Just-in-Time needs Kaizen quick
A pandemic exposed the inadequacies of American healthcare.
COVID-19 has left many with doubts about lean management, stakeholder modeling and the encumbered search for revenue in healthcare. The United States remains one of few countries without a national program. The election of Biden may increase the need for political rivals to pursue erasure of present programs, but younger generations demand healthcare as a right and the process of its administration is under discrepancy at large. Why didn’t we have the capacity and staff to handle the problem, in aggregate? Had the modern idea of logistics included healthcare systems running at lean protocols? This didn’t bode well for a pandemic. How are lean systems a true reflection of stakeholder responsibility to their communities? What possible solutions could there be and what types of business models will emerge. There just aren’t enough resources for public health emergencies.
While many European nations were able to give paid sick leave for infected individuals as the prevalence rose, many in the United States did not have that option. The American idea that healthcare is tied to a (good) job created a deficient response and again, a higher prevalence. How does the healthcare system survive and what, if any help can one see from American institutions?
That is currently unknown at this time but there are commercial innovations using A.I. and the possibilities of blockchain technologies. As Dr. Bertalan Meskó states, “…artificial intelligence is on course to usher the real era of the art of medicine. By automating administrative tasks and aiding in decision-making, these smart algorithms promise to free up physicians’ valuable time; time that can be dedicated where the human touch is essential in healthcare.”
Focus on Telemedicine for increasing financial margins and let blockchain facilitate A.I. and IoT asset tracking.
The Obvious: E-health & Telemedicine can adapt and introduce new inputs for increasing margins with the maturity of services. Digital doors increase the number of entrances, digital suites, and exam rooms. Telemedicine can reduce variable costs and shift implicit costs to other stakeholders. The use of Blockchain and asset tracking reduce transaction points and intermediaries while increasing security. Legacy systems and centralized administrators like those common in current healthcare systems are vulnerable to attack and ransomware. The only thing holding back innovation is lack of serious competition.
Medical Systems are reluctant to modernize payment systems. They are at the mercy of insurance companies for revenue management. A larger, independent corporation getting in to medical care would not. Imagine Wal-Mart, a corporation with equidistant locations across the nation and a recently unveiled, 2 year old medical program with $20 child visits and $40 adult visits with no insurance required. They could expand quickly, they’re proficient with customer service, they know blockchain and have the ability to leave the gambling business. I mean, insurance. “These aren’t your usual walk-in clinics that might serve as a quick place to get vaccinated or get a cold checked out. Rather, they’re more like a one-stop shop for healthcare, with primary care, urgent care, diagnostics, x-rays, behavioral health and dental care.” Remember, GE has automated XR machines. Walmart can afford them.
Imagine a “Patient Care Pass” modeled around a blockchain technology that lowers variable costs in administration. A pass that would be private, bypass registration, automate revenue cycling and have deep-learning, data mining methods. Similar systems are in use in Estonia and working behind the scenes in other ways people don’t realize. For example, Apple and Google created their COVID-19 tracing with blockchain. Essentially, a health system could create a Crypto Token. Stateful smart contracts on hybrid chains and create the incentives to always use their health services. (Certain utility coins are on the open market for tangible services but health services would need closer off-chain governance and not be on the open market. Not everyone should be responsible for knowing market mechanics to handle their health) Imagine if Wal-Mart let you accumulate “health tokens” (reward points) when buying retail? Legacy medical systems don’t have that payment option when Tokenomics, web 3 and the industry 4.0 economy starts. Why would someone go to a hospital or urgent clinic when they could get an x-ray for free after buying $200 worth of groceries? Low assurance of quality care is assuaged by modern services and ease of access.
But wait, what if you are an urban, non-profit hospital with few resources to command or participate in payment experimentation?
Go for the TWO target populations:
1) Consumers that prefer digital, remote access. They prefer privacy, multiple access points and create higher margins with elective choices. They have higher income and search out consumer products, e.g. cosmetic.
