Innovaccer founder and CEO Abhinav Shashank has written more than 300 articles for various international media and was also listed in Forbes’ “30 Under 30 Asia 2017: Enterprise Tech” and among the “Top 60 Rising Leaders in US Healthcare under 40” by Becker’s Hospital Review 2019.
Mike Sutten, CTO at Innovaccer, has more than two decades of IT leadership experience at Fortune 500 companies including Kaiser Permanente, Royal Caribbean Cruises, and General Electric, as well as serving as CTO and Deputy CIO at the CIA.
The US health care system The industry is in the midst of one of the biggest changes any industry has seen since the dot-com boom in the late 1990s. This massive change is being promoted by federal mandates, technological innovations and the need to improve clinical outcomes and communication between providers, patients and payers.
An aging population, an increase in chronic illnesses, lower reimbursement rates and a shift to value-based payments – as well as the COVID-19 pandemic – have increased the pressure and highlighted the need for new technologies to improve virtual and value-based care.
In order to improve medical outcomes, huge amounts of health data must be processed today, and the cloud plays a central role in meeting the current needs of health organizations.
Most of today’s healthcare challenges fall into two broad categories: rapidly increasing costs and increasing stress on resources. Rising costs – and the resulting inadequacy of health resources – can be caused by:
An aging population: As people get older and live longer, healthcare becomes more expensive. As medicine improves, people aged 65 and over are projected to make up 20% of the US population by 2030, according to the US Census Bureau. And as older people spend more on health care, an aging population is expected to contribute to rising health care costs over time.
Chronic Disease Prevalence: According to a report from the National Center for Biotechnology Information, treating chronic illness accounts for 85% of health care costs, and more than half of all Americans have a chronic illness (diabetes, high blood pressure, depression, lower back and neck pain, etc.)
Higher outpatient costs: Outpatient care costs, including outpatient hospital services and emergency rooms, rose the most of all treatment categories covered in a 2017 study by the Journal of the American Medical Association.
Rising health premiums, own costs as well as Medicare and Medicaid: Health premiums increased by an estimated 54% between 2009 and 2019. The COVID-19 pandemic has spurred participation in government programs such as Medicaid and Medicare, which has increased overall demand for medical services and contributed to rising costs. A 2021 IRS report highlighted that a shift to high-deductible health insurance – with out-of-pocket expenses of up to $ 14,000 per family – also increased healthcare costs.
Delayed Care and Operations Due to COVID-19: A survey by the Kaiser Family Foundation (KFF) in May 2020 found that up to 48% of people have avoided or postponed medical care due to concerns about the COVID-19 pandemic. About 11% of these people said their health deteriorated after they skipped or postponed treatment. Non-emergency surgeries were often postponed as resources became available for COVID-19 patients. These delays make treatable diseases more expensive and increase the overall cost.
Lack of price transparency: Without transparency, it is difficult to determine the real cost of health care. The fragmented data landscape does not capture complete details and complex medical bills and does not give patients a complete overview of payments.
Need for modernization
To mitigate the impact of increased costs and inadequate resources, healthcare organizations need to replace outdated IT programs and adopt modern systems that support rapid innovation for location-independent, collaborative, holistic care – all at affordable and accessible prices.