5 Ways Tech and Care Delivery Models Get Payers Closer to the Quadruple Aim

For health insurance executives, pursuing the Quadruple Aim is the name of the game.

While it's a noble ambition to focus on enhancing the patient experience, improving population health, reducing costs, and improving the work life of healthcare providers, it takes a lot of effort to make that happen.

As with any industry-related goal, the Quadruple Aim can be best achieved through targeted investments of resources and innovations.

Research recently published in the American Journal of Medical Quality detailed the pursuit of the Quadruple Aim throughout the COVID-19 pandemic and the subsequent opportunities to reshape the traditional healthcare delivery model.

The study underscored how new technologies and human factors can boost the patient experience, promote population health, drive down costs, and improve health worker wellness.

"Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape," the researchers wrote.

Similarly, a HIMSS blog post published in June recommended the adoption of connected care solutions, such as personal emergency response systems (PERS) or remote patient monitoring (RPM), to support efforts to accomplish the Quadruple Aim.

"All stakeholders need to collaborate to document and develop evidence on connected care innovations aligned with the Quadruple Aim," the blog post read. "Information on how the innovation incorporates into provider workflow, the ease of use for patients/consumers; and impact on quality of life (not just improved health) must become routine parts of clinical evidence development."

Below are five ways these new technologies and care delivery models can assist health insurers to achieve the quadruple aim.

1. Operationalize user satisfaction

Payers can benefit from tools or processes that boost the patient experience, especially as more quality standards account for this metric.

Utilizing technological features that are easy for senior adult patients to use and provides them with a sense of comfort while receiving consistent care goes a long way towards satisfaction and engagement.

Additionally, since we're amid a healthcare worker shortage that is only getting worse these tools can help mitigate the labor gap. A recent survey conducted by Morning Consultfound that since February 2020, 30% of healthcare workers have either lost their jobs or quit.

The work that clinical frontline staffers are trying to do is important, but they also have more on their plate than ever. If we can reduce the burden on these staffers while also making the patient experience more meaningful, we can generate user satisfaction and retain our tireless workers.

2. Reduce utilization and costs

Connected care technology is a critical component of the utilization and cost dynamic in healthcare. Now that organizations are considering more proactive methods to administering care to patients beyond the four walls of the hospital, proven technologies can play a key role in making these goals attainable.

As more payers seek to reduce unnecessary utilization, they can explore PERS and RPM technologies that offer more time-sensitive treatment and reduce the inclination for patients to go to the emergency room (ER) for care.

This reduction in utilization not only lessens the system burden by freeing up beds in the ER but also affects costs.

If fewer individuals are going to the ER, then there isn't a need to bring on more staff to treat them at the ER. The more we can do to treat patients in the home helps with both utilization and the cost of care.

3. Early detection for at-risk populations

Similar to improving care utilization, early detection of diseases or chronic conditions is important when addressing at-risk populations.

We often hear about how America's healthcare system focuses more on 'sick-care' rather than preventative care. If there was ever a time to alter how patients are treated for what ails them, it is now.

The Centers for Disease Control and Prevention estimates that 90% of America's $3.8 trillion annual healthcare expenditures are for patients with chronic and mental health conditions. This is a prime area for intervention through technology that proactively checks in on a patient and gauges their need for treatment.

The earlier the intervention, the better chance the patient has to receive care that will fundamentally improve their way of life and healthcare organizations can reduce the odds that a previously treatable condition worsens into something more costly and time-consuming.

A study published in Population Health Management found that patients enrolled in a personalized preventative care program experienced “reduced utilization of emergency room and urgent care services” compared to nonmembers. Additionally, “increasing percentages of members achieved cost savings” compared to nonmembers.

4. Maintain quality and safety

If the COVID-19 pandemic proved anything, it's that keeping senior adult patients safe from infection is a critical priority for healthcare organizations. Quality and safety can never be sacrificed in the delivery of care and they aren't mutually exclusive concepts.

PERS and RPM ensure that patients are kept safe in the home and that the quality levels of care which measure providers are adhered to.

Rarely is there ever a mutual win for patients and their caretakers, but these technologies offer better outcomes with meaningful downstream results.

5. Efficiencies drive results

Healthcare can always benefit from greater efficiencies in operations, especially around streamlining communications with patients. According to McKinsey & Co., approximately $1 trillion is spent annually on healthcare administration, leaving much room for improvement.

Rather than getting bogged down with interactions that leave patients with more questions than answers and doctors with directives that go unfollowed, connected care technology promotes a more interactive relationship around treatment.

If a patient has a question about their condition, their prescriptions, or even just needs a conversation to help with a bout of loneliness, a provider can instantly step in and rectify the situation without requiring a trip to the hospital.

We've seen how telehealth enjoyed mainstream popularity because of the pandemic and likely will have staying power in the years to come. Therefore, healthcare executives would be wise to pursue innovations like connected care as the industry leans into the prospects of a digital-based future.

The improved clinical and financial outcomes associated with PERS and RPM benefit both patients and providers. Technology is no longer a fringe option for treating patients, it’s a core function with a proven track record of success for those pursuing efficiencies and maintaining quality.

The more proactive and preventative healthcare organizations can be, the more positive downstream effects there will be on the broader landscape.