2) The underserved community. Those that live in the urban area and are stakeholders in a local, non-profit hospital. There are millions of unemployed people who need alternate means of access and minority communities that do not have digital access. The amount of missing tools are insurmountable, it seems.
Many underserved communities may not have access to the technology required. Some of the needed items would have to be provided. The FCC has been given the ability to expand its E-Rate program to include urban, non-profit hospitals. Meaning, millions of dollars will be available for technology upgrades and equipment for the underserved at almost no cost to the hospital.
There are 2 programs to reduce or eliminate the costs for upgrades while CMS has expanded their rate redemptions and deregulations.
Program 1: FCC waived the E-Rate program gift rules to promote connectivity for hospitals. i.e. allowing service providers to provide free and/or reduced services to hospitals. The $200 million-dollar COVID-19 Telehealth Program fund has the ability to grant 1 million dollar a year if qualified. This program can provide end-user connective devices, including smartphones or tablets that allow a patient to “report his or her health conditions directly to a provider”. It will only fund devices that have ‘connectivity’ and not recording devices that only report information when physically presented. The funds are not limited to COVID-19 patients. These hospitals will have to file an expedited FCC Form 460 to satisfy basic eligibility with the Universal Service Administrative Company (USAC), an FCC division that accepts applications for the E-Rate programs and provides subsidized broadband services. They will also require a detailed plan of how the devices and program will be HIPPA compliant and provide statistical tracking to show progress and efficacy of the program.
The FCC had prohibited entities from soliciting and accepting gifts from a service provider. Mostly, to reduce the risk of impropriety, fraud, and unethical behavior that rewards profit over the patient. “The waiver will allow health care providers… to accept improved capacity, Wi-Fi hotspots, networking gear, or other equipment or services to support doctors and patients. For example, some providers have expressed interest in providing free network use for hospitals to treat patients via telemedicine and the associated devices.”
“By waiving certain FCC rules today, we are giving service providers the chance to step up and give health care providers more tools to fight the ongoing pandemic and serve patients more effectively, like increased capacity, more equipment, additional services, and other tools that will help them deliver the best possible patient care” Chairman Pai, FCC
Program 2: Medical Centers should also pursue the Connected Care Program. The pilot program is a three-year, $100 million initiative to provide connected care services. It will “cover 85% of the eligible costs of broadband connectivity, network equipment, and information services necessary to provide connected care services to the intended patient population.” Non-profits qualify and preferences are given to hospitals that have already invested in technology. It is a very intensive application process that will require an IT team that includes risk-management and executive direction.
Non Profits Pursuit of Consumer Revenue:
If a health system is to achieve >90th percentile with CMS and physician satisfaction it will need a big idea. Non-profits will have to pursue consumer products and attain a Joint Commission accreditation like one for THKR (Total Hip, Knee Replacement). This Advanced Certification program helps health care organizations develop consistent communication and collaboration among all health care providers involved in the care of the patient. The amount of vertical and horizontal integration is a textbook case for a blockchain solution. Use of federal funds to increase technological adaptations could include asset tracking and sidechains to guarantee identity and erase attestations.
In addition to the accreditation, a non-profit could pursue 3-D modeling for joint and hip replacements. Mako joint modeling is a program with little cost to the hospital, mostly incurred by the patient and the promotional activity of Stryker, the manufacturer. With the assistance of an MRI or CT, Mako modeling and Da Vinci robotic-assisted joint replacement surgeries, hospitals can achieve patient satisfaction and staff retention through successful outcomes. They also participate in the integration of A.I. and blockchain technologies. That all translates in to less inpatient time (if any) and recidivism while achieving a higher likelihood of personal recommendations for the hospital, a powerful part of a future patient’s decision for surgery location. Below is the story of Barbara, who had surgery with Mako modeling and Robotic assistance.
“Barbara decided to have her knee replaced and under the supervision of her doctor, started rehabilitation the very next day. Soon after her first surgery Barbara decided to have her other knee replaced. She went to a rehabilitation facility where she did physical therapy three times a day. After ten days at the facility she returned home where she continued her therapy. “Physical therapy was hard but I knew it was an important part of my recovery, so I pushed myself, and I am glad I did.” (Stryker, n.d.)
