As conjectures fly regarding the potential disruption the proposed acquisition of Aetna by CVS will have on the healthcare industry, IDC Health Insights will confine its comments to the technology implications, in particular access to and sharing of data within the existing healthcare ecosystem. This blog will also consider the implications of the acquisition creating a local care delivery presence for Aetna with the intent to increase consumer value.
Healthcare presents a unique case for DX because of its complex and challenging nature. Nowhere is this precedent more applicable than for the United States, where regulatory frameworks (e.g., MACRA), incentive programs (e.g., QPP, MIPS, and APMs), professional and community advocacy, and consumer-driven market forces are shifting healthcare priorities. These factors are driving the need for data-driven decisions and consumer engagement to recalibrate care from the mere fulfillment of fee for service and driving volume to the realization of pay for performance and driving value. U.S. healthcare organizations have much to gain by embracing DX on their journey toward value-based goals and responding to future challenges.
We hear everyday of the challenges facing provider organizations as they straddle the shifting reimbursement landscape. Well grounded in the fee for service reimbursement models, providers struggle to balance their volume-based operating models with the growth of value-based models. In the former model, if a procedure is done it is reimbursed, regardless of the outcome. The latter it is the outcome that is rewarded and for which at least partial payment is attributed. Adding additional financial risk is the requirement for providers to invest in technology and people to deliver the results required of the contract while not understanding what an expected return on investment might be. We have long understood that improved quality eventually translates into savings, but what are providers to do in the short term to keep the lights on?