve problems, it has also often exacerbated the central issue plaguing health care consumers today known as fragmentation. 

Finding a solution to a health issue often involves wading through a sea of health care professionals, administrators, and offices to connect with someone who can help or offer clear next steps. This process can be complicated and confusing, especially for patients who might not understand how to navigate the health care system. The explosion of telehealth at the outset of the COVID-19 pandemic–and the subsequent dropoff months later—only further exposed how transactional telemedicine solutions increase issues of fragmentation.  

According to a recent study in the journal Health Affairs, the number of telemedicine visits each week increased 23-fold during the first half of 2020 compared with the period before the pandemic. Changing regulations around reimbursement, payers temporarily waving cost sharing, and a need for alternative forms of care when people couldn’t visit their provider in-person, largely drove this increase. However, by the third quarter of 2020, in-person visits had rebounded to pre-pandemic levels, and traditional, transactional telemedicine providers saw a significant dropoff from April 2020 highs.

This subsequent decrease in utilization speaks to the limitations of traditional telemedicine solutions; they remain episodic, and they fail to address patients’ broader concerns related to general guidance, insurance coverage, prescriptions, and aftercare follow-up.

The Challenges of Fragmentation In Today’s Health Care System 

There are currently more than 50,000 health care apps available to consumers, and the vast majority of these are transactional point solutions that aim to address individual health concerns and episodic needs, rather than whole-person health. Yet, because no health care encounter or health issue exists in isolation, a solution to truly improve the care experience must guide consumers through the entirety of the health care journey. It must connect them with the right people, at the right time, without putting the responsibility on the consumer to navigate the complexities of the system itself.  

For a consumer attempting to resolve a health issue, getting help does not fall neatly into siloed business units. Most of the health issues that a person encounters are intertwined, and when digital health tools do not effectively address the overarching concern— or do not link the pieces of the care journey together—individuals are left trying to navigate the system maze on their own.  

For example, a person may need support from a benefits team to understand the costs of care, including:

• a care coordinator to identify which health care professional to see;
• a pharmacist to understand a new prescription; and
• a case manager to learn how to manage a chronic condition.  

But if they cannot access these services in one place, it takes them longer to understand the full picture—time during which their overall health could be at risk.  

An unguided patient journey also takes a toll on the provider experience. This means that patients are self-triaging and often escalating their care as they think is appropriate. However, we’ve seen that emergency room or specialist escalations are often driven by fear and uncertainty rather than a proper evaluation of medical needs. In fact, a large volume of patients that would go to the emergency room can be appropriately serviced by nurse-directed self-care or other virtual care encounters. 

How Purposeful Integration Improves the Health Care Experience 

Leveraging a balanced combination of AI, tools, and clinical experts that offers the right information and support at the right time can help to guide consumers along the entirety of their care path. This ensures they get access to the services they need in a single place, with an emphasis on appropriateness of care.  

A streamlined experience also empowers patients to take control of their own health, because they understand and trust where to go the next time they have a medical concern. It can be especially helpful and frictionless if they can turn directly to their health plan to access care.  

With the right tools and engagement tactics, managed care organizations are best positioned to deliver true virtual care navigation and advocacy, given their holistic expertise around benefits, member health, provider networks, care management, and other service inquiries. Furthermore, these organizations should also have the most comprehensive data and insight into a patient’s health status and journey, from underlying conditions to past prescriptions and specialist visits, which can provide more personalized information about their specific needs. 

Armed with these data, tools and knowledge, health plans must then consider how to integrate information, services and care teams purposefully in order to present the next-best action or insight to members at the time they need it. By providing this personalized, contextual care along the way, health plans can build trust, which will ultimately result in improved engagement and adherence.

When this happens in a coordinated manner, with purposeful service and data integrations at the right time, consumer satisfaction increases, and convenience leads to trust in the care services and adherence to the guidance they are receiving. 

It is only by purposefully integrating care and support into a unified experience that the health care industry can truly solve the issue of fragmentation. This seamless delivery of virtual care and services ultimately means consumers can have better experiences, more easily access appropriate medical care, reduce costs, and improve their overall health.

Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of the Population Health Learning Network or HMP Global, their employees, and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, or anyone or anything.