For example, Kettering Health Network in Dayton, Ohio which serves a population of 800,000 struggled with the movement of patients through its system. Technological adaptation allowed them to create more entry points for a patient, e.g. digital doors. The Kettering Network launched a comprehensive patient journey program that mapped the whole process from admission to discharge with an integrated Command Suite analyzing indices for patient care readily visible on digital monitors. Their program has a hands-on Medical Director involved, centralized information systems and patient movement algorithms. It has increased new patient volume and revenue since early 2018 and reduced support service times, e.g. environmental services and information desks (administrative costs).
Insourced medical care via telehealth (instead of an outsourced rural model, per se, where the physician is random) will allow direct hospital to home care. Meaning, the same physician one would see at a physical appointment is the same one they would relate with electronically. A doctor or nurse practitioner can discuss lab results, do follow ups for surgery and speak with people unable to physically attend an appointment, e.g. a paralyzed or other disabled patient. Insourced medical care allows for direct conversations with referring providers about real time results and continuing plans.
It just makes sense, a growing digital program allows for health providers to introduce new inputs as the program ages to increase margins of all kinds. New programs can be introduced to small populations of patients more inclined to use new services. Feedback, average usage and net promoter scores can determine which programs work best, if they work and ones that could be expanded. Decentralized ledgers and SaaS providers would allow for the elimination of a Medical Records department, registration processes and payment processes. It is a future worth looking in to. Many new inputs with large returns.
Barthelemy, J. (2020, May). The newest trends in telehealth in 2020. Retrieved from Medical Group Management Association: https://www.mgma.com/resources/health-information-technology/the-newest-trends-in-telehealth-in-2020
Douglas Busvine, A. R. (2020, April 26). Germany Flips to Apple-Google approach on smartphone contact tracing. Retrieved from Reuters: https://www.reuters.com/article/us-health-coronavirus-europe-tech/germany-flips-to-apple-google-approach-on-smartphone-contact-tracing-idUSKCN22807J
Drees, J. (2020, May 19). Telehealth to grow nearly 65% in 2020, report finds. Retrieved from Becker’s Hospital Review: https://www.beckershospitalreview.com/telehealth/telehealth-to-grow-nearly-65-in-2020-report-finds.html
FCC. (2020, March 18). FCC Waives E-Rate Gift Rules Program. Retrieved from Federal Communications Commission: https://docs.fcc.gov/public/attachments/DOC-363137A1.pdf
Hering, B. B. (2020, February 13). Remote Work Statistics: Shifting Norms and Expectations. Retrieved from FlexJobs: https://www.flexjobs.com/blog/post/remote-work-statistics/
John Weimer, F. (2019, Nov/Dec). A Patient Experience Command Center. HealthCare Executive, pp. 30–32.
Morgan Lewis Law Firm. (2020, April 06). FCC Launches COVID-19 Telehealth Program and Connected Care Pilot Program. Retrieved from Morgan Lewis: https://www.morganlewis.com/pubs/fcc-launches-covid-19-telehealth-program-and-connect-care-pilot-program-cv19-lf
Park, A. (2019, June 25). What the US can learn from Estonia’s cloud-based, blockchain-secured EHR system. Retrieved from Becker’s Hosptial Review: https://www.beckershospitalreview.com/ehrs/what-the-us-can-learn-from-estonia-s-cloud-based-blockchain-secured-ehr-system.html
Stryker. (n.d.). Patient Stories of Mako Surgeries. Retrieved from Stryker Mako : https://patients.stryker.com/knee-replacement/testimonials/barbara-cotoia
The Joint Commission. (n.d.). The Joint Commission. Retrieved from The Joint Commission: https://www.jointcommission.org/en/accreditation-and-certification/certification/certifications-by-setting/hospital-certifications/orthopedic-certification/advanced-orthopedic/advanced-total-hip-and-total-knee-replacement/